EyeWorld Asia-Pacific December 2011 Issue

December 2011 22 EW FEATURE accommodation,” but human trials have not yet begun. Dr. Nichamin said proof of concept has been shown for the FluidVision (PowerVision, Belmont, Calif., USA), a fluid-filled device “that can emulate the natural accommodative process and has the potential of somewhere between 5-6 D, where we currently are, up to perhaps as much as 10 D of accommodative power through technology that looks very similar to contemporaneous implant technology.” (Dr. Nichamin is the original medical advisor for the lens.) The lens is currently in human trials in S. Africa and the company is “working through newer iterations that will allow us to implant it through an injector delivery device through a contemporary small incision.” Dr. Nichamin expects European trials to begin shortly. He said surgeons’ learning curves would be short on the lens “because there’s nothing particularly unusual about the appearance of the lens or the way it’s implanted—it goes in the bag through a small incision. And unlike the NuLens technology [Herzliya Pituach, Israel], which is based upon a reverse accommodative process opposite of Mother Nature, this lens emulates or replicates the natural processes of how the crystalline lens provides us with near vision.” The NuLens is comprised of two lens elements; as the ciliary body relaxes, one element is pushed up into the other to cause a bulge that provides for near reading, Dr. Koch explained. Any accommodating IOL “that truly accommodates” is eagerly awaited, “not only for this group of patients, but for our cataract patients as well,” Dr. Lane said. “Technology like the NuLens is not yet in full-fledged clinical trials, but if any accommodating technology becomes available that lives up to what it should do, we’d all embrace it.” Final thoughts Because of the multitude of challenges in treating near emmetropes, “I’m not an enthusiast of our current technologies,” Dr. Lane said. “It’s the one frontier we’ve yet to be able to get a good grasp on.” For the time being, he discusses monovision LASIK, “which doesn’t have any of the risks” of the current lenses, but only a select group of patients will be willing or able to tolerate monovision. “There aren’t any technologies that are coming shortly that are going to be the be-all and end- all for this group of patients,” Dr. Koch said. “There are some promising approaches that are being looked at, but they are all going to have some element of compromise. I think we’ll have something much better in 3-5 years. It won’t be perfect. I’m anticipating it’s going to take a lot longer than that to get a really ideal product.” Dr. Nichamin believes “within the next 3-10 years, we’ll have an explosion in interest in emmetropic presbyopic lens exchange.” He even goes so far as to speculate the surgery will be office-based, “particularly in conjunction with the femtosecond laser.” Presbyopia “is an experiential thing, and we all go through it,” Dr. Weiss said. “It’s much more disabling than people initially think.” Unless patients are willing to accept wearing progressive bifocals, “they’ll just keep looking for something to ‘fix’ them. Baby boomers don’t accept aging.” EW Editors’ note: Dr. Harton has financial interests with Lenstec, Sonomed Escalon (Lake Success, NY, USA), and STAAR Surgical. Dr. Koch has financial interests with Abbott Medical Optics (AMO, Santa Ana, Calif., USA), Alcon (Fort Worth, Texas, USA/ Hünenberg, Switzerland), and NuLens. Dr. Lane has financial interests with AMO, Alcon, and Bausch & Lomb (Rochester, NY, USA). Dr. Nichamin has financial interests with PowerVision and Bausch & Lomb. Dr. Weiss does not have any financial interests related to his comments. Contact information Harton: 706-233-8502, pharton@harbinclinic.com Koch: 713-798-6443, dkoch@bcm.edu Lane: 651-275-3000, sslane@advancedeyecare.com Nichamin: 814-849-6547, ldnichamin@aol.com Weiss: 858-455-6800, jackweissmd@gmail.com “I’ve had many patients get second opinions, and all it does is support me,” he said. What if the patient insists on getting his money back? “If you feel you gave a good informed consent, things are well documented, and the patient is unhappy because he didn’t understand, I don’t think you need to give a refund,” Dr. Abbott said. However, if the complaint is legitimate, he said he would either pay for the secondary consult, give a partial refund, or help pay for glasses. “It’s OK to do those things, but it’s certainly not mandatory. Take it on a case-by-case basis,” Dr. Abbott said. “It does not admit guilt or that you did something wrong. It’s there to help support a patient who you feel has a legitimate issue with what happened.” A refund does not equal an admission of guilt, Dr. Potter agreed. “Surgeons have been taught that if you give a patient his money back, you’re admitting you’ve done something wrong,” he said. “That’s the wrong mindset. I’ll make a trade. I’ll give the patient back X dollars, whatever he paid, and I will negotiate a release on the surgeon’s behalf.” Alan E. Reider, JD, MPH, a Washington, DC-based attorney who represents ophthalmology practices throughout the country, said the instinct is for surgeons to refund money. “Obviously, it’s going to be a lot cheaper to do that than get embroiled in any kind of adversarial situation,” he said. “You don’t want the patient to file a complaint or a lawsuit because, even if you were successful, you’re going to spend more money to defend yourself than you would to refund.” Mr. Reider agreed that physicians should have the patient sign a release before issuing the refund. The release should be simple and straightforward, he added. “You don’t want to make it overly formalistic because that might make the patient concerned,” he said. “It should be a simple letter, making no admission that there was anything wrong done and releasing you from any other claims the patient may otherwise have in connection with this.” EW Editors’ note: Drs. Abbott and Potter and Mr. Reider have no financial interests related to their comments. Contact information Abbott: 415-502-6265, richard.abbott@ucsf.edu Potter: 636-534-2300, johnwpotter@gmail.com Reider: 202-942-6496, alan.reider@aporter.com Managing - from page 15 Presbyopia - from page 21