According to http://www.orthok.co.uk/nerfs.htm, orthokeratology isn’t
permanent because the epithelial cells migrate outwards rather than a
consistent change through the whole of the cornea.
The report suggests that the Bowman’s membrane is too stiff to move.
Yet, I understand LASIK works by removing removing stromal cells
underneath the Bowman’s membrane. Presumably Bowman’s is also altered
in shape by this procedure?
Later on in the report (about 60% down), Charles May is investigating a
technique using enzymes to break down the stroma. Will this be enough
to change the shape of the Bowman’s membrane (and hence the cornea)?
The middle of the article, "that Bowman’s membrane… bent more with a
high âkâ reading than with a low âkâ reading."
I presume this is talking about the shape of the reverse geometry lens,
but I have no clue what this means apart from that if anyone can explain
it?
Lastly, I have myopia of -8.0D. I understand that the image is focused
in front of my retina, but how far in front? Are we talking 1mm or
10mm?
Thanks.
Dave, http://www.deep-trance.com
Frames are 39mm not 39cm, top to bottom, but I suppose most know what you
meant.
"Paul Cox" <pm…@marshallnet.com> wrote in message
news:pmcox-48466A.11590409102002@news.marshallnet.com…
- Hide quoted text — Show quoted text -
> (I am reposting with minor revisions, hoping to get a few more responses
> from the professionals I often read here.)
> It’s time for some new lenses after 3+ years wearing Sola Perceptas. I
> know there are newer designs out there and would like some advice on the
> best one for my eyes (see new Rx below). My optician fits a lot of
> Varilux Comfort, but doesn’t like the Panamic. She does like the Zeiss
> Gradal Top, but don’t think she sells a lot of those. Those are probably
> the 2 PAL lenses she has most experience with, and I’m sure most of her
> sales are Varilux.
> Here’s my new Rx:
> O.D.
> Spherical -6.75
> Cylindrical +0.75
> Axis 080
> Prism 1B1
> O.S.
> Spherical -7.75
> Cylindrical +0.75
> Axis 071
> Prism 1B1
> Add for Near is +2.50 for O.D. and O.S.
> I would definitely like a wide reading area, but am at the computer a
> lot, too. Can’t afford 2 pairs, so need an all-around pair. I will
> appreciate your advice on lens brand, material, etc., and any special
> considerations concerning my prescription.
> Perceptas have been OK, but I know they are always improving progressive
> designs. Rx hasn’t changed much:left eye a little less distance
> correction, Add for near is up +.5 in each eye. Optician says several
> customers disliked Panamic, so she stuck with Comfort. Says she likes
> the lack of distortion at the edges with Gradal. That sounds good to me,
> too. Solamax sounds good due to wide reading area. Open to
> recommendations on optimum frame size, current ones are approx. 39 cm
> top to
> bottom.
> Paul Cox
I really do need those new lenses–can’t tell mm from cm!
Paul
In article <LM%o9.40$yQ5.47…@news.uswest.net>, "maf"
- Hide quoted text — Show quoted text -
<Rm000…@Rqwest.netR> wrote:
> Frames are 39mm not 39cm, top to bottom, but I suppose most know what you
> meant.
On Wed, 09 Oct 2002 11:59:04 -0500, Paul Cox
- Hide quoted text — Show quoted text -
<pm…@marshallnet.com> wrote:
>(I am reposting with minor revisions, hoping to get a few more responses
>from the professionals I often read here.)
>It’s time for some new lenses after 3+ years wearing Sola Perceptas. I
>know there are newer designs out there and would like some advice on the
>best one for my eyes (see new Rx below). My optician fits a lot of
>Varilux Comfort, but doesn’t like the Panamic. She does like the Zeiss
>Gradal Top, but don’t think she sells a lot of those. Those are probably
>the 2 PAL lenses she has most experience with, and I’m sure most of her
>sales are Varilux.
>Here’s my new Rx:
> O.D.
> Spherical -6.75
> Cylindrical +0.75
> Axis 080
> Prism 1B1
> O.S.
> Spherical -7.75
> Cylindrical +0.75
> Axis 071
> Prism 1B1
> Add for Near is +2.50 for O.D. and O.S.
>I would definitely like a wide reading area, but am at the computer a
>lot, too. Can’t afford 2 pairs, so need an all-around pair. I will
>appreciate your advice on lens brand, material, etc., and any special
>considerations concerning my prescription.
