Eyeworld

EW MEETING REPORTER 92 September 2011 essence of the ethical conundrum associated with femtosecond laser surgery," said panelist Stephen G. Phillips, M.D., Seattle. At this point, "We do not have a good mechanism for saying this is a medically neces- sary part of the treatment." D. Brian Kim, M.D., Dalton, Ga., agreed. "We need more studies [before we can] say that it's safer and it gives us bet- ter results," he said. "Still, this is a tool, just like an iris retractor, Malyugin Ring [MicroSurgical Technology, Redmond, Wash.], or trypan blue. It's up to us to make the decision whether or not we need that tool." Attendee Joseph Calderone Jr., M.D., Cranford, N.J., said the sce- nario puts doctors in a tough posi- tion. "We're going to be trapped now between the costs of providing the standard of care and the ethics of providing it," he said. The discussion then turned to U.S. regulations and the billing re- strictions put on surgeons. Edward J. Holland, M.D., Cincinnati, said the answer is political. "The average ophthalmologist doesn't know his state legislator and doesn't know in- dividuals in Congress," he said. "If we want to change things, we need to get [politically] active. If you talk to the physicians who are now in Congress, they are begging us to get involved and be a part of the process. We can make a difference, but we need to get active like other specialties are." In another scenario presented to the audience, a 72-year-old patient wants a multifocal lens and also re- quests the use of the femto laser. The surgeon does not have the laser, but his competitor does. The surgeons discussed whether the doctor in this case is obligated to refer the patient. "We need to give [patients] full disclosure that this technology is available," Dr. Kim said. "At this point, it remains to be seen if it is better, but I think we are obligated to tell them if it is." The question was posed whether sur- geons are obligated to tell patients about every new piece of equipment that comes on the market. "It would be a reasonable thing for you to do, especially if you think you have a technology that is superior and that is going to advance the patient's welfare," said John D. Banja, Ph.D., medical ethicist, Atlanta, Ga. How- ever, "you don't have an ethical ob- ligation to recommend a treatment that's not FDA approved and whose inclusion in the standard of care is debatable." Stephen S. Lane, M.D., Stillwa- ter, Minn., said patients may be the ones bringing the discussion to the table. "Doctors aren't going to push this thing through, the patients are," he said. Attendees reminded early adopters of the technology of their responsibility to report all results, good and bad. "This could be the Titanic," said Mark Cherney, M.D., Melbourne, Australia. "We want to know if we're on the right vessel. If the captain steering isn't telling us there are icebergs here or there, how are we going to make the right judgment? In the discussion of ethics, there is a responsibility for those people to give us good infor- mation." Harvey Uy, M.D., Makati, Philippines, promised to continue collecting data and to publish his data. During the entire Town Hall meeting, no one was a more vocal opponent to the femto-for-cataract technology than Steven G. Safran, M.D., Lawrenceville, N.J. Many of the attendees, even those who were in favor of adopting the technology, sang Dr. Safran's praises. "Dr. Safran has to be congratulated for having the guts to come out here … to take on a panel with Dr. Lindstrom," Dr. Cherney said. "[Dr. Safran] is incred- ible—a good communicator and clear thinker, and for him to take this position was very coura- geous." Dr. Safran said he feels very passionately that the femto ap- proach yields no better results than a manual procedure. "Honestly, I felt I had a responsibility to do this," he said about being on the panel. "I'm trying to help us avoid making a big mistake. I'm worried about my pro- fession, truly." Despite Dr. Safran's passionate and sometimes entertaining misgiv- ings about the technology, the senti- ment that prevailed was one of excitement. "The pure ethical ques- Reporting live from the ASCRS/ EyeWorld Town Hall Meeting on Laser- Assisted Cataract Surgery, Chicago, July 14-17, 2011 Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team. tion is fascinating," said audience member J. Alberto Martinez, M.D., Rockville, Md. "It's exciting technol- ogy. When LASIK came out, I didn't jump on it right away. Some of the guys who did jump on it, I watched them move on and do very well. I don't want to wait now. I am more confident that this is the way to go." Although there were some unanswered questions remaining at the end of the weekend, overall, at- tendees at the meeting were pleased with the format and the content of the sessions. They especially enjoyed the more intimate size of the meet- ing and the resulting in-depth inter- action among participants. Editors' note: Dr. Donnenfeld has financial interests with Bausch and Lomb (B&L, Rochester, N.Y.), Abbott Medical Optics (AMO, Santa Ana, Calif.), and LenSx Lasers. Dr. Kim has no financial interests related to his talk. Dr. Koch has financial interests with AMO, Alcon, and OptiMedica (Santa Clara, Calif.). Dr. Lane has financial interests with AMO, Alcon, B&L, and OptiMedica. Dr. Lindstrom has finan- cial interests with AMO, Alcon, and B&L. Dr. Phillips has no financial in- terests to report. Dr. Reddy has no fi- nancial interests related to his talk. Dr. Safran has financial interests with B&L and Heidelberg Engineering (Heidelberg, Germany). Dr. Seibel has financial in- terests with OptiMedica. Dr. Talamo has financial interests with Alcon, B&L, and OptiMedica. Dr. Uy has financial interests with Alcon and LensAR. Contact information Banja: jbanja@emory.edu Calderone: eyegolf2020@gmail.com Corcoran: kcorcoran@corcoranccg.com Donnenfeld: eddoph@aol.com Holland: eholland@holprovision.com Kim: kim@professionaleye.com Koch: douglaskoch@mac.com Lane: sslane@AssociatedEyeCare.com Martinez: jalbertom@comcast.net Lindstrom: rllindstrom@mneye.com Phillips: sgp@soundeye.com Reddy: prasadkasureddy@yahoo.com Safran: safran12@comcast.net Seibel: idoc2020@me.com Shah: ras72@columbia.edu Talamo: jht1@comcast.net Uy: harveyuy@yahoo.com

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