Sunday, September 18, 2005

Chapter 2 Preoperative Preparation - Consent

Consent
The Consent is the most important part of the pre-operative visit.

There are five essential parts of a consent:

  • identify yourself

  • describe all options - cataract surgery or hold off on cataract surgery

  • describe the procedure

  • describe potential risks - 1/100 chance vision will be worse after surgery

  • describe potential benefit - 9/10 chance vision will be normal with glasses following surgery

Talk your patient through the procedure briefly:

  • we replace your cloudy natural lens with a clear artificial lens

  • use the words: injection (with RB), cut, and possible stitches in your discussion

  • explain that we do not use the laser. (There is much confusion about Yag capsulotomy for secondary cataract)

  • we may patch your eye overnight following the surgery

  • we will prescribe new glasses when the eye is stable – 2-4 weeks post-op

Benefits:

  • 95% of patients are better than 20/40

  • 96% of patients are better vision than pre-op

  • I lower these percents with increasing retinal or optic nerve disease

Risks:

  • 1% vision worse than pre-op

  • death (loss of eye (irregular pupil (1:100)

  • posterior capsule opacity (PCO) cataract ( 1:20 requiring laser in 2 years with the Alcon SA60/MA60 intraocular lenses)

Document

  • Functional visual disability, give examples

  • Complete consent form legibly

  • In patient's chart write something like: “I discussed the risks and benefits of cataract surgery with Mr. Jones and his son in terms they seemed to understand. Mr. Jones expressed to me that he understood the small but real risk of surgery, including loss of vision as outlined in the consent form, and he decided to have surgery.”

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