In reading the article on cataract surgery and consent, I was amazed by what appears to be a serious omission.1 In this review of 23 331 patients referred by outside physicians to what is apparently a central cataract clinic at Princess Alexandra Eye Pavilion in Edinburgh, Scotland, the authors note that patients are “initially assessed by nursing staff, who perform biometry, assess suitability for day-case surgery, explain what happens the day of surgery, and read through the standardized consent and information form with patients. Patients then see a doctor who again reviews the procedure and consent form with the patients, addresses specific questions, and obtains informed consent. Most patients have their procedure within 2 months of an appointment at the preassessment clinic.”
While the article seemed to be well grounded in consent evaluation, at the conclusion, I noted there was something missing and I searched to find whether the operating ophthalmologist (or any ophthalmologist) at the surgical clinic did a personal medical evaluation of the patient. I found none. I consider this to be a rather glaring oversight, considering that I personally find, and other ophthalmologists have also noted, that many patients referred for cataract surgery have, on ophthalmologic examination including careful refraction, contraindications to surgery. This is based on significant improvement in visual acuity obtained with glasses, refraction, or other ocular pathology rendering cataract surgery not indicated.
I am concerned that in this National Health Service system, there are shortcuts that may impair proper evaluation of indications for cataract surgery.
Harold J. Goldfarb MD
Allentown, Pennsylvania, USA
1. Vallance JH, Ahmed M, Dhillon B. Cataract surgery and consent: recall, anxiety and attitude toward trainee surgeons preoperatively and postoperatively. J Cataract Refract Surg 2004; 30:1479-1485