ACOS 2011 Year End Newsletter

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ACOS Newsletter Year-End 2011

Dear ACOS Members,

We can all be proud of the quality and success of the first ACOS Summit that

was held on October 21st in Orlando. True to the ACOSs mission of

providing education on the clinical, business, and medicolegal aspects of

ophthalmology, the Summits program featured sessions on the renaissance

of cataract surgery, product development and financing, and regulatory

affairs. We look forward to bringing you the post-Summit materials soon. In

fact, a few presenters videos are already available online at Eyetube.net.

In the meantime, this newsletter features a few items of interest from our

meetings this year in Deer Valley and Orlando. First, we have a unique perspective on the current state

of affairs in this country between the FDA and the medical field from Daya Sharma, MD, one of our

members who trained in the UK and practices in Australia. Additionally, we summarize presentations

from both meetings that were exceptionally well received.

Finally, remember to register now for the ACOS-Dulaney Winter Meeting, held at the beautiful St. Regis

Aspen, February 26-29, 2012. This meeting is always very popular and fills up quickly!

Best,

Stephen G. Slade, MD

ACOS President

The Intersection of Regulation, Innovation, and Medicine

By Daya Sharma, MBBS, FRANZCO

The ACOS Summer Symposium in beautiful Deer Valley, Utah, brought together an incredible array ofleaders, including ophthalmic experts and industry heavyweights. As an outsider to the US healthcare

system, it was a privilege to attend and learn about the challenges that innovators and companies face

in developing new technology and translating that research into clinical practice.

A recurring theme of the meeting was that the FDA obstructs access to medical treatments that may be

widely available elsewhere. Although the agency cites reasons of safety and efficacy, its process blocks

patient access to important treatment options. One example is the Visian toric ICL (STAAR Surgical

Company, Monrovia, CA), which would allow effective astigmatic correction with the same operation
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and essentially the same risk profile as the Visian spherical ICL (STAAR Surgical Company), yet only

the latter is FDA approved.

There are a number of treatments available outside the United States that domestic patients do not

have access to. To name just a few:

corneal cross-linking

toric and multifocal secondary sulcus IOLs

topography-guided PRK

the Synchrony IOL (Abbott Medical Optics Inc., Santa Ana, CA) (although trials were conducted

in the US that demonstrated safety and efficacy)

the Oculentis M-plus lens (Oculentis GmbH, Berlin, Germany)

REGULATION AND ACCESS TO CARE

Delays in FDA approval slow the pace of innovation and development. In Europe, some perceive this

behavior as the FDA protecting US economic interests by blocking foreign companies from accessing

the US market. However, it is clear that US companies, large and small, are being severely hampered

by the FDA as well. George Waring IV, MD, introduced a useful acronym, OUS, meaning outside the

US, because of the frequent need to refer to treatments only available OUS.

In addition to the FDA, the Centers for Medicare and Medicaid Services also obstruct patient choice.

Regarding access to treatment options such as femtocataract surgery, the rallying call from Richard

Lindstrom, MD, was that patients have the right to want it, the right to ask for it, and the right to pay for

it. American cultural ideals of freedom, liberty, reward for hard work, and autonomy are, ironically, not

well integrated in the US healthcare system, particularly with regard to patients ability to choose

treatments. There is an inconsistency: patients can pay extra for a private room in a hospital, but they

do not have the right to choose to have a more expensive surgical option for something that is

considered a covered service. To an outsider, this certainly seems un-American.

Patients can pay extra for a private room in a hospital, but they do not have the right

to choose to have a more expensive surgical option for something that is considered acovered service. To an outsider, this certainly seems un-American.

This arrangement has apparently developed because of the fear in some quarters of having a two-

tiered health system. In the UK, which has a socialized healthcare system, many well-off people choose

treatments within the National Health Service, while some choose private treatment. A two-tier system

exists, yet, there is no sense of unfairness in a person choosing private treatment and paying for it.

Likewise, in Australia, having two tiers is seen as a benefit: moving people from the public health

system into private, elective day surgery takes pressure off the public system. Indeed, the taxation

system penalizes people for not taking up private insurance if they can afford it, and encourages people

to take it up early.

