MAY 01, 2023
Question: A patient unhappy with her post-operative visual acuity following cataract surgery asked for a second opinion. My examination revealed suboptimal BCVA, a vitreous strand to the surgical wound with a peaked pupil, and a sulcus IOL. An OCT revealed macular edema. The patient provided her records from the cataract surgery, which stated that the IOL was placed in the bag and there were no complications. Should I tell the patient about what appear to be surgical complications that are likely contributing to her suboptimal visual acuity? Should I call the operating surgeon first to assure I am not missing something?
Answer: Your primary responsibility is to offer the second opinion and to act in her best interest. Before commenting on whether the patient was misled about the outcome of her cataract surgery, collect all pertinent facts and data. This would include a thorough patient history, a review of the operating ophthalmologist's medical and surgical records, and, ideally, a discussion with the surgeon. Only after all this information has been gathered can the patient be properly informed. Then, if the patient wishes, you can work with her to develop a medical and/or surgical plan for moving forward.
The Rules of the Code of Ethics which may potentially be involved include Rules 1. Competence, 5. The Impaired Ophthalmologist, 8. Postoperative Care, and 9. Medical and Surgical Procedures (which includes the concept of misrepresentation of the services provided to the patient).
Learn more at aao.org/clinical-education/redmond-ethics-center.
To submit a question, contact the Ethics Committee at ethics@aao.org.