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EW FEATURE 40 however, Dr. Tsai said she will use the immersion technique. Both surgeons use corneal mark- ing instruments for their toric pa- tients. Dr. Tsai said she uses them for her multifocal IOL patients if she's doing a peripheral corneal relaxing incision. Dr. Aden said she some- times uses them to determine the center of the visual axis if she is con- cerned about where the visual axis is in order to align a multifocal lens properly. Neither uses an intraoperative aberrometer. While Dr. Aden said there are certain circumstances where it would be useful, she has found her own results consistent enough that she doesn't have a need for it. Providing appropriate patient counseling When it comes to what a physician's ethical responsibility is, Dr. Tsai said treating all patients like they've come in for a cataract removal, with- out leaping to the part where they are offered a premium IOL, is impor- tant to her. "Whether or not they want a premium IOL, I would treat them like any other pre-op patients and give them all the risks and benefits of the surgery, and I definitely offer them the option of a premium IOL as well as a standard IOL," she said. It's important to offer both op- tions even though some practices may feel strongly about the pre- mium IOLs, Dr. Tsai said, as she thinks of it as a personal choice for the patient. Patients who come in asking for premium lenses may not understand all the benefits and risks they entail; it's a physician's duty to take the extra time to explain so patients un- derstand and have reasonable expec- tations, Dr. Tsai said. If the patient decides to go with a premium IOL, then doing extra testing like Schirmer's, topography, and BAT testing to maximize the outcome for the patient is an ethical responsibility. On the other hand, if the sur- geon knows the patient will not do well with a certain technology, the ethical responsibility is on the physi- cian to make the choice against this technology, Dr. Aden said. Another ethical concern is that as soon as patients decide to pay out of pocket, the way they are treated changes. Dr. Tsai said that the only thing that she thinks should change is the extra time she spends counsel- ing patients to get a better outcome. How much testing is enough? Surgeons can run the risk of throw- ing a lot of testing at patients with- out having a clinical plan, Dr. Tsai said. "Testing by itself is not a substi- tute for having a clinical picture in mind of some of the issues that you're concerned about and having a discussion with the patient using the results of the tests," Dr. Tsai said. Although she thinks how much testing is enough varies from one patient to another, Dr. Aden said premium lens patients have to have a definitive evaluation of astigma- tism, which may mean topography at the very least and, in her opinion, other methods of confirming and verifying that the astigmatism is measuring in the same way because it has to be addressed. In her clinic, ruling out the pos- sibility of any abnormalities in the visual system that could potentially interfere with the function of the lens means she does an OCT on some patients and uses, at mini- mum, an IOLMaster, a Lenstar (Haag-Strait, Mason, Ohio), or an immersion technique as the stan- dard of care, Dr. Aden said. EW Editors' note: Drs. Aden and Tsai have no financial interests related to their comments. Contact information Aden: 601-969-1430, contact@mississippivision.com Tsai: 314-362-3937, tsai@vision.wustl.edu February 2011 Ethics of IOLs August 2011 Evaluating continued from page 38 Podcast highlights the latest and greatest in ophthalmology research J osh Young, M.D., pro- fessor of ophthalmology, New York University School of Medicine, New York, wants you to be well read. That's the primary mis- sion of his weekly podcast, As Seen From Here, sponsored by the American Society of Cataract & Refractive Surgery (ASCRS). If you haven't stopped to lis- ten, you're missing out on a weekly highlight of the most im- portant current research. On his show, Dr. Young interviews au- thors who have been published in the last couple of months in peer- reviewed literature. "I read everything," Dr. Young explained. "I go through all the major journals every month and I pick out articles that I think would be of interest to the general comprehensive ophthal- mologist." Dr. Young tries to touch on all topics in his podcast, but be- cause it's geared toward general- ists, he wouldn't focus on the nitty-gritty techniques for lid lift surgery while airing a show on ocular plastics, for example. "Most of the articles are about what's going on in ophthalmol- ogy now," he said. "Things like the use of anti-VEGF agents, lens calculations after LASIK, and the challenges that we face every day or every week." Some recent topics include nanotechnology, what to do when anti-VEGF agents fail, floppy eyelid syndrome, and the significance of treating optic disc hemorrhages. In the latest episode, "All Cruelty Springs from Weakness," Dr. Young spoke with frequent guest David F. Chang, M.D., clinical professor of oph- thalmology, University of Califor- nia, San Francisco, about zonular weakness, the thorn in the cataract surgeon's side. "The idea is to create an envi- ronment that's similar to what you'd get at a meeting, where an author is describing his research or a topic," Dr. Young said. Thanks to the podcast, Dr. Young is making that meeting en- vironment available to ophthal- mologists all over the world. This is especially important because many ophthalmologists live in areas where flying off to interna- tional meetings isn't cost effective or practical. The As Seen From Here pro- gram runs anywhere from 20 to 40 minutes, but Dr. Young tries to keep it short. Typically, the pod- cast features an interview with one author on a single topic, but occasionally Dr. Young will break that rule. Depending on length and topic, he sometimes produces a series of programs on a solo sub- ject as he did with "The Very Small," a program on nanotech- nology in ophthalmology. The podcast has about 12,000 downloads monthly and is lis- tened to in more than 100 coun- tries around the world. It transfers more than half a terabit of pod- cast every month and is com- pletely free on http://asseen fromhere.com/. It's also available on iTunes and as an iPhone/iPad app for $9.99. Contact information Young: jyoungmd@gmail.com Stay informed with As Seen From Here by Faith A. Hayden EyeWorld Staff Writer N o w a v a i l a b l e o n l i n e EyeWorld.org/replay Featuring Programs From the 2011 ASCRS•ASOA Symposium and Congress

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