News reports from the conference

Proper perception of cataract surgery needed: AAO President

Patients and physicians need to understand that the fact that cataract surgery can be done quickly and efficiently does not mean it should be trivialized.

That was one of the main messages of a plenary address by Dr. Richard Abbott, president of the American Academy of Ophthalmology and chair of ophthalmology at the University of California San Francisco.

In an address focused on the need to build a link between risk management and quality of care for cataract and intraocular lens (IOL) surgery, Abbott repeatedly warned the audience not to minimize the procedure and to follow well-established steps for communicating with patients.

Abbott noted that 32% of claims made in 2010 to the Ophthalmic Mutual Insurance Company, which provides malpractice insurance coverage to U.S. ophthalmologists, involved cataract and IOL surgery. These claims also represented 18% of the indemnity paid.

Because of this and trends in the United States toward mandating maintenance of competence and tying reimbursement to quality measures, Abbott said that it made a lot of sense to pay attention to risk management and quality of care.

He was critical of surgeons and other physicians who tell patients that cataract surgery can be done in 10 minutes and "you can play golf in the afternoon." As a result of this type of statement, he said, "anything that goes wrong is immediately magnified."

Abbott outlined steps that his organization is taking to provide guidelines on obtaining informed consent from patients and other risk management measures including dealing with unrealistic patient expectations.

According to Abbott, patient expectations are high with new types of premium IOLs and femtosecond laser surgery and, therefore, patient selection must be done carefully. He noted that expectations are such that not achieving the refraction goal may be considered a complication in itself by some patients.

Patient safety is becoming a global issue, Abbot said, in supporting the move to link risk management and patient safety with quality of care.

During the question period, Abbott and other ophthalmologists bemoaned the fact that other physicians and payment agencies feel cataract surgery can be done in 10 minutes and that, therefore, remuneration should be reduced accordingly.

Abbott noted that reimbursement for cataract surgery is now $670 in the United States compared with $2000 30 years ago. This rate will drop further to $400.