[The importance of informed consent in the field of ophthalmology]

Ocular diseases have some characteristics that are different from diseases of other organs. First, patients clearly can judge for themselves whether or not they can see better postoperatively. Second, because several parameters such as visual acuity and intraocular pressure, are obtained from patients, patient's families and others can objectively judge the post-treatment status. Therefore, clinical information is easily available to others besides the physician. Third, except for acute ocular diseases such as retinal detachment, acute glaucoma, and ocular trauma that easily can result in blindness, ophthalmologists usually treat eyes that will maintain a certain visual acuity level. These are the primary reasons why patients and families complain about unfavorable post-treatment subjective symptoms. Because of these three characteristics of ocular disease, informed consent (IC) is extremely important in the field of ophthalmology. I studied ophthalmology and IC at Harvard Medical School, Boston, from 1980 to 1983, and again in 1989. Strict IC is mandatory in the United States. However, the concept of IC in the US cannot always be adapted to fit Japanese culture. The different legal concepts of IC in the two countries are discussed in this paper. Since I returned to Japan, our Department of Ophthalmology incorporated several new concepts into our clinical practice. For example, we now broadcast live surgeries of patients with severe proliferative diabetic retinopathy by closed-circuit TV to their families in the hospital. This has fostered great communication and confidence among patients, their families, and doctors. In 1994, we also began inter-hospital and international IC via telemedicine and telescience. The video conferencing system VisionSeries (Panasonic Broadcast and Television System Company) is used to communicate between Asahikawa Medical University and 10 branch hospitals. INS net 1500 or INS net 64 (3 lines) transmits full-motion (30 frames/second) color fundus images and biomicroscopic images. Ocular surgeries performed by ophthalmologists using operating microscopes at each branch hospital also are transmitted to Asahikawa Medical University to facilitate consultation with more experienced ophthalmologists. The transmitted images of the fundus and biomicroscopic findings are satisfactory, and they allow surgeons to conduct useful discussions among themselves and with the family members during the surgeries in real time. When the patients' families are in local cities, surgeons can transmit the operations via the telemedicine system link to the nearby hospital, and the ophthalmologists there can narrate the surgeries in real time. On November 14, 1996, our technology was used internationally for the first time to transmit ocular images and live ocular surgeries between Asahikawa Medical University, Japan, and the Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA. Telemedicine and telesurgery will be useful scientific tools in the field of Ophthalmology in the near future. We believe that this technology literally opens up the world to scientific and medical collaboration. Patients with vision deficiencies and blinding disease are certain to be the ultimate beneficiaries of these interactions. Lastly, ideal implementation of IC in the field of Ophthalmology are discussed in this paper.