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Patient feedback will help guide surgeons to preferred treatment options for presbyopia
WAIKOLOA, Hawaii — The abundance of elective options now available for presbyopia necessitates a new model of ascertaining which surgical approach is best for each patient.
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Rather than the information flowing from the surgeon to the patient so that the patient can decide, the reverse now must occur, according to Frank A. Bucci Jr., MD, who spoke at Hawaiian Eye 2008. Dr. Bucci was named "Speaker of the Day" yesterday for his talk on how surgeons can tailor the preoperative interview for presbyopic IOL candidates.
"In this new paradigm of elective surgery, the quality of the preoperative decision making is directly related to, and dependent upon, the amount of information moving, not from the practice to the patient, but on the amount of valuable information moving from the patient to the doctor," Dr. Bucci said.
This requires surgeons to educate themselves about who the patient is and what he or she hopes to achieve from the surgery.
Dr. Bucci said he relies on what he terms his "three core questions" to distinguish between patients who merely want their cataracts removed and those who do not yet have cataracts, but who are seeking spectacle independence and might be candidates for presbyopia-correcting IOLs.
These include: asking patients if they have interest in achieving spectacle independence, if they would be willing to tolerate some light phenomena while driving at night to achieve this and if they would be willing to pay out of pocket for it.
Based on the answers, Dr. Bucci decides if they would readily embrace the idea of a presbyopia-correcting lens.
For emmetropic patients who do not yet have a cataract, the issue becomes whether they will have LASIK or refractive lens exchange, he said.
"To make that distinction, I raise what I call one fundamental question: 'If we use custom LASIK to give you excellent distance vision, and all you need is reading glasses after surgery, will that make you happy?'" he said.
If the answer is not definitive either way, the surgeon should present a balanced case about refractive lensectomy vs. LASIK.
"Watch their reaction; they will lead you. You then lead them in a very biased, unbalanced way toward the procedure they informed you is best," he said.
The "single most correlating factor with success postoperatively" is how badly patients want to be free of their reading glasses, he said.
Dr. Bucci stressed that the information must flow from the patient, and not the other way around.
"Do not manipulate a 'yes' from the patient — you'll get burned," he said.