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Incorporating presbyopia-correcting IOLs requires a different approach
The surgeon takes on the role of educator to both the patients and staff members.
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 Kerry D. Solomon |
Incorporating presbyopia-correcting IOL surgery into your practice requires procedures similar to those in a LASIK practice in that presbyopia-correcting IOL implantation is a premium procedure that requires extra consultation with patients.
When patients pay for this premium technology, they expect premium service in return, and that involves extensive training and consultation with the staff.
From my overall experience, incorporating presbyopia-correcting IOLs such as the AcrySof ReSTOR IOL (Alcon, Inc.) has been positive, and patients are happy with the results. These satisfied patients will help sell the product, and that is why excellent surgical skills and meticulous patient education are keys to success.
Overcoming challenges
As with any practice, several challenges exist in incorporating this new technology.
The majority of patients are unaware of their multifocal IOL options prior to their office visit. Patients must learn about basic cataract surgery in addition to learning about other treatment options.
To meet this challenge at the Storm Institute, we send brochures to patients prior to their initial visit so that they have ample time to review the procedure, to discuss it with family members and perhaps to realize their vision goals and expectations.
The second challenge is training the staff to shift out of their daily routines in dealing with general medical patients and to get them into an elective surgery mode similar to that in a LASIK practice. Teaching the staff how to communicate with patients is crucial. For many ophthalmologists in practice, the approach is familiar from experience with LASIK centers where the staff has one-on-one contact with patients in educating them on the procedure before seeing the doctor. The staff should familiarize patients with their options concerning cataract surgery, and the surgeon should then educate the patient on the risks and benefits of the available options. In addition, payment plans should be made available to patients to meet their financial needs, as is done in a LASIK practice.
Proper training is important, and the surgeon should be dedicated to training his or her staff members making them as knowledgeable as possible.
Ongoing training
To have a successful practice, the surgeon must play the role of educator to both patients and staff members. There needs to be a dialogue among all staff members, from the surgeons to the receptionists. The mechanisms of the IOLs should be explained to the staff members, highlighting the differences in multifocal IOL options, and their benefits, tradeoffs and technological issues.
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To develop his or her practice, the surgeon must be committed to the technology and convey that to his or her staff. As a result, the staff will have confidence when consulting with patients. Otherwise, patients will sense a lack of motivation and confidence in the staff member and in turn, may become wary of the technology itself.
Through proper training, staff members should feel comfortable educating patients about their options so that by the time patients see the surgeon, they already know their options and have established their goals and expectations.
A questionnaire should be given to patients so that they can assess their needs and desires specifically related to spectacle-independence. If a patient expresses no interest in becoming spectacle-independent, perhaps a multifocal IOL is not necessary. This should be determined before the surgeon meets the patient.
Accurate biometry and astigmatism management
To successfully incorporate IOL implantation into a practice, surgeons must adjust practice settings and be accurate in biometry and be aggressive with astigmatism treatment. Surgeons should get into the habit of routinely following outcomes closely. The surgeon should follow each patient closely.
I often repeat IOL calculations if there is any suspicion related to accuracy due to contact lenses or irregular symmetric caves. Additionally, it is important to optimize the ocular surface using artificial tears for dry eye.
Astigmatism management is critical. In the past, ophthalmologists believed that astigmatism <1 D was not visually significant. Today, less than 0.5 D is my goal.
In my practice, I treat even 0.75 D of astigmatism and, in some cases, 0.5 D, through placement of incision or limbal-relaxing incisions.
Meeting expectations
Determining the patients’ expectations through consultation and the questionnaire will result in better outcomes. I tell patients that these new IOLs can allow them to do most daily activities without being dependent on spectacles. However, I remind them they may need to fine tune their vision and wear low-powered spectacles for some activities such as driving at night, reading fine print or reading a computer screen.
Over time, patients will adapt to their new lenses, and the spectacles may not be necessary. However, it is important to remind patients that there is no absolute guarantee of 100% seamless vision like that of a young adult. This way, the surgeon can under promise and over deliver.
Overall, the surgeon must provide the staff with proper training and education because they present the technology to the patient.
It is the surgeon’s responsibility to commit to ongoing training to have a successful practice. Communication in the office and with the patients will facilitate the incorporation process.
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Dr. Solomon is the professor of ophthalmology at the Storm Eye Institute, medical director of the Magill Laser Center for Vision Correction and director of the Magill Research Center in Charleston, S.C. He was also a participant in the AcrySof ReSTOR IOL clinical studies and is a member of the Ocular Surgery News Editorial Board. He is a consultant for Alcon Laboratories, AMO, Allergan and Bausch and Lomb.