August 2011




The ethics of premium IOLs

by Bonnie An Henderson, M.D., cataract editor


Bonnie Henderson, M.D.

Bonnie An Henderson, M.D., cataract editor


The word "premium" is derived from the Latin word "praemium," which means profit or reward. The Merriam-Webster Dictionary defines "ethics" as a "guiding philosophy and a discipline dealing with moral duty and obligation." When used together, as in this month's cover feature focus, Ethics of premium IOLs, this phrase properly describes difficult moral obligations that surround the use of these new technology IOLs. After the initial excitement abated of having an IOL that could potentially correct presbyopia, ophthalmologists realized that there is more than "meets the eye" with these new lenses. Ophthalmologists are often characterized as detail oriented, compulsive, and controlling perfectionists. Fortunately, the practice of ophthalmology fits well into this personality type. Most ophthalmic diseases can be eradicated or surgically removed. The new presbyopia-correcting IOLs, however, are different from the monofocal IOLs that have been implanted over the past several decades. The premium IOLs add an element of unpredictability to the usually stable surgical arena of cataract surgery. In this month's issue, we delve into the nuances of the use of premium IOLs. Who should discuss these IOLs with the patients? Can this task be delegated to a staff member or must the doctor be the one to hold the discussion? What pre-op tests can we perform to screen for success or failure with this technology? How do we improve the accuracy of our testing? Doctors share their approaches to educating patients and staff. Others describe the extra measures they take in their pre-op evaluation to ensure optimal outcomes. Novel methods of neural testing, assessing neuroplasticity, and training the visual cortex are introduced. Since these "premium" IOLs are associated with an out-of-pocket expenditure, many doctors are uncomfortable discussing the financial aspect of these lenses. It is generally agreed upon that patients who pay for a premium IOL have higher expectations than those who receive a standard lens. There is no single correct method of discussing costs. Some doctors prefer to discuss the finances directly with the patient while others prefer to have their experienced staff members have the conversation. Although different methods are used successfully in different practices, the principles of being honest and upfront remain constant. With the introduction of premium IOLs to correct presbyopia and astigmatism, patient satisfaction after cataract surgery continues to rise. Although all of the currently available premium IOLs are effective for some patients, none are effective for all. Overcoming presbyopia is within reach, but still remains the holy grail of ophthalmology.

Related articles:

Talking finances with premium IOL patients by Faith A. Hayden EyeWorld Staff Writer

Evaluating patients for premium IOLs by Enette Ngoei EyeWorld Contributing Editor

Blepharitis and premium IOL patients by Elizabeth A. Davis, M.D.

Premium intraocular lenses by Nick Mamalis, M.D.

The ethics of premium IOLs The ethics of premium IOLs
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