>Perceptas have been OK, but I know they are always improving progressive
>designs. Rx hasn’t changed much:left eye a little less distance
>correction, Add for near is up +.5 in each eye. Optician says several
>customers disliked Panamic, so she stuck with Comfort. Says she likes
>the lack of distortion at the edges with Gradal. That sounds good to me,
>too. Solamax sounds good due to wide reading area. Open to
>recommendations on optimum frame size, current ones are approx. 39 cm
>top to
>bottom.
>Paul Cox
Paul,
In your e-mail you said your lenses were 1.6 index sola
percepta, and that you do a lot of close work as well as computer
work. The 1.6 index would make the lens material finalite, which
is a bit thinner than spectralite, similar in weight, and a lower
abbe value (low 40′s as opposed to 47). It is a good lens for
some folks, but with your add power going from 2.00 to 2.50 you
will find the full reading power is pretty far down in the lens,
enough to make you lift your chin more than you would like.
Varilux, rodenstock, genesis, outlook, natural/ovation would be
better choices. When material is considered, the sola max and
rodenstocks life C would be the two I would recommend.
With your occupation and the amount and type of close work that
you are involved with, it would be foolish of me to recommend
that you try to get everything you need in one pair of glasses.
You need computer glasses. You will read with more comfort, and
you will see the monitor with much greater comfort. They do not
have to be expensive, just functional. Many opticians have
"special value packages" where you probably could get an uncoated
plastic lined bifocal with a made in china frame for about a
$100.00. Once your discover how useful they are you might add an
anti-reflection coating, and at some future date upgrade the lens
and frame. Unless I’ve misunderstood your work situation, you
will wonder why you did not get them before now.
Watch your e-mail, I’ll send a testimonial from one of my
clients.
Robert Martellaro
Optician/Owner
Roberts Optical
Replace "nospam" with "execpc" for replies.
"Robert Martellaro" <rob…@nospam.com> wrote in message
news:3da5dab7$0$1402$> Paul,
- Hide quoted text — Show quoted text -
> In your e-mail you said your lenses were 1.6 index sola
> percepta, and that you do a lot of close work as well as computer
> work. The 1.6 index would make the lens material finalite, which
> is a bit thinner than spectralite, similar in weight, and a lower
> abbe value (low 40′s as opposed to 47). It is a good lens for
> some folks, but with your add power going from 2.00 to 2.50 you
> will find the full reading power is pretty far down in the lens,
> enough to make you lift your chin more than you would like.
> Varilux, rodenstock, genesis, outlook, natural/ovation would be
> better choices. When material is considered, the sola max and
> rodenstocks life C would be the two I would recommend.
> With your occupation and the amount and type of close work that
> you are involved with, it would be foolish of me to recommend
> that you try to get everything you need in one pair of glasses.
> You need computer glasses. You will read with more comfort, and
> you will see the monitor with much greater comfort. They do not
> have to be expensive, just functional. Many opticians have
> "special value packages" where you probably could get an uncoated
> plastic lined bifocal with a made in china frame for about a
> $100.00. Once your discover how useful they are you might add an
> anti-reflection coating, and at some future date upgrade the lens
> and frame. Unless I’ve misunderstood your work situation, you
> will wonder why you did not get them before now.
> Watch your e-mail, I’ll send a testimonial from one of my
> clients.
> Robert Martellaro
> Optician/Owner
> Roberts Optical
Robert,
Rodenstock makes 3 progressives
– Progressiv life C
– Progressiv life 2
– Multigressiv 2
Can you explain the difference between these (other than available
materials)?
Also, I am confused about the differences between Varilix Comfort and
Varilux Panamic
On Thu, 10 Oct 2002 16:13:35 -0600, "maf" <m…@switchboard.net>
wrote:
- Hide quoted text — Show quoted text -
>"Robert Martellaro" <rob…@nospam.com> wrote in message
>news:3da5dab7$0$1402$> Paul,
>> In your e-mail you said your lenses were 1.6 index sola
>> percepta, and that you do a lot of close work as well as computer
>> work. The 1.6 index would make the lens material finalite, which
>> is a bit thinner than spectralite, similar in weight, and a lower
>> abbe value (low 40′s as opposed to 47). It is a good lens for
>> some folks, but with your add power going from 2.00 to 2.50 you
>> will find the full reading power is pretty far down in the lens,
>> enough to make you lift your chin more than you would like.
>> Varilux, rodenstock, genesis, outlook, natural/ovation would be
>> better choices. When material is considered, the sola max and
>> rodenstocks life C would be the two I would recommend.
>> With your occupation and the amount and type of close work that
>> you are involved with, it would be foolish of me to recommend
>> that you try to get everything you need in one pair of glasses.
