Eyeworld

EW MEETING REPORTER 90 September 2011 this time, when we're fighting and saying that they do not have the skills or training and should not use the lasers, I obviously would be very concerned if we all of a sudden de- cided they can do the femtosecond laser surgery." "This is a distinct ethical issue," Dr. Banja said, "one that boils down to patient safety." Audience member Mark Cherney, M.D., Melbourne, Aus- tralia, added that a surgeon delegat- ing this responsibility might destroy medical heritage created over the centuries. "We're asking people to trust us to operate on their eyes," Dr. Cherney said. "They have chosen us above all other surgeons to take the responsibility and have that rela- tionship with them. This is impor- tant to them. We are not willing to take 6 minutes to go across the corri- dor to be with them, to look after them? That would be a travesty." SUNDAY The closing day of the ASCRS/ EyeWorld Town Hall Meeting on Laser-Assisted Cataract Surgery, Sunday, July 17, began with mock scenarios set up to pose ethical dilemmas to the panelists and audi- ence, which sparked spirited discus- sion and debate. In the first case, a 67-year-old Medicare patient asked for femto with a standard monofocal lens im- plant. The patient had been told that he has a very shallow anterior chamber where the capsulorhexis would be more challenging than usual. He also has a dense cataract, which could increase the value of using the laser. This patient, though, said he prefers to wear glasses after- ward, and he does not need astig- matic correction. The surgeons discussed whether they would use the femto laser and/ or suggest multifocal IOLs and how they would charge for using the femto in this instance. "Your cataract procedure has already been paid for, and if you attempt to make the multifocal IOL a camouflage for what has already been paid for, you are on a slippery slope," said Kevin J. Corcoran, C.O.E., C.P.C., F.N.A.O., president, Corcoran Consulting Group, San Bernardino, Calif. Attendee Ravi A. Shah, M.D., Portland, Maine, asked hypotheti- cally whether a surgeon could end up in hot water for not using a tech- nology that may produce better re- sults. "If you have a femto laser and you're doing a standard phaco case, and you have a problem with that case, would you ever be held ac- countable when you're asked the question, 'Doctor, you had this com- plication during the surgery and you had another tool at your disposal that might have been a better choice. Why did you choose not to use that, and did your decision not to use that lead to harm?'" Dr. Shah asked. "Those questions are at the Reporting live from the ASCRS/ EyeWorld Town Hall Meeting on Laser- Assisted Cataract Surgery, Chicago, July 14-17, 2011 continued on page 92 rently can use some lasers in Ken- tucky and Oklahoma, but their scope of practice has not been widened to include laser surgery be- yond those two states. "We in organized ophthalmol- ogy are spending hundreds of thou- sands of dollars in fighting scope of practice battles across the United States," Ms. McCann said. "Yes, there are two states that allow op- tometrists to do laser surgery, but at

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