To the Editor,
A soul can be sold for various prices. The Bible says Judas Iscariot with a kiss sold Jesus to the Pharisees for 30 pieces of silver. Checking the market today, silver was at $17 an ounce.

So, Judas sold his soul for about $500.

We ophthalmologists are a tougher bunch ... and more typically hold out for about $4,000 for our souls.

The speaker encouraged us to tell patients, "If you were my momma, of COURSE I'd tell you to get these lenses." "You've worked hard all your life for others, you DESERVE to do this for yourself." 
I saw a patient today for his three-month dilated check after his cataract surgeries. An 85-year-old in good health, certainly not the smartest patient I have ever seen, but ordinary enough. He was seeing OK, but I told him he would need a YAG at some point in the future. He told me he wouldn’t be able to ever have the YAG, because he had already gone through most of his savings. His wife had surgery prior to him, by another ophthalmologist, and her surgery had cost them about $4,500 up front in cash. He told me the surgeon had told them it cost that much because she “needed” special lens implants. Like most Midwesterners, they put great faith in their physicians, and they went along.

I have no doubt that is a slight mischaracterization of the premium lens consultation conversation, but it is the impression these simple people had when they left that office. I’m less certain an 85-year-old “needed” to spend the majority of her bank savings on a premium IOL.
They had left the first surgeon and come to me for the husband’s surgery because a friend told them I didn’t charge “extra.”

I use “premium” lenses when asked. I have great personal doubt that “premium” lenses are premium at all. There is little compelling evidence to support their superiority, and thousands of articles written on techniques to convince patients to opt to pay for them. It surprises me that something so very “premium” would be so very hard to sell. There are thousands of other articles on how to handle patient dissatisfaction after they receive the lenses. Odd, that a “premium” product could have such questionable outcomes. I have no doubt my patient’s prior surgeon feels very sure in his heart the “premium” lenses are better. 

I have no doubt they are better ... for him.

I went to an all-expenses paid marketing event last winter for premium lenses. The speaker encouraged us to tell patients, “If you were my momma, of COURSE I’d tell you to get these lenses.” “You’ve worked hard all your life for others, you DESERVE to do this for yourself.”
And for him.

So, the marketing of premium lenses has been vastly forward of any scientific demonstration that they are better in outcomes. And now, with equal aggression, our magazines and journals are filled with the “talking heads” of ophthalmic surgery pushing femtosecond laser, far in advance of any evidence of its superiority. Because it is the “new paradigm,” because it is billable, because it is good ... good, for the companies that manufacture them, and for the surgeons who charge for them.


Judas used his money to buy a potter’s field. I intend to use mine for a Ferrari.

And this is how a profession sells its soul.

Mark Johnson MD, FACS
Venice, Fla.