>> You need computer glasses. You will read with more comfort, and
>> you will see the monitor with much greater comfort. They do not
>> have to be expensive, just functional. Many opticians have
>> "special value packages" where you probably could get an uncoated
>> plastic lined bifocal with a made in china frame for about a
>> $100.00. Once your discover how useful they are you might add an
>> anti-reflection coating, and at some future date upgrade the lens
>> and frame. Unless I’ve misunderstood your work situation, you
>> will wonder why you did not get them before now.
>> Watch your e-mail, I’ll send a testimonial from one of my
>> clients.
>> Robert Martellaro
>> Optician/Owner
>> Roberts Optical
>Robert,
>Rodenstock makes 3 progressives
>- Progressiv life C
>- Progressiv life 2
>- Multigressiv 2
> Can you explain the difference between these (other than available
>materials)?
To the best of my knowledge, they all use the life 2 design, or
mold. The life C is cast instead of ground. The material is a mid
index, low specific gravity, moderate abbe (low 40′s). Similar to
spectralite, but lower abbe. Best for minus powers, edge
thickness can not be as precise with plus powers.
The multigressiv is ground with an atoric back curve with special
equipment in germany. This results in lighter and thinner lens
(especially with minus powers), and if there is a fair amount of
astigmatism, less distortion than any other progressive lens.
>Also, I am confused about the differences between Varilix Comfort and
>Varilux Panamic
Good question. The panamic is fully aspheric resulting in a
flatter front curve (in most powers). This is important to me
when I fit plus power Rx’s. The panamic also has a little more
blur in the distance peripheral vision. Essilor says the
intermediate is wider, but I see very little difference, even
when compared to the sola max. If you have a fair amount
intermediate focal length task, you are much better off getting
it from a separate pair of glasses designed for such use.
Hope this helps
Robert Martellaro
Optician/Owner
Roberts Optical
Replace "nospam" with "execpc" for replies.
- Hide quoted text — Show quoted text -
> >Rodenstock makes 3 progressives
> >- Progressiv life C
> >- Progressiv life 2
> >- Multigressiv 2
> >Can you explain the difference between these (other than available
> >materials)?
"Robert Martellaro" <rob…@nospam.com> wrote in message
> To the best of my knowledge, they all use the life 2 design, or
> mold. The life C is cast instead of ground. The material is a mid
> index, low specific gravity, moderate abbe (low 40′s). Similar to
> spectralite, but lower abbe. Best for minus powers, edge
> thickness can not be as precise with plus powers.
> The multigressiv is ground with an atoric back curve with special
> equipment in germany. This results in lighter and thinner lens
> (especially with minus powers), and if there is a fair amount of
> astigmatism, less distortion than any other progressive lens.
> >Also, I am confused about the differences between Varilix Comfort and
> >Varilux Panamic
> Good question. The panamic is fully aspheric resulting in a
> flatter front curve (in most powers). This is important to me
> when I fit plus power Rx’s. The panamic also has a little more
> blur in the distance peripheral vision. Essilor says the
> intermediate is wider, but I see very little difference, even
> when compared to the sola max. If you have a fair amount
> intermediate focal length task, you are much better off getting
> it from a separate pair of glasses designed for such use.
> Hope this helps
> Robert Martellaro
> Optician/Owner
> Roberts Optical
Thank You Robert
In article <7e9ca5fa.0210090653.768d3…@posting.google.com>,
nipi…@ix.netcom.com (nipidoc) wrote:
> INFORMED CONSENT FOR DILATION
We used a similar disclosure/permission form and the result was that
many people who really could benefit from dilation chose not to do so
and, as you experienced, many signed or did not sign having not really
read it anyway.
Two ways around that: verbally present the info and have the patient
sign off, if necessary, directly on the exam form. Takes a little more
time, but it’s nice for patient education and to involve them in their
care.
Or: please a line at the beginning and end of the document stating:
"I have read this document completely and have signed where appropriate
after reading and understanding the presentation."
PS: We do not mention "insurance" (we’ve eliminated all but one
third-party plan and would like to drop that one, too!) and dilation is
an included service with no additional fee or fee reduction if declined.
That eliminates the money issue.
–Larry
–
Larry Bickford, O.D.
Family Practice Eye & Vision Care
The EyecareConnection
http://www.eyecarecontacts.comSPAMTRAP
Or perhaps a line at the top of the form that says:
"If you don’t do this you may go blind."
nipi…@ix.netcom.com (nipidoc) wrote in
news:7e9ca5fa.0210090653.768d36fb@posting.google.com:
- Hide quoted text — Show quoted text -
> lasikdisas…@aol.com (LASIKdisaster) wrote in message
> <news:b854ce72.0210080518.4eb28f44@posting.google.com>…
>> > Refractive surgery volume is down, but not as much as you state and
>> > not entirely because of good informed consent.
