Eyeworld

November 2011 W ith cataract surgery transforming, in many ways, into re- fractive surgery, prac- titioners seem to be heading toward a gray area where they may face a conflict of interest when deciding on profit margins. In fact, it "may tip the balance in a way that doesn't feel quite right," said Mark Packer, M.D., clin- ical associate professor of ophthal- mology, Casey Eye Institute, Oregon Health & Science University, Port- land. Dr. Packer moderated a panel discussion on ethics during this spring's ASCRS Symposium & Con- gress in San Diego. Part of the dis- cussion included talking about cataract refractive surgery and the following real-world scenario. A 58-year-old woman with 20/20 best corrected visual acuity complains that she can't drive at night anymore due to vision problems, and she has worn glasses (prescription is +2.00 + 1.00 X 90 OU) since age 40. She has moderate hyperopia and astigmatism, and she tells her surgeon that she hates glasses and that she'd love to be able to "throw them away." She's heard about accommodative lens technology and wants to know more about it. Because she has a problem driving at night, a technician agrees to work up a bright- ness acuity test on medium, and the vi- sion declined one line to 20/25. To push it further, the visual function questionnaire (VF-14) is 80%, which means there are some mild to moderate issues but nothing severe. The surgeon does a mesopic contrast sensitivity with glare test that shows a generalized re- duction of 1.5–3.0 log units at all spa- tial frequencies relative to the lower limit of normal. Three log units is what the FDA considers to be clinically sig- nificant. The slit lamp shows mild nu- clear sclerosis, but clearly this is a very borderline cataract and yet she wants an accommodative lens. by Jena Passut EyeWorld Staff Writer John D. Banja, Ph.D. Mark Packer, M.D. Steven H. Dewey, M.D. Audrey R. Talley-Rostov, M.D. Ethical dilemma: When a borderline cataract patient wants a premium lens www.ASOA.org The Physician's PERSPECTIVE In today's economic climate... I trust my business to ASOA. www.ASOA.org I trust my business to ASOA. In today's economic climate... The Physician's PERSPECTIVE day o In t onomic clima c s e 's e day ... e t onomic clima

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