Former US Congressman Christopher Cox elaborated on reasons why the FDA is slow to approve new

treatments. First, it has become populated with former staffers of politicians, and hence is an overly

politicized organization. Second, there is no incentive or reward to approve new treatments, only fear of

being criticized later if an approved treatment causes harm. Junior staff members are afraid of being

rebuked by their seniors, and senior staff members are afraid of rebuke by politicians. The FDA needs

some protection against blame for approving treatments. It is inevitable that there will always be a risk

that a product will need to be removed from the market, and the only real guarantee against this is to

block all new treatments from reaching the market.


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The FDA needs some protection against blame for approving treatments.

The most likely motivating factor to get faster approvals appears to be shame. In my opinion, the FDA

should be embarrassed that US citizens are travelling abroad for safe and effective treatments that are

not available to them domestically. It is a fundamental principle in all of medicine, and life, that risk must

be balanced against benefit. If a treatment option is delayed too long, patients can suffer. The most

topical example is corneal cross-linking (CXL) for treating keratoconus. Denying widespread access to

this treatment at a time when it is widely available elsewhere undoubtedly means that some patients

will undergo a corneal transplant with all of the attendant risks and costs that potentially could have

been avoided. Although there is much more to be learned about CXL, how much more information is

required before patients have it as an option? It is important to recognize that there is definite harm in

not approving a technology or drug, just as there is potential for harm in a patient delaying a decision to

have surgery. Seemingly arbitrary requests from the FDA for additional (and often redundant) data

foster concerns that the regulatory body causes deliberate delay. There must be some means to make

the FDA accountable to patients for their lost opportunities.

There must be some means to make the FDA accountable to patients for their lost

opportunities.

THE ROLE OF VENTURE CAPITAL

The European model of CE Marking was discussed as a system that works well and promotes jobs and

development. It is funded by companies, is focused on safety rather than efficacy, and it has less red

tape. Although it seems doubtful that a similar system has a chance of being approved in the US, one

suggestion is that the FDA should focus primarily on safety rather than efficacy. Then, let the clinicians

make a judgment on efficacy based on their experience and available data, and let the patients decide

if they think it is worthwhile.

J. Andy Corley of Yelroc Consulting, Inc., in California, and Tony Natale, MD, of Prism Venture

Management in Massachusetts, explained how venture capitalists help foster innovations and bring

new treatments to the clinic that larger companies cannot. Large companies may be hampered

because they cannot focus on running their business while developing multiple new ideas. Venture

capitalists have the advantage of being smaller and can choose projects after researching the potential

of the market.

There are, however, multiple challenges that venture capitalists face. Dr. Natale emphasized a critical

point: that the US has great innovators and entrepreneurs, but they are hampered by over-regulation.

This means that great innovations must be developed OUS, with clinical trials often conducted in

Europe prior to seeking FDA approval. This creates extra travel costs, and it means that collaborators

and investigators, who work in a different system, need to be identified. There are more unknowns, and

businesses would much prefer to be able to continue development within the United States.

There is also a risk that US companies conducting trials abroad can be perceived as experimenting onpoorer populations, with ensuing reputational damage. Overseas R&D can wrongly promote the

perception that Americans are prepared to experiment on others with unknown treatments that they

would consider unsafe for themselves. More to the point, would American patients be happier if

treatments developed in the US had been tested overseas first? Many patients simply want access to

the latest options, and would be prepared to accept the risks.

ECONOMIC PRESSURES

An important point made by Bill Link, PhD, of Versant Venture Management in California, is that it is


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difficult to innovate in a very tight market, where there are small margins. A high return on the initial

investment produces capital for further research and development. Unfortunately, the current economic

reality means that many brilliant and clinically useful innovations will never be developed at all, either

because of exorbitant development costs or because the market is too small to recoup the initial

investment. While innovations in other sectors are becoming cheaper, drug and device development

costs appear to be increasing massively. Is there any way to make drug development cheaper?

A new balance must be reached. Mr. Corely stressed that we need to understand the issues the FDA is

facing. As he said, firing letters between one another will not create an effective relationship.

Negotiating a better position requires a good understanding of what the FDAs internal issues are. Mr.

Corely is optimistic that the relationship with the FDA can be improved to facilitate moving the

translational phase of research back to the US.

INNOVATION

Individual surgeons should not be afraid to be part of the innovation cycle. They are in the fantastic

position of talking to patients every day about their needs, and hence can identify unmet needs and

develop ideas to fulfill those needs. The next steps are to identify the scope of the market and liaise

with companies and entrepreneurs to develop the idea into a marketable opportunity. By bringing

surgeons and industry together, ACOS meetings will certainly facilitate this type of innovation toimprove patient care.

