1003: Why did the patient go elsewhere?

This video shows two complete surgeries, both presented at high speed. The original cataract surgery was performed by me and it is shown at 3x speed, followed by the IOL exchange surgery by an anonymous surgeon which is shown at 10x speed. But the real learning in this video is the audio where I explain the clinical situation and we discuss why the patient felt the need to go elsewhere.

When I performed the cataract surgery, I aimed for perfection. The IOL calculations were spot-on accurate and I even shifted the incision to the 90 degree meridian and paired it with an opposite limbal relaxing incision to address the 0.65 diopters of corneal astigmatism. This resulted in a plano refraction and vision of 20/20 distance and J1 near with the trifocal IOL.

The patient, however, felt that the IOL was causing him headaches which I attributed to the anisometropia and difference between the two eyes. I encouraged him to perform cataract surgery in his second eye, but he hesitated. The patient sought the opinion from other ophthalmologists in the community, the last one advising to perform an IOL exchange.

It is important to cooperate and help the other ophthalmologists who are seeing this patient. I provided a full set of all of my records and I even forwarded surgical footage of the original cataract surgery that I performed. It is your duty to do what is best for the patient and that means supporting his desire for other opinions. Help your colleagues and provide all requested information in a timely manner.

So how did the patient do? And did his headaches resolve? Time will tell…


  1. If a patient visits enough doctors, she will eventually get the answer that she likes. We are only here to serve.

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