Net value of multifocal IOL outweighs that of conventional monofocal IOL

[matt_ret_d_vitrectomy]

I saw this abstract
Net value of multifocal IOL outweighs that of conventional monofocal IOL
J Cataract Refract Surg. 2008;34(11):1855-1861
at
http://www.jcrsjournal.org/issues/contents?issue_key=S0886-3350(08)X0010-0

Reportedly, this study included " 495 patients — 339 with a multifocal IOL (AcrySof model MA60D3 or SA60D3, Alcon) and 156 with a monofocal lens (AcrySof model MA60BM, Alcon). "  These are ReStor lense, I think.

I am curious, but without access to the full article:  Was the findings that patients really feel they got $11,000 worth of benefit from these multifocal lenses (vs a value of onlyh $155 for monofocal lenses), or is this study merely are report of what patients would be "willing to pay" to be spectacle free?    Not sure if the patients felt that these lenses delivered that "value" or not

[Lerbea]

What most everything boils down to is the almighty $$$. I know one manufacturer/researcher fled to Europe years ago and is still publishing articles saying the FDA was critical of him and his product. He is Charles Homsey if anyone wants to look up info.  It was TMJ related. He pushed his mighty invention on all the European nations.

Oh well off subject.

[JodieJ]

I certainly wouldn't want to make a sweeping statement concerning all physicians.  I'd assume that Ph.D students in the sciences generally have more interest in conducting research, whereas medical students are more interested in doing clinical work.

I do strongly agree with the second paragraph of your post (above).  It's my understanding that the use of (potentially dangerous) hormone replacement therapy by thousands of women was based on seriously flawed research conducted by the manufacturer of the medication.  It amazes me that the physicians who prescibed the stuff for years never took a good look at the basis for this treatment.

  

[John C Hagan III, MD, FACS, FAAO]

Kg 17 thanks for the comments. For the record I disagree with you.

JCH MD

[kg17]

I have been quite dismayed at physicians' general lack of ability to objectively and critically assess the medical/scientific literature (actually, it's been my experience that most doctors don't even read their own medical journals).  I taught statistics and research methodology for years, and one observation I made was that, generally speaking, students in the basic sciences were eager to learn how to critically conduct and analyze research, whereas students in clinical fields were quick to give a "yawn" to this type of information.

I do believe that med schools really need to better incorporate into programs of study knowledge of research design, bias, and critical thinking skills as it pertains to the medical literature.  That way, a doctor can know how to look at a study with "a grain of salt" when the occasion calls for it (if he/she can be convinced to read the medical literature in the first place).

[John C Hagan III, MD, FACS, FAAO]

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[walkietalkie]

Healthcare is a commodity like any other business. It’s a multi-billion dollar industry.

‘Value’-added services certainly take on new meaning here.

[JodieJ]

This forum is one of the few places where a prospective patient can find unbiased opinions about the "premium" IOLs.  I'm continuously surprised by the extent to which corporate interests affect most other information sources.

[matt_ret_d_vitrectomy]

Thanks for your comments. I figured authors and articles could be quite biased by their sponsors, but I didn't realize that an entire "journal" distributed through one of the big scientific publishers would / could be.  It's hard work being an informed medical consumer!  Your continued posts on this forum make it muh easier though!

[John C Hagan III, MD, FACS, FAAO]

I think that particuliar journal is especially sensitive to manufacturer pressure.

In the early 80's I submitted a paper critical of the IOLAB 91Z Azar IOL.  The IOL company contacted the editor and he sat on the paper. Only when many many other surgeons identified the same problems did they publish the papers and gave me a one paragraph statement that I had indeed been the first to inform them of the problem.

In the mid 70's I proposed a public finanacial disclosure for all papers in that journal and all talks given at their meeting. they refused and were probably the last major journal to adopt a disclosure policy.

Other journals such as Archives of Ophthalmology, American Journal of Ophthalmology and "Ophthalmology" are not as susceptable to manufacturer's pressure.

JCH MD

[John C Hagan III, MD, FACS, FAAO]

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[JodieJ]

I've wondered why there are so few (actually, virtually no) published articles that are critical of the multifocals.  Yet the journals are filled with glowing reports of happy multifocal recipients who have thrown away their spectacles (all of which were written by researchers on the manufacturers' payroll).

[John C Hagan III, MD, FACS, FAAO]

This araticle states that it is worth $5.00/day or $1,825.00 per year to be free with glasses. Assuming a life expectancy of 10 years that $18,250.  More if the person lives longer.

I think the study is flawed and biased.

This is the same journal that refused to publish my article critical of the ReZoom IOL.

JCH MD

[John C Hagan III, MD, FACS, FAAO]

Accepted for publication July 7, 2008.
From California Eye Institute (Maxwell), Fresno, California; Alcon
Laboratories (Waycaster, Hileman), Fort Worth, Texas; and Xcenda
(Meissner, D’Souza), Palm Harbor, Florida, USA.
Dr. Maxwell served as a medical monitor for the clinical trial that
collected the willingness-to-pay data. Additionally, he is a paid consultant
to Alcon Laboratories. However, Dr. Maxwell was not directly
compensated for his participation in this manuscript nor
does he have a direct financial interest in the presented results.
Drs. Waycaster and Hileman are employees of Alcon Laboratories.
Drs. Meissner and D’Souza are employees of Xcenda, which provides
consulting services to Alcon Laboratories.
Presented at the 12th Annual International Meeting of the International
Society for Pharmacoeconomics and Outcomes Research,
Arlington, Virginia, USA, May 2007.
Supported by a grant from Alcon Laboratories, Inc., Fort Worth,
Texas, USA.
Corresponding author: Curtis Waycaster, PhD, 6201 South Freeway,
TC-41, Fort Worth, Texas 76134-2099, USA. E-mail: curtis.

[JodieJ]

I found the disclosure statement.  Yes indeed--Dr. Maxwell is a paid consultant to Alcon, and the study's other authors are all Alcon employees and/or consultants.  According to their findings, a remarkable 80% of the subjects receiving bilateral ReStors never wear glasses, and it's implied that they are all delighted with their vision.  This is SO much higher than the percentages I've seen elsewhere.  

[JodieJ]

I checked out the abstracts of the articles written by the first author, Dr. William A. Maxwell.  Given the topics chosen, the study's designs, and the statistics used,  I'd bet my next paycheck that Dr. Maxwell is a paid consultant for Alcon.  If this is indeed true, then Alcon is undoubtedly paying the doctor big bucks (probably more than six figures annually) to design and carry out research which will make their IOLs (especially the "premium" ones) look good.

If anyone can access the financial dislosure statement, please post the results.