EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/76185
July 2012 Positioning continued from page 23 legs and buttocks, with a single towel and pillow beneath his head. With the patient's buttocks and legs raised in the air, his head was at a 35-40 degree down gaze, which could be sufficiently visualized with the operating room microscope. With these cases the preparation was half of the battle. "We found that once we got the patients in a comfortable position the case pro- ceeded fairly uneventfully," he said. "It takes probably twice as much time to position them as to do the surgery, but once we got them there both of the patients were quite com- fortable." In another unusual case, Dr. Miller combined loupe magnifica- tion with headlamp illumination on a wheelchair-bound woman on face- mask oxygen who was unable to re- cline. "I thought, 'She's going to be sitting straight up—how can I do this?'" Dr. Miller said. "We don't have microscopes that turn side- ways, and even if we did she was a moving target [because] she was breathing so hard." Thinking on the fly, Dr. Miller taped her head to the back of the chair to help quell the movement. He then used a loupe to view the eye in conjunction with fiber optics illuminators usually re- served for plastics cases and per- formed the surgery while standing next to her. The results turned out well; at 6 months the woman had 20/20 acuity. While this case worked out well on the spot, Dr. Miller urges practi- tioners faced with these unusual cases to plan things out beforehand and get the patient on board. "The patient needs to know that this is not typical surgery, and there's a greater risk for problems," he said. "Most of them are highly motivated because when you can't see, you'll do what it takes." Dr. Eke was impressed when he read about Dr. Miller's face-to-face positioning with loupe magnifica- tion. "Luckily, we have an operating microscope that rotates toward the horizontal, and this must be far easier than using loupes," he said. "Because my face-to-face patients are seated upright and comfortable, I have yet to find a patient who I cannot position for cataract surgery." EW Editors' note: Drs. Eke and Miller have no financial interests related to this article. Contact information Eke: tom.eke@nnuh.nhs.uk Miller: 310-206-9951, kmiller@ucla.edu Patients complain about cataract surgery without sedation A second Canadian woman has stepped forward to complain about having cataract surgery without sedation and blames budget cuts to the Ontario Health Insurance Plan (OHIP) for the "painful and extremely stressful" operation, according to a report in the Toronto Star. Fern Cooper, 65, and Sharon Phillips, also 65, said they were two of 14 patients who underwent cataract surgery without sedation on June 25 at Oakville-Trafalgar Hospital, Oakville, Ontario. "(Imagine) having to lay perfectly still while you watch the doctor bring a scalpel to your eyeball and then make an incision. All this while you are wide-awake and alert!," Mrs. Cooper wrote in a letter of complaint to the hospital. "To have to do this without sedation is, quite frankly, inhuman." According to the Star, Ontario doctors and the province are currently at odds about cuts to physician fees because the province unilaterally made 37 changes to the OHIP fee schedule after negotiations with the Ontario Medical Association fell apart in May. The provincial government wants to hold the line on physician com- pensation at $11 billion annually in an effort to slay a $15 billion deficit, the newspaper reported. The hospital, while apologizing in an official statement for possible miscommunication with patients, denied that budget cuts dictated the decision to operate without intravenous sedation. "Sedation during ophthalmology procedures is usually administered and will continue to be offered by our anesthetists when it is both safe and clinically appropriate," the statement read. "There is a wide variation in clinical practice for cataract surgery, and not all cataract surgery patients require or receive sedation."