Eyeworld

Audrey R. Talley-Rostov, M.D., Northwest Eye Surgeons, Seattle, said she would be upfront and let the patient know that the cataracts are borderline and don't fit the bill for medically significant cataracts. "Therefore, at this point, it is a refractive lens exchange," Dr. Talley- Rostov said. "She certainly has the option for an accommodative IOL with all of the informed consents, and this would be her decision at this point. If, however, she thinks that she can hang in there for 6 months, 1 year, 2 years, we certainly could see her back and repeat the testing. [The cataracts] may become medically significant and then at least the medical portion will be covered by her insurance." Steven H. Dewey, M.D., Col- orado Springs, Colo., said he also would have the patient wait. In the meantime, he would try and treat her visual issues. "I would take some ancillary steps to treat things that may give her some benefit, like dry eye," Dr. Dewey said. "You may say, 'Isn't that a placebo treatment?' In my experi- ence, if she's coming in for the ac- commodative lens, she'll be back in 6 months ready to pay out of pocket with or without cafeteria plan fund- ing. If she's really there because of visual difficulties, I think being em- pathetic is important." Dr. Packer turned to the stand- ing-room only crowd for an audi- ence response question. Fifty-six percent of respondents said that they believe patients "game the sys- tem" by professing they have de- creased visual function in order to pay cataract rates for refractive lens exchange. The statement, "I let pa- tients 'game the system' if they try because it's better to do surgery than not to do surgery" met with 68% of respondents answering "false." Dr. Dewey said that it is impor- tant for surgeons to look beyond simple Snellen acuity to determine the appropriateness of cataract sur- gery for an individual patient. He said one patient, who was part of a family of Persian rug deal- ers, immediately came to mind dur- ing this scenario because he also was considered a "borderline" case. "He came in and said, 'I'm los- ing my ability to distinguish the blue and violet colors in these rugs, and the value of the rugs depends on the quality of the dyes that are used. I can only judge those by eval- uating the color.' "He had yellow opalescent nu- clear sclerotic cataracts," Dr. Dewey said. "We know that when the crys- talline lens turns yellow it blocks EW Ophthalmology Business 53 November 2011 blue and violet light, so that change in color perception is almost cer- tainly due to changes in the crys- talline lens. This scenario is markedly different from someone who has trouble distinguishing navy blue from black socks. This is his family's livelihood." John D. Banja, Ph.D., professor, Department of Rehabilitation Medi- cine, and a medical ethicist, Center of Ethics, Emory University, Atlanta, asked the panel if it was possible to seek special permission from Medicare. "There are very rare situations," Dr. Talley-Rostov said. "I'd say it is the exception rather than the rule. As long as you don't have 300 of these in your practice and this hap- pens very occasionally and you doc- ument it well, then I think this is a reasonable thing to pursue." EW Editors' note: Drs. Banja and Dewey have no financial interests related to this article. Dr. Packer has financial in- terests with LensAR (Winter Park, Fla.). Dr. Talley-Rostov has financial interests with Abbott Medical Optics (Santa Ana, Calif.). Contact information Banja: 404-712-4804, jbanja@emory.edu Dewey: 719-471-4139, deweys@prodigy.net Packer: 541-687-2110, mpacker@finemd.com Talley-Rostov: atalleyrostov@nweyes.com Friday Focus Surveys are a member benefit of the American Society of Ophthalmic Administrators. For membership information contact asoa@asoa.org or 703-591-2220. ASOA, 4000 Legato Road, Suite 700, Fairfax, VA 22033. www.asoa.org. ASOA Friday Focus Surveys Focusing on the BUSINESS of Ophthalmology 2. If your practice implements a social media policy, will you address (within your policy) images and comments that may be perceived negatively in relation to your company culture? Response Percent Yes 77.1% No 22.9% 1. Does your practice have a social media policy? Response Percent Yes 33.6% No 40.6% Under consideration for the future 25.8%

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