>> Glenn, I am quoting a lasik surgeon who told me that sales in Los
>> Angeles are down 75%. I didn’t just pull that number out of thin
>> air.
>> The doctors who are blaming this on the economy are just fooling
>> themselves. It’s the horrific complications, media coverage and
>> litigation which have brought about better informed consent forms
>> which, unless they show pictures of what lasik-induced aberrations
>> look like and explain that suicidal ideation is very common in
>> patients with lasik complications, are still woefully inadequte.
> Let’s take a moment and discuss the issue of informed consent. I
> helped out a friend covering her office for a few days, and she has an
> informed consent for pupillary dilation. The following is her form:
> INFORMED CONSENT FOR DILATION
> In a dilated retinal examination, drops are instilled in your eyes
> that open the pupil to allow a much wider angled view into the back of
> your eye. Once we put the drops in, they will take about 15 minutes
> to take effect. After your pupils have reached the proper size, we
> will examine your retina for approximately 5-10 minutes using special
> lights and lenses. The normal side effects of the drops include light
> sensitivity and blurry near and intermediate vision for approximately
> 2-4 hours. Distance vision is usually unaffected and we can provide
> you with temporary sunglasses to aid in your drive home. If any
> redness or pain develops after the drops, please call or return to the
> office immediately.
> We strongly recommend this test be done initially on each patient as a
> baseline and at least every 2-3 years thereafter. It checks for
> holes, tears, tumors, degenerations, and detachments of the peripheral
> retina that we would otherwise be unable to detect. It can also aid
> in the detection of blood vessel changes in diabetes, high blood
> pressure, arteriosclerosis, and high cholesterol. This is part of a
> complete glaucoma evaluation. This test is absolutely vital if you
> suffer from diabetes, loss of vision, flashing lights, new floating
> spots, cataracts, high nearsightedness, or suspicious intraocular
> pressure.
> This test is covered under all insurances that have vision coverage.
> In addition, we also offer a senior discount included for all tests.
> For those with no insurance coverage or discount benefits, there is an
> additional charge of $20.00 for this test, which will be collected at
> the time services are rendered.
> If you have any questions about this procedure, please discuss them
> with the doctor.
> PLEASE CHECK ONE OF THE FOLLOWING AND SIGN:
> ______ Yes, I would like to have a dilated retinal exam today. I give
> my permission for the doctor to perform this procedure
> ______ No, I would not like a dilated retinal exam today. I
> understand that this test is necessary to detect diseases of the
> retina that may otherwise go undetected, but I choose not to have it
> performed. I understand that if I choose to reschedule this exam for
> another day, it is my responsibility to make and keep that
> appointment.
> *END*
> This form takes up about half of one side of a standard piece of
> paper.
> While I was covering her office, I was surprised at the number of
> patient who checked off "NO", when in fact, they should have had the
> test done for any number of different reasons. At the end of the
> examination, I would ask them "When was the last time this dilation
> test was performed?" The following are a couple of converstaions I
> had with patients:
> ME: "When was the last time this dilation test was peformed?"
> PNT: "What dilation test?"
> ME: "This test that this form talks about."
> PNT: "I didn’t read that form."
> Another patient:
> ME: "When was the last time this dilation test was performed."
> PNT: "I don’t think I’ve ever had that test done."
> ME: "OK, try to make an effort to have that test done sometime in the
> next couple of months."
> PNT: "Why? What does that test for?"
> ME: "It explained it in this form here. Did you not read this?"
> PNT: "No, I just signed it."
> (an interesting aside, this patient was a LAWYER)
> ME: "You signed a form that you didn’t read?"
> PNT: "Yeah, I guess so."
> ME: "And you’re a lawyer?"
> PNT: "HAHA. Yeah, I guess I did. HAHA. (looks sheepish)"
> I must have a had about about 15 patients in the three days I spent at
> her office sign that form without reading it. How did they know that
> it didn’t say that the fee for the exam was $500?
> I’m not implying that anyone here did this, but I wonder how many
> patients with poor outcomes didn’t read their infomred consent
> packages. If people aren’t willing to read a half page informed
> consent about pupillary dilation, are they going to be willing to read
> a lasik consent form, which is much more lengthy?