Daya Sharma, MBBS, MSc, FRANZCO, is an ophthalmologist based in Sydney, Australia. He was a

Corneal, Cataract, and Refractive Surgery Fellow at Moorfields Eye Hospital in London, England, and a

Refractive Surgery Fellow in Heraklion, Crete. Dr. Sharma may be reached at

[email protected].

Dealing With Unwanted Images in Patients with Pseudophakia

By Samuel Masket, MD

In the July issue of the Journal of Cataract and Refractive

Surgery, Nicole Fram, MD, and I published a new theory on

the etiology of negative dysphotopsia and our method for

managing it surgically.1 This is a summary of what is known

about the condition to date.

BACKGROUND

Negative dysphotopsia, a dark crescent in the patients temporal visual field, is a frustrating

phenomenon in that it occurs after anatomically perfect cataract surgery and it appears to have nocorrelation with either the type of IOL implanted or the location of the main incision.2,3 However, there

have been no reports in the literature of negative dysphtopsia occurring with lenses implanted in the

sulcus or the anterior chamber, nor has it been reported with malpositioned IOLs. The condition is not

associated with LASIK flaps, penetrating keratoplasty, astigmatic corneal incisions, radial corneal

incisions, or pre- or postoperative ametropia.

HYPOTHESIS

A review of the literature led us to conclude that negative dysphotopsia is induced at the interface of the
mailto:[email protected]


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anterior capsulotomy and the anterior surface of the PC-IOL, perhaps due to the edge of the anterior

capsulotomy being reflected onto the nasal peripheral retina. Pharmacotherapy does not work; surgical

treatments of negative dysphotopsia seem most effective. The surgical strategies most commonly

tested for this purpose have been IOL exchange with sulcus placement of the new IOL, secondary

piggyback IOL implantation, and reverse optic capture. Our study showed the most reliable results

using the reverse optic capture and piggyback IOL techniques.1

TECHNIQUE

To perform reverse optic capture at the time of cataract surgery, I clean the anterior lens epithelial cells

to reduce postoperative fibrotic changes in the capsule. I place the three-piece IOL in the bag, and then

use a spatula to pop the optic anterior to the edge of the capsulorhexis. To succeed with this

maneuver, it is crucial that the capsulorhexis is properly sized. Alternatively, I can simply place the lens

in the sulcus, but the optic-capture technique provides better centration and fixation for long-term

stability. For highly symptomatic patients, I can perform a secondary reverse optic capture or exchange

the IOL for one placed in the ciliary sulcus.

Samuel Masket, MD, is a clinical professor at the David Geffen School of Medicine, UCLA, and is in

private practice in Los Angeles. Dr. Masket may be reached at (310) 229-1220; [email protected].

Nicole Fram, MD, is a clinical instructor at the David Geffen School of Medicine, UCLA, and is in private

practice in Los Angeles. Dr. Fram may be reached at (310) 229-1220.

1. Masket S, Fram NR. Pseudophakic negative dysphotopsia: Surgical management and new

theory of etiology. J Cataract Refract Surg. 2011;37(7)1199-1207.

2. Narvez J, Banning CS, Stulting RD. Negative dysphotopsia associated with the implantation of

the Z9000 intraocular lens. J Cataract Refract Surg. 2005;31(4):846847.

3. Trattler WB, Whitsett JC, Simone PA. Negative dysphotopsia after intraocular lens implantation

irrespective of design and material. J Cataract Refract Surg. 2005;31(4):841845.

The Way We Evaluate Eyes with Thin Corneas for LASIK May Need to Change

By William B. Trattler, MD

Evaluating eyes with thin corneas for potential LASIK surgery is an inexact science, and some of our

common assumptions about these patients may actually be based on flawed logic. Although several

studies have demonstrated that abnormal preoperative topographic readings are a risk factor for post-

LASIK ectasia, there is no consensus on what constitutes an abnormal reading. Moreover, some

patients with normal preoperative topography still develop ectasia, and we do not have good guidance

for identifying these individuals in our presurgical planning.

DIFFICULTY GRADING TOPOGRAPHY

The scoring system developed by Randelman and Stulting1 has been helpful for understanding some

of the potential risk factors for developing post-LASIK ectasia. This system assigns points for variables

such as age, planned residual stromal bed, preoperative corneal thickness, and manifest refraction.

