Should patients with presbyopia be swapping their natural lens for a multifocal IOL? Graham Barrett is clear; surgical interventions need to be in the patient’s best interest before any commercial considerations are raised. But he fears for the reputation and status of ophthalmologists if clear lens extraction for presbyopia becomes routine. Australian ophthalmologist Graham Barrett spoke at the ESCRS Congress, and he was given the title: “Clear lens extraction. Have we gone mad?”
“I think the session was meant to be controversial,” said Graham, “but when you sit down and think about it, it’s worth considering. One of the issues is that presbyopic patients, without any refractive error, who are neither short sighted nor long-sighted, who only need reading glasses, are undergoing clear lens extraction. Is this something that is just responding to patient demand? Or is this perhaps being driven by commercial interests?” Those commercial interests are not difficult to identify – it’s a very large potential market: all forty and fifty year olds who need to wear reading glasses. “The financial implications of that are huge, both for industry and surgeons,” noted Graham. “Essentially, what is being offered is cataract surgery, with all of the risks and technical problems inherent with that procedure – and you can’t completely eliminate those issues,” which means that results may not always please the patient. “For someone who just needs reading glasses, you’re stretching the capabilities of the technologies we have,” he explains.
The key question is: what is best for the patient? “This sort of procedure fundamentally alters a very important part of being a physician, which is thinking about patients’ best interests. We still have a role to provide our advice. We understand, much better than patients ever can, what the possibilities of success are, and what the risks are. When we provide that advice, it has to be in the patient’s best interest. And the reality is that advice will have commercial implications, but these must always be secondary considerations.” Putting profit first won’t end well for the profession, warns Graham. “An overly commercial approach risks diminishing the professional status of ophthalmologists as physicians and as surgeons, and may also devalue cataract surgery in itself. But when you get into that mode of selling, you risk diminishing the reputation of ophthalmology in general.”