> nipidoc
As a human researcher, I deal with informed consent quite often, and I
have received formal extensive training in what our University considers
good practice (meaning sufficient not to have our human subjects
privilege yanked). In the unversity environment, government
organizations review the procedures by which informed consents are
obtained. It is generally agreed that (at least for these purposes) the
process of handing somebody a piece of paper and asking them to sign it
does NOT constitute informed consent, regardless of how thorough the
paper might present the issues that the subject needs to know! The
information on the consent form should be discussed with the subject, and
the subject should be offered a clear opportunity to discuss the form and
have questions answered.
The standards used to solicit informed consent in the office you describe
clearly do not meet the standards placed on investigators using human
subjects. Whether they legally need to or not, I don’t know. Also, it
would seem that a consent form for a dilated exam should contain some
language informing patients of the possible dangers of driving while
dilated.
Again, I don’t know if clinical standards of informed consent are as
rigorous as research standards, but if a Lasik surgeon were serious about
making sure that their patients understood their risks, they wouldn’t
simply hand them a form and say "read this". I’ve never seen this
process for Lasik surgery informed consent, so I don’t know the standards
at all, but I really hope the surgeons go a little bit farther than
asking patients to sign a form
–
Scott
Reverse first field of address to reply
In article <Xns92A2B5992648ScottSeidmanminds…@130.133.1.4>, Scott
Seidman <namdiestt…@mindspring.com> wrote:
> nipi…@ix.netcom.com (nipidoc) wrote in
> news:7e9ca5fa.0210090653.768d36fb@posting.google.com:
[snip]
> > 2-4 hours. Distance vision is usually unaffected and we can provide
> > you with temporary sunglasses to aid in your drive home. If any
> would seem that a consent form for a dilated exam should contain some
> language informing patients of the possible dangers of driving while
> dilated.
See above. I’d rather not drive with dilated eyes (although I usually get
the "extra strength" drops), but have done so many times.
> Again, I don’t know if clinical standards of informed consent are as
> rigorous as research standards, but if a Lasik surgeon were serious about
> making sure that their patients understood their risks, they wouldn’t
> simply hand them a form and say "read this". I’ve never seen this
> process for Lasik surgery informed consent, so I don’t know the standards
> at all, but I really hope the surgeons go a little bit farther than
> asking patients to sign a form
LASIK is one thing, but an informed consent form for a dilation sounds a
little excessive.
I bought a little handheld digital camera last week. It came with a
little 60 page booklet. No, that wasn’t the instruction manual, it was
the safety guidelines! Now, it was really just 15 pages, printed in four
languages, but still, how ridiculous! Almost all users are going to use
this camera with batteries. Of the few people who would buy the AC
adapter, few would use it often. Yet, they spent 15 pages telling us not
to use it in the rain, or take it apart, or hold it while we submerge it
in water while plugged in.
–
Dan Abel
Sonoma State University
AIS
da…@sonic.net
nipidoc wrote:
> This test is covered under all insurances that have vision coverage.
> In addition, we also offer a senior discount included for all tests.
> For those with no insurance coverage or discount benefits, there is an
> additional charge of $20.00 for this test, which will be collected at
> the time services are rendered.
So if you have to pay for it yourself you have to pay $20 extra? Huh?
> I’m not implying that anyone here did this, but I wonder how many
> patients with poor outcomes didn’t read their infomred consent
> packages. If people aren’t willing to read a half page informed
> consent about pupillary dilation, are they going to be willing to read
> a lasik consent form, which is much more lengthy?
I don’t read the forms that you have to sign in order to be treated. If I
don’t sign, I won’t be treated, so there’s really not much point in reading
two pages of fine print (hospital admission, generally presented on the
spot). I do refuse to submit to arbitration, though. That’s easy.
This is, of course, for essential treatment that I understand and about
which I haven’t much choice. I would definitely read the IC forms for
anything optional.
–
Cheers,
Bev
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Screw the end users. If they want good software,
let them write it themselves." — Anon.
da…@sonic.net (Dan Abel) wrote in news:dabel-0910021559150001@ssu-
64en129.sonoma.edu:
> LASIK is one thing, but an informed consent form for a dilation sounds
a
> little excessive.
Of course, but not quite addressing the context of this thread. The
poster questioned the value of informed consent, providing experience
with this dilation form and the patients’ response to it as evidence
supporting that argument. My counter-argument is that by research
standards, the informed consent form for the dilated exam and especially
the way the consent was solicited does not constitute informed consent,
the point being that a proper informed consent provides a real service to
a subject or patient.
A proper redirect would probably point out that I really don’t know what
the standard of informed consent is for clinical practice, as I’ve
already admitted.
