Eyeworld

EW FEATURE 37 the latest technology continue, Dr. Hamilton said. "As time goes by, I think we're going to see more and more anterior segment surgeons recommending and using these lenses," Dr. Hamilton said. "The genie's out of the bottle. We're not going to be going back in the other direction. "The sooner surgeons realize that and start adopting that philoso- phy, I think the better off we'll be." Ultimately, surgeons who are in- volved in the multifocal and toric markets make the final recommen- dations to patients, and that is a role they have to embrace, Dr. Katz said. "The final decision in our prac- tice is made by me, the surgeon," he said. "I never assume the technician or the coordinator, just by looking over the data, knows more. I'm the one who has to put it all together. Sometimes that's very straightfor- ward and takes a minute or two. Other times it's almost like nothing's ever been said and I am repeating everything. You have to spend a lot more time with the patients. Expec- tations are everything." EW Editors' note: Dr. Hamilton has finan- cial interests with Abbott Medical Optics (Santa Ana, Calif.). Dr. Katz has financial interests with Alcon (Fort Worth, Texas). Dr. Scoper did not indi- cate any financial interests related to his comments. Contact information Hamilton: 310-825-2737, hamilton@jsei.ucla.edu Katz: 847-824-3127, jkatz@tmcfs.com Scoper: 757-622-2200, clong@vec2020.com February 2011 August 2011 Ethics of IOLs to believe that he or she is offering the right things." Ethically, he pointed out, doc- tors are required to do what's best for the patient, even if that means another surgeon is a better fit. "I think patients should have the opportunity to have the best technology that there is at the time that that they need the surgery," Dr. Katz said, adding that those sur- geons who don't offer premium lenses may have a multitude of rea- sons for not doing so. "Part of it may have to do with their capabilities and whether they're willing to learn new proce- dures, and part of it may have to do with whether they believe in those procedures," Dr. Katz said. Dr. Scoper said surgeons, even if they don't agree with the efficacy of the premium lenses, should still tell patients about them. "I think that all cataract sur- geons and practices should make sure that their patients know what the options are out there with lifestyle IOLs," he said. "Even if they don't do them or they don't believe in them, they need to inform the pa- tient that they are out there. I get patients from time to time who had surgery somewhere else and didn't even know the options. They come in upset that they had cataract sur- gery with the standard monofocal lens and weren't given the opportu- nity to make their own decisions." Surgeons could soon have a re- sponsibility to patients to get on board with premium lenses, espe- cially as they become more main- stream and patients' demands for According to Dr. Scoper, surgeons' primary concerns should be taking care of patients and recommending what is best for them Source: Teresa L. Cartwright International point of view Seoul, South Korea I am working for a tertiary hospi- tal, so almost all patients are re- ferred patients. They already know that they have cataracts, and it is not difficult to explain to them that they need a cataract op- eration to recover their vision. Actually, one-third of the referred patients already know about pre- mium IOLs. However, it is still very important to educate them because many of them come in thinking that they will have perfect vision with these premium IOLs. We have to re-educate these patients so that they have realistic expectations for premium IOL implantation. I think this is the key to successful cataract surgery these days. The higher the expectation, especially when it is unrealistically high, the lower the satisfaction. After examining a patient, I make a de- cision on whether he or she needs cataract surgery, and then I ex- plain the surgery itself and the options of IOLs. Then other staff members will explain the details, especially about premium IOLs. My staff and I always educate patients about all available IOLs even though the patients, such as those with macular degenera- tion, may not be indicated for premium IOLs. We want patients to know not only that we are able to offer different kinds of IOLs, but also that we choose the best and most suitable IOL for them. Fur- thermore, from an ethical viewpoint, patients are entitled to know every option available for the surgery. Sometimes I explain new IOLs that are not available in my country because some patients may be able to go outside of my country for surgery if they want that. One thing I emphasize to my staff when educating patients is that when patients decide not to choose a premium IOL, especially for economic reasons, their decision must be respected. We should assure them that they made a reasonable decision even though they did not choose a premium IOL. This is an important ethical consideration. Also, it is important in terms of patient satisfaction for the surgical outcome. If a patient has some uncorrected inter- mediate or near vision, he would be very satisfied because he did not expect that result. If he does not have any uncorrected inter- mediate or near vision, he would also be satisfied because he did expect that result. In the past, my colleague and I used video systems to educate patients about IOLs. However, many of our patients had a hard time understanding the information provided by foreign IOL man- ufacturers. This may be a result of their advanced age, because the context of the information was simply too difficult to understand, or because there were differing cultural assumptions and expecta- tions on the parts of the manufacturer and patient. So we adapted a verbal interactive education with illustrations. It is more time consuming, but results in a better response from the patients. Contact information Tchah: hwtchah@amc.seoul.kr Hungwon Tchah, M.D.

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