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Learn more at Booth 1626 ASCRS•ASOA SYMPOSIUM SHOW DAILY CHICAGO 2012 EW & CONGRESS, 3 ASCRS News Today continued from page 1 Important Safety Information –TECNIS® Toric IOL Indications: The TECNIS® Toric 1-Piece posterior chamber lenses are indicated for the visual correction of aphakia and pre-existing corneal astigmatism of one diopter or greater in adult patients with or without presbyopia in whom a cataractous lens has been removed by phacoemulsification and who desire improved uncorrected distance vision, reduction in residual refractive cylinder, and increased spectacle independence for distance vision. The device is intended to be placed in the capsular bag. Warnings: Physicians considering lens implantation should weigh the potential risk/benefit ratio for any circumstances described in the TECNIS® Toric 1-Piece IOL Directions for Use that could increase complications or impact patient outcomes. The clinical study did not show evidence of effectiveness for the treatment of preoperative corneal astigmatism of less than one diopter. The TECNIS® Toric 1-Piece IOL should not be placed in the ciliary sulcus. Rotation of the TECNIS® Toric 1-Piece IOL away from its intended axis can reduce its astigmatic correction. Misalignment greater than 30° may increase postoperative refractive cylinder. Precautions: Accurate keratometry and biometry in addition to the use of the TECNIS Toric Calculator (www.TECNISToricCalc.com) are recommended to achieve optimal visual outcomes. The safety and effectiveness of the toric intraocular lens have not been substantiated in patients with certain preexisting ocular conditions and intraoperative complications. Refer to the TECNIS® Toric 1-Piece IOL Directions for Use for a complete description of the preexisting conditions and intraoperative complications. All preoperative surgical parameters are important when choosing a toric lens for implantation. Variability in any of the preoperative measurements can influence patient outcomes. All corneal incisions were placed temporally in the clinical study. Do not reuse, resterilize, or autoclave. Adverse Events: The most frequently reported adverse event that occurred with the TECNIS® Toric 1-Piece IOL was surgical reintervention, which occurred at a rate of 3.4% (lens repositioning procedures and retinal repair procedures). Other reported events included macular edema, which occurred at a rate of 2.9% and retinal detachment which, occurred at a rate of 0.6%. Caution: Federal law restricts this device to sale by or on the order of a physician. Attention: Reference the Directions for Use labeling for a complete listing of Indications, Warnings and Precautions. newspaper, or go online without seeing these things. "Patients are increasingly aware of the existence of controversies in medicine," Dr. Hartzband said. Dr. Groopman discussed medical decision analysis that is linked to economics and trying to calculate decision making through formulas. A formula from mathematician Daniel Bernoulli is often used and is calculated by looking at the probability of a certain outcome and multiplying it by the utility or impact that that outcome has. Dr. Groopman said this theory has been imported into medicine. "You can estimate the probability of an outcome." However, he said it's hard to put a number on how a patient's life will be affected. There are three methods that have been used for medical decision analysis. The first is a linear scale, he said, with numbers from zero to one. Zero is death and one is perfect health. The patient determines where he or she would classify life on the scale after developing a certain condition or complication. The second method is a time trade off, which asks the patient to determine how many years of life he or she would be willing to give up to avoid becoming incontinent or impotent. The third method is the standard gamble, he said, derived from game theory. In this method, patients are asked to imagine that they have a magic pill to prevent an outcome, however, in some cases there is instant death. "You're supposed to estimate what odds you would be willing to take to completely avoid a certain outcome versus the chance that this magic pill would kill you immediately." However, research shows that all three methods are flawed, Dr. Groopman said. "You can't accurately understand the impact that a certain outcome will have if you've never experienced it." Dr. Groopman also said medical conditions are not static and can change over time. In addition, people adapt, so the effect of certain conditions on life can change over time. Dr. Hartzband said consulting textbooks was not particularly en- lightening, and listening to patients and asking how each person makes decisions gave a different perspective. It was found that people were individual in making decisions, but there were common threads in how people approached health and medical problems. This brought out a variety of medical mindsets a patient can have. She said people can be minimalists or maximalists. There can be a difference in whether patients prefer a naturalism approach, where they would rather take a medication or treatment made from natural materials. This differs from the technology approach, where a patient prefers the most up-to-date technology and updated medicine. Finally, patients can be believers or doubters, where they are either confident or skeptical that a treatment will be successful. Dr. Hartzband said another way patients tend to get medical information and numbers is from drug advertisements. Watching the evening news and primetime television, people see a plethora of ads from different companies. "Drug advertisements are carefully constructed to use both the power of numbers and the power of stories to sell the product," she said. However, the advertisements often make the drug seem even more impressive than it really is. To close the session, Dr. Groopman discussed how people often have much different mindsets about their medical treatment when they are actually sick. He said you cannot forecast how you will think in the future under circumstances that you have not had before. Dr. Groopman acknowledged that it is hard for an individual to make a decision, especially when the expert disagrees. To access a particular person's mindset, look at the numbers and attempt to determine how they apply to a particular individual, and consider stories of people who have similar backgrounds and mindsets. "We believe that when a patient knows his or her medical mind, he or she can communicate this to us, their physicians," Dr. Groopman said. EW