BTW, an offer to provide temporary sunglasses does not address the risks
associated with driving while dilated. A frank statement like "You might
not see well while dilated, so operation of a car might prove hazardous.
Sunglasses will reduce, but not eliminate, this hazard" is more on
target.
My informed consent forms, and the process by which I solicit signatures
on them, are reviewed in detail by a committee before I am allowed to
show them to a subject. After having about a dozen or so of these forms
reviewed by this committee and returned for revision, I tend to look at
informed consent forms as if I were sitting on such a review committee.
While certainly carrying legal ramifications, informed consent carries
ethical responsibilities as well, and goes a little further than "cover
your ass"
—
Scott
Reverse first field of address to reply
>I bought a little handheld digital camera last week. It came with a
>little 60 page booklet. No, that wasn’t the instruction manual, it was
>the safety guidelines! Now, it was really just 15 pages, printed in four
>languages, but still, how ridiculous!
Dan,
Is the world of "cover your ass" wonderful?
I keep a lawyer on retainer 
now just for those reasons.. and in this sue happy society we live in who could
blame them for having 60 pages of telling you things that common sense should
already keep you from doing it..but regardless I still bet even with the
booklet someone is going to do what they said not to do and still try to sue
them… shoot someone is trying to sue McDonalds because the fast food made
them fat? COME ON….
I have been dragged into a few lawsuites over the years, namely the person
has a "problem" with the Doc, but some fantatic lawyer figures if they sue
everyone, the practice, the lab the lens manufacturer and everyone they can
think of they will make more money… so far all of them (4 times) was thrown
out as crap suites but I still was out around $2,000 every time in "lawyer" and
paralegal fees and on and on not counting my yearly retainer fee….
Most people think.. oh well they are wasting their time filing something so
stupid, but it STILL costs the person money to fight it even if it is thrown
out ..
Sometimes even have seen where they (the lawyer) told us just offer this
guy a token payment it would be cheaper than going to court even though WE DID
NOTHING WRONG….
No wonder I’m selling out of optical.. let someone else put up with this
crap
Jeff "shoulda went to law school"
Specs31 wrote:
> NOTHING WRONG….
> No wonder I’m selling out of optical.. let someone else put up with this
> crap
> Jeff "shoulda went to law school"
Not too late. A friend did it when he was 40. He was too nice about
helping out his fellow lawyers at no charge and ultimately got eased out of
the partnership due to insufficient billed hours.
First a technical business executive, then a lawyer, now a high school
teacher. Wonder what he’ll do next…
–
Cheers,
Bev
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
"History I believe furnishes no example of a priest-ridden people
maintaining a free civil government."
– letter from Thomas Jefferson to Baron vonHumboldt, 1813
- Hide quoted text — Show quoted text -
> Of course, but not quite addressing the context of this thread. The
> poster questioned the value of informed consent, providing experience
> with this dilation form and the patients’ response to it as evidence
> supporting that argument. My counter-argument is that by research
> standards, the informed consent form for the dilated exam and especially
> the way the consent was solicited does not constitute informed consent,
> the point being that a proper informed consent provides a real service to
> a subject or patient.
> A proper redirect would probably point out that I really don’t know what
> the standard of informed consent is for clinical practice, as I’ve
> already admitted.
> BTW, an offer to provide temporary sunglasses does not address the risks
> associated with driving while dilated. A frank statement like "You might
> not see well while dilated, so operation of a car might prove hazardous.
> Sunglasses will reduce, but not eliminate, this hazard" is more on
> target.
You are correct. There are different standards for research purposes
as opposed to clinical practice. I’d like to state again that that is
not my form. It’s a form used in a collegues’ office. For the
record, I asked her how she came up with it, and she said her
brother-in-law, who is a health care law attorney made it. So, I’m
going to opperate on the assumption that it’s kosher.
Also, I did not post this thread to argue over the minutia of this
particular informed consent. The point I was trying to make is that
health care in this day and age, is a partnership between the doctor
and the patient. Unlike the old paternalistic days where the doctor’s
word was taken as the word of God, patients play a much more active
role in their care, and quite frankly, I think that this is a
desireable situation.
I don’t think that asking a patient to read a half page form is
unreasonable for routine eye care. If people aren’t willing to do
this simple one, are they willing to read over a much more in depth
informed consent document for lasik?
nipidoc
nipi…@ix.netcom.com (nipidoc) wrote in
news:7e9ca5fa.0210101811.627c68d7@posting.google.com:
- Hide quoted text — Show quoted text -
>> Of course, but not quite addressing the context of this thread. The
>> poster questioned the value of informed consent, providing experience
>> with this dilation form and the patients’ response to it as evidence
>> supporting that argument. My counter-argument is that by research
>> standards, the informed consent form for the dilated exam and
>> especially the way the consent was solicited does not constitute
>> informed consent, the point being that a proper informed consent
>> provides a real service to a subject or patient.
