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40 EW SHOW DAILY Monday, April 22, 2013 Meeting Reporter Ethics symposium focuses on femto by Chiles Aedam R. Samaniego EyeWorld AP Senior Staff Writer F emtosecond cataract surgery has often been proclaimed the next best thing since phaco, the technology representing an inevitable new paradigm in ophthalmic surgery. But not everyone is convinced, and perhaps all along, behind the more measured to and fro discussions between skeptics and believers, another, more vitriolic conversation has been taking place. That conversation exploded to the forefront at Sunday's Ophthalmology Business Focus on the "Ethics Surrounding Marketing of Femtosecond Laser Cataract Surgery." There are those who believe that the technology has yet to sufficiently distinguish itself from standard phaco in terms of either safety or outcomes to justify the cost; there are those who take an even dimmer view. Is femtosecond cataract technology, for instance, asked John D. Banja, PhD, medical ethicist, Center of Ethics, Emory University, Atlanta, nothing more than a tool that "takes a surgeon of mediocre skill and John D. Banja, PhD Attendees answer an audience poll at the well-attended session. makes him a superstar," a product of "hype and glamor"? Several such skeptics were on hand to raise rather vehement objections to the influence the technology has had on the marketplace. "I've always been surprised and fascinated by how much ophthalmology, out of all the fields of medicine, lends itself so much to a marketplace model," said Dr. Banja. "Can you imagine a heart surgeon offering patients the choice between regular and 'premium' heart valves?" In an audience response survey question, a 38% majority of attendees at the symposium agreed that, when "the competition" gets a femtosecond laser and "advertises the hell out of it," it forces them to get one as well. ASCRS-Authorized Education Change in opinions on the targets for astigmatism management after refractive IOLs. Data taken from the EyeWorld Education event "New Technologies and Techniques for Tackling Astigmatism: Diagnostic, Intraoperative, and Postoperative Management." The jury's still out on the technology itself, but the issue surrounding it reveals some very interesting things about the practice model of ophthalmology, the way the environment that model creates potentiates what some practitioners clearly believe is unethical—but also, in some ways, tragically, not unexpected—behavior. Unfortunately, said moderator Rosa M. Braga-Mele, MD, "at the end of the day, we can't control the ethics of others." However, said Dr. Banja, you can penalize bad behavior; the ethical are not entirely powerless in the face of the unethical, and it may even behoove them to take action in instances where the unethical takes place. And when you can't decide whether what you're doing is ethical, Dr. Banja said to simply ask yourself these "big 3" questions: Does this "feel" OK to do? Could you justify your behavior to your mom? What if your decision and its rationale appeared on the front pages of tomorrow's news? "If you're cool with the big 3, then you're probably ethically OK," he said. EW Editors' note: Dr. Braga-Mele has financial interests with Abbott Medical Optics (Santa Ana, Calif.), Alcon (Fort Worth, Texas), and Allergan (Irvine, Calif.). Dr. Banja has no related financial interests.