AMA Journal of Ethics^®

This issue of Virtual Mentor explores some of the key ethical questions in ophthalmology that will impact patients and clinicians and engage ethicists today and for years to come as the field continues to advance. What are the responsibilities of ophthalmologists to patients, other practitioners, and society?

This month’s authors focus primarily on two dimensions of responsibility to the patient: resisting the lure of commercialism and going the extra mile to provide the best possible care. Resisting the influence of industry can be a significant challenge for ophthalmologists. Yvonne M. Buys, MD, professor in the University of Toronto Department of Ophthalmology and Visual Sciences and co-director of the Glaucoma Unit at the University Health Network, warns physicians of the prevalence of “spin” in industry-funded studies of new drugs and exhorts them to read articles in their entirety and consider the source in order to make more accurate judgments about which products will be most beneficial to patients. Steven R. Kaufman, MD, elucidates the potential conflict of interest created by the fee-for-service reimbursement system and manufacturer rebates that confronts physicians as they decide between treatments for age-related macular degeneration.

But good business and good ethics don’t have to be mutually exclusive, argues Penny A. Asbell, MD, MBA, professor of ophthalmology at Mount Sinai School of Medicine and director of its Cornea Service and Refractive Surgery Center. Her case commentary tackles the challenges ophthalmologists face in defending their practices from the encroachment of online contact lens purveyors and other practitioners; she advises physicians to focus on improving and expanding the services they provide to attract and retain patients. (An excerpt from the AMA Code of Medical Ethics covers the related topic of selling and dispensing drugs and other health-related products in the physician’s office.)

Thomas A. Oetting, MD, professor of clinical ophthalmology at the University of Iowa, also emphasizes the importance of going above and beyond to provide high-quality care in his case commentary about how residents can work to offset the elevated risk they bring to patient surgeries. Helping keep the physician informed about the latest developments in the care of the eye are Usha Rao, MD, senior resident in ophthalmology at Baylor College of Medicine, who provides an overview of the recent advances in understanding and treating glaucoma, and Michael Hughes, BCO, who introduces the reader to artificial eye makers—ocularists—and how they tailor their creations to the patient. Brad Feldman, deputy editor in chief of the American Academy of Ophthalmology’s EyeWiki online encyclopedia, explains this novel initiative’s contributions to ophthalmological education.

Ophthalmologists’ duties to society are explored in the health law and medicine and society sections. Paul Steinkuller, MD, of Baylor College of Medicine and Texas Children’s Hospital discusses the physician’s responsibility to impaired drivers to protect them and others on the road. Dr. Steinkuller cites and we reprint the AMA Code of Medical Ethics opinion on the physician’s duty to impaired drivers and society. Kiran Motaparthi, MD, from the department of dermatology at Baylor College of Medicine, raises questions about the social and ethical import of cosmetic blepharoplasty to alter the characteristically Asian eyelid.

Lastly, two commentators consider the ophthalmologists’ relationship with other practitioners. Andrew Lee, MD, professor and chair of the ophthalmology department at The Methodist Hospital, writes about the importance of respect and mutual consideration in the referral-consultant relationship. Kristin E. Schleiter, JD, LLM, state government affairs analyst for the American Academy of Pediatrics, gives a short history of the recent scope-of-practice struggles between ophthalmologists and optometrists in Oklahoma and West Virginia.

We hope readers leave the pages of this month’s Virtual Mentor with an enhanced appreciation of the art and science of ophthalmology and the ethical questions that accompany advances in the specialty.