Eyeworld

T he word "premium" is derived from the Latin word "praemium," which means profit or reward. The Merriam-Webster Dictionary defines "ethics" as a "guiding philosophy and a discipline dealing with moral duty and obligation." When used together, as in this month's cover feature focus, Ethics of pre- mium IOLs, this phrase properly describes difficult moral obligations that surround the use of these new technology IOLs. After the initial excitement abated of having an IOL that could potentially cor- rect presbyopia, ophthalmologists realized that there is more than "meets the eye" with these new lenses. Ophthalmologists are often characterized as detail oriented, compulsive, and controlling perfectionists. Fortunately, the practice of ophthalmology fits well into this personality type. Most ophthalmic diseases can be eradi- cated or surgically removed. The new presbyopia-correcting IOLs, however, are different from the monofocal IOLs that have been implanted over the past several decades. The premium IOLs add an element of unpredictability to the usually stable surgical arena of cataract surgery. In this month's issue, we delve into the nuances of the use of premium IOLs. Who should discuss these IOLs with the patients? Can this task be del- egated to a staff member or must the doctor be the one to hold the discus- sion? What pre-op tests can we perform to screen for success or failure with this technology? How do we improve the accuracy of our testing? Doctors share their approaches to educating patients and staff. Others describe the extra measures they take in their pre-op evaluation to ensure optimal out- comes. Novel methods of neural testing, assessing neuroplasticity, and train- ing the visual cortex are introduced. Since these "premium" IOLs are associated with an out-of-pocket expen- diture, many doctors are uncomfortable discussing the financial aspect of these lenses. It is generally agreed upon that patients who pay for a premium IOL have higher expectations than those who receive a standard lens. There is no single correct method of discussing costs. Some doctors prefer to dis- cuss the finances directly with the patient while others prefer to have their experienced staff members have the conversation. Although different meth- ods are used successfully in different practices, the principles of being honest and upfront remain constant. With the introduction of premium IOLs to correct presbyopia and astig- matism, patient satisfaction after cataract surgery continues to rise. Although all of the currently available premium IOLs are effective for some patients, none are effective for all. Overcoming presbyopia is within reach, but still re- mains the holy grail of ophthalmology. Publisher Donald R. Long dlong@eyeworld.org Editorial Editor Stephanie Graham stephanie@eyeworld.org Assistant Editor Stacy Majewicz smajewicz@eyeworld.org EyeWorld Staff Writers Faith Hayden faith@eyeworld.org Jena Passut jena@eyeworld.org Production Graphic Designer Julio Guerrero jguerrero@eyeworld.org Production Manager Cathy Stern cstern@eyeworld.org 703-383-5702 Production Assistant Karen Salerni ksalerni@eyeworld.org Contributing Editors Vanessa Caceres Lakeland, Florida Michelle Dalton Reading, Pennsylvania Rich Daly Arlington, Virginia Enette Ngoei Singapore Matt Young Malaysia Senior Contributing Editor Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Advertising Sales Managers Jeff Brownstein jbrownstein@eyeworld.org 703-788-5745 Paul Zelin pzelin@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cstern@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jdonohoe@eyeworld.org 703-591-2220 ASCRS Publisher: EYEWORLD (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4003; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EYEWORLDNews Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4003; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. Advertising Offices: ASCRSMedia, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4003; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. Copyright 2011, ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4003. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. Letters to the editor and other unsolicited material are assumed intended for publication and are subject to editorial review and acceptance. Subscriptions: Requests should be addressed to the publisher. Annual subscription prices: Individual: 1 year, $120; 2 years, $220; 3 years, $320. Institutional: 1 year, $250; 2 years, $330; 3 years, $425. Foreign: 1 year, $240, 2 years $470, 3 years, $700. 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POSTMASTER: Send change of address to EYEWORLD, 4000 Legato Road, Suite 700, Fairfax, VA 22033. Periodical postage paid at Fairfax, VA 22033 and at additional mailing offices. The ideas and opinions expressed in EYEWORLDdo not necessarily reflect those of the editors, publisher, or its advertisers. P U B L I S H I N G   S T A F F August 2011 Volume 16 • No. 8 A S C R S The official publication of the American Society of Cataract & Refractive Surgery The ethics of premium IOLs Bonnie An Henderson, M.D., cataract editor

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