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Baby boomers are strongest 'constituents' for RLE
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WAIKOLOA, Hawaii — Surgeons should consider incorporating refractive lens exchange into their practices as a means of growing their presbyopia-correcting IOL business, according to one cataract and refractive surgeon.
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Speaking at Subspecialty Saturday, which precedes Hawaiian Eye 2008, Jason E. Stahl, MD, explained how his practice has positioned refractive lens exchange (RLE) as a "four-in-one procedure" to patients of the baby boomer generation.
RLE offers this patient group these four benefits: it provides excellent distance vision as well as excellent near vision, eliminates the need for future cataract surgery and provides visual stability, because the IOL will not age like the natural crystalline lens, he said.
"There is a small percentage of these patients who are true Medicare insurance cataract [patients], but our real constituents are baby boomers," Dr. Stahl said.
These patients have active lifestyles, are invested in improving their quality of life and do not want to follow in their parents' footsteps by waiting until they have experienced a decline in vision to have cataract surgery, he said.
Dr. Stahl stressed that proper patient education is essential to determining the best candidates for RLE.
"Patients need to understand why lens surgery is the best surgery [option] for them, what emmetropia is, what accommodation is and why they're losing it," he said.
Upon understanding these concepts, patients are in a better position to decide which presbyopia-correcting strategy would be best for them. Surgeons can incorporate interactive educational tools and anatomical images of the eye to help patients understand how even "small amounts of nuclear sclerosis can impact their quality of vision," he said.
Taking into consideration patients' ocular health, as well as their lifestyle and hobbies, is also paramount to success with presbyopia-correcting IOLs, Dr. Stahl said.
"Ocular health is important because not all patients are going to be good candidates for these presbyopic IOLs," he said.
For instance, Dr. Stahl said he would not recommend multifocal IOLs for patients with moderate to severe dry eye, Fuch's dystrophy, significant corneal scarring, pseudoexfoliation syndrome, or those with surgically induced higher-order aberrations.
In terms of which IOL combination he would choose, Dr. Stahl said he likes to "combine the strengths of different lenses" to get the best range of near and intermediate vision.
An essential part of patient education is the management of expectations, he added. Having an honest discussion about the possibility that they might still need correction in some instances, and that they might experience halos or other effects, is critical to fostering a positive experience.
"Tell them, 'I can't guarantee you'll be spectacle-free at all distances,'" he said.