Topographic readings are an important element of the Randelman scoring system, but recent research

presented at the AAO in Orlando suggests that there can be significant variability in how these scores

are graded. Renato Ambrosio, MD, PhD, reported on his study wherein 10 different experienced

topography experts evaluated preoperative topographic maps, and some of the eyes ended up


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developing post-LASIK ectasia.2 There was marked disagreement by the graders in the interpretation

of the preoperative topography. For most of the cases that developed ectasia, the final Randleman risk

score varied based on the interpretation of the preoperative topography. As a result, the study found

that the patients candidacy for LASIK varied according to which doctor was interpreting the

preoperative topography.

Thin Corneas and LASIK

Keratoconus results in corneal thinning and irregular astigmatism. It has been suggested that if a

patients corneal findings, such as corneal thickness, are two standard deviations outside of normal,

then this may be a clue that the patient is developing early keratoconus, and therefore he or she may

be at greater risk for post-LASIK ectasia. However,

it is interesting that the same thinking is not used to

exclude eyes that are two standard deviations or

more outside the norm with regard to astigmatism

(Figure). One of the underlying assumptions is that

the corneas thickness is a direct measure of its

rigidity/strength. This thinking would suggest that

thin corneas have less corneal strength and are thus more susceptible to developing ectasia. Contrary

to this hypothesis, however, are various findings that demonstrate that the actual thickness of thecornea is not a direct measure of corneal strength. A few examples: (1) our corneas naturally become

stiffer as we age, even though their thickness changes very little; (2) after corneal cross-linking, the

cornea becomes thinner yet stronger; and (3) African and African-American populations have thinner

corneas compared with other ethnicities, but do not show any greater incidence of keratoconus or post-

LASIK ectasia. So, the central corneal thickness does not appear to be a direct measure of corneal

strength.

ECTASIA RISK FACTORS

With these thoughts in mind, it seems that the current thinking about excluding patients with thin

corneas from LASIK may be overly cautious. In a retrospective review of 1,702 eyes that underwent

myopic LASIK with normal preoperative topography, Perry S. Binder, MS, MD, noted that 12% of theeyes had a Randelman score of 3 or higher, yet none developed ectasia.3 Interestingly, the original

paper by Randelman and Stulting included a control group of 133 eyes, and 12% of eyes in the control

group had a score of 3 or higher, yet none developed ectasia.

Other studies in the literature have also noted a low risk of post-LASIK ectasia in patients with thin

corneas after operations performed with microkeratomes.4-7 It is notable that in these studies, with

populations ranging from as small as 39 eyes to as large as 400 eyesand including studies

specifically in patients with moderate-to-high myopia and thin corneasthat no cases of ectasia were

reported through the follow-up of these studies.

What I take away from the limited data on thin corneas as it pertains to the risk for post-LASIK ectasiais that it is crucial to evaluate the corneal shape in both eyes. There are many available technologies

that can provide valuable information in assessing the candidacy of patients, including the Orbscan

(Bausch + Lomb, Rochester, NY), Pentacam Comprehensive Eye Scanner (Oculus, Inc., Lynnwood,

WA), or the Galilei (Ziemer Ophthalmic Systems AG, Port, Switzerland). Measuring corneal

biomechanical strength with the Ocular Response Analyzer (Reichert, Inc., Depew, NY) may provide

additional information. Additionally, flap creation with femtosecond lasers and more advanced

microkeratomes may be safer compared with older microkeratome technology, because flap thickness

is more predictable. Lastly, to ensure that the flap is not cut too deep, it may be prudent to perform


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intraoperative pachymetry whenever possible.

William B. Trattler, MD, is the director of cornea at the Center for Excellence in Eye Care in Miami and

the chief medical editor of Eyetube.net. Dr. Trattler may be reached at (305) 598-2020;

[email protected].

1. Randleman JB, Woodward M, Lynn MJ, Stulting RD. Risk assessment for ectasia after corneal

refractive surgery. Ophthalmology2008;115:37-50.

2. Ramos I, Ambrosio R Jr, Guerra FP, et al. Impact of the subjective variability of corneal

topography classification on the ectasia risk score system. Poster presented at: The AAO

annual meeting; October 22-25; Orlando, FL.

3. Binder PS, Trattler WB. Evaluation of a risk factor scoring system for corneal ectasia after

LASIK. J Refract Surg. 2010;26(4):241-250.

