consent for cataract surgery

The consent is of course the most important part of the pre-operative visit -- especially if things go wrong later.   consents can be tricky as different patients want different levels of detail.   the consent

for cataract surgery has also gotten a bit trickier as toric and presbyopic IOLs have entered our practice.   here i'm going to briefly focus on the essentials for consenting patients for cataract surgery.

5 essential parts of a consent

• identify yourself and your role in the surgery
• describe the two options – cataract surgery or hold off on cataract surgery
• describe the procedure briefly
• 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(w/RB), cut, and possible stitches in your discussion
• no we don’t use the laser (much confusion about Yag 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 % better than 20/40 
• 96 % better vision than pre-op
• I lower these percents with increasing retinal or optic nerve disease

Risks:

• 1% vision worse than pre-op
• death (<1:100>
• loss of eye (<1:10>
• irregular pupil (1:100)
• after cataract (1:20 requiring laser in 2 years with sa60/ma60)

Document

• Functional visual disability, give examples
• Complete consent form legibly
• In pts 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”