EW CATARACT
33
October 2015
Moving to another topic, Dr.
Banja and Dr. Snyder stressed the
importance of not making assump-
tions about what a patient can
afford. Dr. Banja tells healthcare
providers that they should be careful
about making assumptions about a
patient's ability to pay. Dr. Snyder
agreed and said he has had patients
tell him that they can't afford
certain premium treatments only to
find out that they likely could have.
People choose how they wish to
allocate their funds, and they choose
how they wish to present themselves
at the office, he said.
In one example, a 92-year-
old woman said she can't afford a
premium IOL or the additional costs
of the femtosecond laser, but the
surgeon performing the surgery has
a laser and believes that it would be
advantageous in her case. Dr. Banja
said that healthcare providers do not
have an obligation to provide free
care.
The experts debated questions
such as: If the femtosecond laser is
better, how much better is it than
manual? If it is a superior technolo-
gy, wouldn't this mean that every-
one should be using it? How much
better would it need to be over man-
ual surgery before it becomes uneth-
ical to not use it for all patients?
Some ophthalmologists are
concerned that if they go entirely to
femto, they will lose their manual
skills, Dr. Banja said. There is also a
possibility that the laser could have
mechanical problems that would
impact its effectiveness. Dr. Serafano
described a case where he experi-
enced an error with the laser and
it wouldn't work. For his patients
scheduled for that day, he had to
offer them the option of resched-
uling or proceeding with a conven-
tional procedure. "It's all about the
patients," he said. "My financial
interest is my problem, not theirs."
This means that it has to be very
clear to surgeons that if there is a
problem and the laser can't be used,
they need to be prepared to proceed
in the best interest of the patient. EW
Editors' note: Dr. Banja has no related
financial interests. Dr. Donaldson has
financial interests with Alcon (Fort
Worth, Texas) and Abbott Medical
Optics (Abbott Park, Ill.). Dr. Hoffman
has financial interests with Carl Zeiss
Meditec (Jena, Germany). Dr. Snyder
has financial interests with Alcon,
Haag-Streit (Koniz, Switzerland), and
HumanOptics (Erlangen, Germany).
Drs. Serafano and Vasavada have
financial interests with Alcon.
Contact information
Banja: jbanja@emory.edu
Donaldson: KDonaldson@med.miami.edu
Hoffman: rshoffman@finemd.com
Serafano: serafano@verizon.net
Snyder: Msnyder@cincinnatieye.com
Vasavada: icirc@abhayvasavada.com
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