|Articles|April 11, 2015

Dysfunctional lens syndrome paradox

In his latest blog, Mark Packer, MD, FACS, CPI, defends why doctors should not allow the restrictions of third party payers on reimbursement for cataract surgery to drive your diagnosis or your recommendations for treatment, as diagnosis and treatment must remain the surgeon’s sole responsibility if our profession is to retain any of its natural inherent authority.

Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Mark Packer, MD, FACS, CPI. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Advanstar.

 

The most important question I ask a new patient is this:

“Are you here because you’d like to be able to see just as well without glasses or contact lenses as you do with them, or are you here because the quality of your vision-even with the best glasses or contact lenses-is not satisfactory for performing your activities?” 

Blog: Give your staff more field trips

The answer to this question effectively divides those desiring a solely refractive solution from those suffering from decreased functional vision. Of course, the latter may also desire a refractive solution in addition to correction of their diminished function, but their complaint is primarily functional.  In practice, this distinction really matters because it cuts to the heart of our individual customer’s most basic needs and desires.       

Recently, the term dysfunctional lens syndrome (DLS) has been advocated to describe decreased functional vision related to the effects of increasing optical aberrations, as well as subtle age-related opacification of the lens.  DLS has also been defined to include presbyopia, and thus it links what is essentially a refractive condition to a decline in functional vision.  However, while some patients with cataract or DLS may also desire a refractive solution to reduce their dependence on glasses, those who in fact see fine with glasses or contacts, but don’t want to wear them any longer, have purely refractive complaints.  Even in this new hybrid diagnostic category, a distinction between the functional and the refractive applies.

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