>> A proper redirect would probably point out that I really don’t know
>> what the standard of informed consent is for clinical practice, as
>> I’ve already admitted.
>> BTW, an offer to provide temporary sunglasses does not address the
>> risks associated with driving while dilated. A frank statement like
>> "You might not see well while dilated, so operation of a car might
>> prove hazardous. Sunglasses will reduce, but not eliminate, this
>> hazard" is more on target.
> You are correct. There are different standards for research purposes
> as opposed to clinical practice. I’d like to state again that that is
> not my form. It’s a form used in a collegues’ office. For the
> record, I asked her how she came up with it, and she said her
> brother-in-law, who is a health care law attorney made it. So, I’m
> going to opperate on the assumption that it’s kosher.
Actually, it seems like the standard for informed consent is pretty close
between the two environments. As a result of this thread, I’ve done a
small modicum of research, and have arrived at the following link that
you might find educational, especially if you go to the "Further Readings
Link" abd read the case studies:
http://eduserv.hscer.washington.edu/bioethics/resource/
Granted, this brief foray into the medical ethics literature clearly does
not constitute rigorous research, but it did substantiate and confirm
what I learned in my formal training of what constitutes informed
consent. Weight this info as you choose.
This paper is particularly interesting : Meisel A, Kuczewski M. Legal and
ethical myths about informed consent. Archives of Internal Medicine
1996;156(22):2521-6.
From this paper, which is in a very clinical and peer reviewed journal,
I’ve quoted out the following.
*******
MYTH 1: A SIGNED CONSENT FORM IS INFORMED CONSENT
Perhaps the most fundamental and pervasive myth about informed consent is
that informed consent has been obtained when a patient signs a consent
form. Nothing could be further from the truth, as many courts have
pointed out to physicians who were only too willing to believe this myth.
Consent forms are used as a matter of routine in both treatment and
research settings because many hospital administrators, physicians, and
their attorneys see these forms as providing protection against
liability, despite the fact that they actually provide little protection.
*********
> Also, I did not post this thread to argue over the minutia of this
> particular informed consent. The point I was trying to make is that
> health care in this day and age, is a partnership between the doctor
> and the patient. Unlike the old paternalistic days where the doctor’s
> word was taken as the word of God, patients play a much more active
> role in their care, and quite frankly, I think that this is a
> desireable situation.
It seemed to me as if you were instead calling attention to an
adversarial relationship between doctor and patient–patients don’t
understand because they didn’t read and/or comprehend a half page consent
form. I would expect any doctor of mine to be more of an advocate for
me. This is why I’m replying to this post–not because I’m concerned
that some patient might be hurt by a dilated exam. Perhaps I’m
misunderstanding, and you were merely expressing your doubt in the value
of the informed consent process. Well, perhaps I can restore your faith
by pointing out that the example you cited did not constitute proper
informed consent.
My position remains that if the doctor who this form belongs to would
have spent an extra two or three minutes with each patient explaining the
form, procedure, and risks to the patients, compliance would have been
higher, and all patients would have been more educated about the
procedure. I’m not insisting that I believe informed consent is
necessary for a dilated exam (this is a toss-up for me), but obviously
someone thought this consent form was necessary, and the person who
believes that this form stands alone as informed consent is likely wrong.
Also, I’m not arguing over the "minutia" of this particular informed
consent– I’m saying that the procedure used does not constitute informed
consent!
> I don’t think that asking a patient to read a half page form is
> unreasonable for routine eye care. If people aren’t willing to do
> this simple one, are they willing to read over a much more in depth
> informed consent document for lasik?
> nipidoc
This is exactly why a surgeon or qualified representative of the surgeon
should be spending a chunk of time going through the form with the
patient before cutting healthy cornea. If the person doing so does not
believe that the patient understands the form, signature should not be
solicited, and the procedure should not be done.
Glenn, if you’re still following– as a member of a patient advocacy
group, can you offer any insight?
–
Scott
Reverse first field of address to reply
On 11 Oct 2002 13:31:58 GMT, Scott Seidman
>big snip but worth going back to the thread and reading<
>This is exactly why a surgeon or qualified representative of the surgeon
>should be spending a chunk of time going through the form with the
>patient before cutting healthy cornea. If the person doing so does not
>believe that the patient understands the form, signature should not be
>solicited, and the procedure should not be done.