4. Kremer I, Bahar I, Hirsh A, Levinger S. Clinical outcome of wavefront-guided laser in situ

keratomileusis in eyes with moderate to high myopia with thin corneas; J Cataract Refract Surg.

2005 2005;31(7):1366-1371.

5. Kymionis GD, Bouzoukis D, Diakonis V, et al. Long-term results of thin corneas after refractive

laser surgery.Am J Ophthalmol. 2007;144(2):181-185.

6. He TG, Shi XR. Clinical study of ultrathin flap LASIK and LASEK for the treatment of highmyopia with thin cornea. Zhonghua Yan Ke Za Zhi. 2006;42(6):517-521.

7. Caster AI, Friess DW, Potvin RS. Absence of keratectasia after LASIK in eyes with

preoperative central corneal thickness of 450 to 500 microns. J Refract Surg. 2007;23(8):782-

788.

Achieving Efficiency with Femtosecond Laser Refractive Cataract Surgery

By Eric D. Donnenfeld, MD

Femtosecond laser refractive cataract surgery is a new technology, and therefore it will take careful

thinking and planning to figure out how best to use it. In the long term, though, I think surgery can

ultimately become more efficient with this new technology. In fact, consumer demand may force us to

figure out how to effectively use a femtosecond laser in a high-volume cataract practice. The early

response to laser refractive cataract surgery from the patients in my surgical center has been

enthusiasticand, in fact, overwhelming. I had initially planned on a 15% to 20% penetration of

patients wanting this procedure. So far, we have achieved a 60% conversion rate. Given the high

demand, we have had little choice but to learn and adapt to the technology so that we can better serve

our patients wishes.

"Given the high demand, we have had little choice but to learn and adapt to the

technology so that we can better serve our patients wishes."

SURGICAL PEARLS

The use of the femtosecond laser in cataract surgery has been studied in controlled settings, and the

results are positive. Because the technology is so new, however, there is still a dearth of information

about how it may be used in the clinic. To that end, my staff and I have learned a few surgical pearls in

our early experience that may be beneficial to share.

1. Patients must be able to comply with the suction element of the femtosecond laser. This may


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mean selecting out patients with medical conditions (ie, tremors) that would prevent them from

lying perfectly still. The laser we use, the LenSx (Alcon Laboratories, Inc., Fort Worth, TX),

requires only a modicum of interpalpebral exposure, but redundant conjunctiva may prevent

suction, as may the use of gels or ointments. One technique my staff and I have found very

useful is to retropulse the globe. We use a speculum to press down on the globe, which causes

the eye to move forward and results in better applanation.

2. Achieving good dilation and staying about 0.5 mm away from the iris during the femtosecond

ablation are essential to a safe surgery.3. The use of a novel device requires increased chair time with patients preoperatively to explain

all the parameters. Although greater chair time may dampen overall efficiency, it is time well

spent if the patient ultimately walks away happy.

4. Laser refractive cataract surgery is a premium procedure, and my staff and I want to make sure

that patients experience a premium service as well. We keep them on the same stretcher from

start to finish so they move seamlessly through our center.

PRACTICE PEARLS

One of the important considerations that will affect patient flow and dynamics is the placement of the

laser in the surgical center. Maintaining or improving patient throughput is best achieved by having the

laser as close to the OR as possible. Optimally, the laser would be just outside the OR, becausesacrificing an OR exclusively for the lasers use forfeits the revenue potential of that room.

The trick is to find a placement that works for you and then maximize how the device is used. For

example, we had to place our femtosecond laser in one of our ORs, simply because we do not have the

space to place it anywhere else. We have three ORs in use on surgical days. When using one room for

laser refractive cataract surgery, I am approximately 50% slower with my surgical time compared with

standard cataract surgery; with two rooms I am 35% slower; and with all three in service, I am still

about 20% slower. Once I realized how inefficient I had become, I decided to have our surgical fellow

perform all of the laser procedures so that I could concentrate on the surgical portion. This change has

increased our centers efficiency by 10% to 20%. I believe that surgeons should strongly consider

performing their first 200 or so cases, but after that point, splitting duties is very beneficial. This mighteven be a good role for a senior associateperhaps someone contemplating retirement and/or scaling

back his or her responsibilities.

Eric D. Donnenfeld, MD, is a professor of ophthalmology at NYU and a trustee of Dartmouth Medical

School in Hanover, New Hampshire. Dr. Donnenfeld is in private practice with Ophthalmic Consultants

of Long Island in Rockville Centre, New York. He acknowledged no financial interest in the products or

company mentioned herein. Dr. Donnenfeld may be reached at (516) 766-2519; [email protected].

