Eyeworld

EW FEATURE 89 When patients do present with more than one disease, "the first thing they want to know is what we are going to do for them. I defer a recommendation until after they've been evaluated and all the diagnos- tic tests have been performed," said Eric D. Donnenfeld, M.D., a part- ner at Ophthalmic Consultants of Long Island, Rockville Centre, N.Y., and clinical professor of ophthal- mology, NYU Medical School, New York. These patients need additional counseling about each of their dis- eases, how they can be managed, and the risks and benefits of manag- ing the diseases together or sepa- rately, he said. "I prefer a step-wise approach to that patient where we diagnose the problem, thoroughly evaluate the problem, provide solution options, and work with the patient to decide what's best for him or her," Dr. Donnenfeld said. Ophthalmology is very technol- ogy-oriented, with diagnostic tools now available that were not on the market even 5 years ago, said Sonia H. Yoo, M.D., professor of ophthal- mology, Bascom Palmer Eye Insti- tute, Miami. For instance, she said, optical coherence tomography "completely changed the way we practice. It's brought a level of so- phistication to our diagnoses. Newer technologies are now emerging that are giving us better ways to differen- tiate lenticular from retinal from corneal abnormalities." She also ad- vised surgeons to take the time to explain the various disease states and what the implications of the disease are on the surgery and vice versa. "It's particularly important with a progressive disease, like with some corneal disturbances," she said. "Once patients understand what's going on in their eye, they're gener- ally quite happy with their out- comes." For Dr. Devgan, in the county hospital he will often recommend a combined procedure from the get- go, especially in cases of cataract and retinal disease. "If we perform a vit- rectomy first, cataract removal at a later stage is more difficult, so I will often perform both simultaneously, even if the cataract is not a high grade," he said. Dr. Lane agreed and emphasized the importance of managing patient expectations in co-morbid situa- tions. "You have to clearly explain that they have different diseases, and their outcomes may be different than those of their next-door neigh- bor who only had a cataract," he said. "They are at a disadvantage, but they understand that." March 2011 COMBINED SURGERY • Industry Leading Resolution • 100% Measurement Capability including dense cataracts • Automatic Alignment Detection • Simplified Personalization of Lens Constants • Unlimited patient data storage, recall, and transfer via USB Memory Stick Every purchase of an A-Scan Plus 4.20 comes with an on-site training program. Receive a Free Toric Marker with Purchase 3222 Phoenixville Pike, Malvern, PA 19355 • USA 800-979-2020 • 610-889-0200 • FAX 610-889-3233 • www.accutome.com Product #24-4200 Right On Target... The New A-Scan Plus ® 4.20 Right On Target... The New A-Scan Plus ® 4.20 Meeting the Needs of Your Premium IOL Patient Visit Us At ASCRS Booth #1728 continued on page 90

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