>Glenn, if you’re still following– as a member of a patient advocacy
>group, can you offer any insight?
>–
>Scott
A very informative and thought provoking post.
Informed consent starts with the first ad, continues through the
entire patient evaluation process, the signing of the document, and
the entire process of recovery. At every turn, the physician and
staff should be seeking to discover anything that may not provide the
patient what the patient wants, and that starts with finding out what
the patient wants.
What CRSQA attempts to do is provide a big objective hunk of informed
consent at our website. It may not be provided by a doctor, but it
does help a patient understand what s/he is getting into.
The document of informed consent is a very important piece of
information, but it is not the only piece of information.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
http://www.usaeyes.org
glenn.hag…@usaeyes.org
I am not a doctor.
Informed consent OR ‘What did the patient know and when did s/he know it?’.
I am so chagrined by this whole process. If there was a mistake to be made,
I made it. Not in a million years would I have consulted the internet with
all its ‘kooks’ for definitive medical information on something as serious as
eye surgery. I trusted no one but my OD of 13 years to steer me toward it or
away from it. I rarely used the computer at that time. Now I’m one of the
‘kooks’.
The informed consent form was presented as mere formality and I was given
). I signed. At
days to read it and ask questions. I remember telling the technician that I
didn’t have any questions because I really didn’t understand what all the
terms meant and there were so many pages it seemed kind of silly. I was told
everything under the sun has to be listed on an informed consent form but the
risk of complications is very rare. Good enough for me
home, I read the material, watched the video and fully understood the
complications as they were described. The video was especially encouraging.
My surgeon described ‘Healing Haze’ in such soothing tones I was actually
looking forward to it and a day or two down time! Reel me in. I fell for it
all. What an idiot.
Glenn Hagele – Council for Refractive Surgery Quality Assurance wrote:
- Hide quoted text — Show quoted text -
> On 11 Oct 2002 13:31:58 GMT, Scott Seidman
> >big snip but worth going back to the thread and reading<
> >This is exactly why a surgeon or qualified representative of the surgeon
> >should be spending a chunk of time going through the form with the
> >patient before cutting healthy cornea. If the person doing so does not
> >believe that the patient understands the form, signature should not be
> >solicited, and the procedure should not be done.
> >Glenn, if you’re still following– as a member of a patient advocacy
> >group, can you offer any insight?
> >–
> >Scott
> A very informative and thought provoking post.
> Informed consent starts with the first ad, continues through the
> entire patient evaluation process, the signing of the document, and
> the entire process of recovery. At every turn, the physician and
> staff should be seeking to discover anything that may not provide the
> patient what the patient wants, and that starts with finding out what
> the patient wants.
> What CRSQA attempts to do is provide a big objective hunk of informed
> consent at our website. It may not be provided by a doctor, but it
> does help a patient understand what s/he is getting into.
> The document of informed consent is a very important piece of
> information, but it is not the only piece of information.
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
> http://www.usaeyes.org
> glenn.hag…@usaeyes.org
> I am not a doctor.
- Hide quoted text — Show quoted text -
On Fri, 11 Oct 2002 12:10:14 -0400, Cindy <t…@voyager.net> wrote:
>Informed consent OR ‘What did the patient know and when did s/he know it?’.
>I am so chagrined by this whole process. If there was a mistake to be made,
>I made it. Not in a million years would I have consulted the internet with
>all its ‘kooks’ for definitive medical information on something as serious as
>eye surgery. I trusted no one but my OD of 13 years to steer me toward it or
>away from it. I rarely used the computer at that time. Now I’m one of the
>’kooks’.
>The informed consent form was presented as mere formality and I was given
). I signed. At
>days to read it and ask questions. I remember telling the technician that I
>didn’t have any questions because I really didn’t understand what all the
>terms meant and there were so many pages it seemed kind of silly. I was told
>everything under the sun has to be listed on an informed consent form but the
>risk of complications is very rare. Good enough for me
>home, I read the material, watched the video and fully understood the
>complications as they were described. The video was especially encouraging.
>My surgeon described ‘Healing Haze’ in such soothing tones I was actually
>looking forward to it and a day or two down time! Reel me in. I fell for it
>all. What an idiot.
A person is not an idiot when they expend reasonable effort to
understand their decision, as you did. Yes, you could have done more,
but everyone always could have done more. You acted appropriately and
reasonably and received a poor result.
The poor result was not caused by what you did or didn’t do to
understand refractive surgery.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
http://www.usaeyes.org
glenn.hag…@usaeyes.org
I am not a doctor.