Emphasize Education and Patient Choice to Improve Conversion Rates

By James D. Dawes, MHA, CMPE, COE

Patients want the best improving vision possible after cataract surgery. Unfortunately, we often do a

poor job of making the decision to spend discretionary dollars on improving vision an easy one. Getting

patients to commit extra, out-of-pocket dollars to a premium lens choice requires a practice-wide

commitment to simplifying the overall educational process. In general, patients come to the practice

unaware of what their vision might be after surgery and unfamiliar with modern technological

advancements in lens replacement surgery. Many practices want to improve their conversion rates to


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premium lenses; and, while our practice has been successful in the premium channel, our focus is

really on allowing the patient to make the decision instead of trying to sell something that they may not

want and probably dont quite understand. We truly believe that informing our patients about all the

parameters involved in cataract surgery represents our best chance for helping them achieve their

desired outcome and to be comfortable and happy with that decision.

Although a lot is involved in educating individuals about these implants, for the purposes of this article, I

will review the points we emphasize in our practice during the patient-counselor encounter.

EDUCATION

I emphasize that patients ought to be educated about their IOL options before consulting with the

surgeon. My staff and I believe that patients really seek a lens recommendation from their surgeon, and

we want them to be well informed of their options so that the discussion with the operating surgeon can

be fruitful. Our commitment to education is all-inclusive and involves the referring physician, the front-

office staff, the technicians, the patient counselors, and the surgeon.

The encounter between the counselor and the patient usually lasts 10 to 15 minutes, and we attempt to

personalize the experience as much as possible. We ask patients about their hobbies, how they use

their vision, and what their visual needs might be after cataract surgery. That knowledge can be a

powerful reference point as the discussion continues.

Visual cues help many patients assimilate the information

we are providing. We have equipped our counseling rooms

with large, flat-screen televisions so that patients can easily

see visual aids that demonstrate how normal vision is

perceived as well as how it degrades due to presbyopia and

cataracts.

We spend a good amount of time reviewing the anatomy of the eye and the pathophysiology of a

cataract. We follow with a discussion about astigmatism and how a cataract and lens replacementprocedure alone does not address near vision or any pre-existing astigmatism. We discuss our

approach to treating and managing astigmatism, which is imperative to achieving the patients best

visual outcome.

Then, we generally describe IOL options for the patient, being careful to identify the advantages and

disadvantages of both standard and premium lenses.

Any discussion about cataracts and lens options must account for potential complications, and time

should be spent explaining why some expected follow-up issues are not, in fact, failures of the

procedure. For instance, we explain that some patients may experience halos and glare after

implantation with premium lenses, and others require an Nd:YAG capsulotomy. We emphasize thatthese occurrences are not a failure by the operating surgeon, but instead expected and very common

postoperative conditions.

SIMPLIFY THE PAYMENT PROCESS

One of the trickiest aspects of cataract surgery for our patients to understand is the insurance and

payment process. In the interest of simplification, we perform a preregistration process to identify the

individual patients responsibilities for copay, coinsurance, deductible, and out-of-pocket expenses. We

then let the patient see a side-by-side comparison of the costs associated with premium and standard


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lenses. At this time, a reminder that he or she may be responsible for a copay, deductibles, and/or

coinsurance payment for a needed Nd:YAG capsulotomy is certainly warranted.

Before wrapping the conversation, we also introduce the various financing options we have available.

We want to assure our cataract surgery candidates that we will continue to work with them to navigate

this process and help them achieve their visual goals. At that point, we emphasize that the next step in

the process is for the surgeon to determine if the patient is a candidate for a premium lens, and that he

or she will make a recommendation as to the best technology to meet the patients desired visual

outcome.

CONCLUSION

An informed consumer is our best customer, and in most cases is a happier patient. Asking a patient to

pay thousands of dollars for an IOL is a tricky proposition, but one that can be greatly aided by

personalizing the decision so the focus is on the patient. My staff and I believe in helping patients

achieve their visual goals and in making sure that they understand all the options and ramifications of

the final lens choice.

James D. Dawes, MHA, CMPE, COE, is the chief administrative officer at Center For Sight in Sarasota,

Florida. Mr. Dawes may be reached at (941) 480-2105; [email protected].

Documents

ACOS 2011 Year End Newsletter