Premier Surgeon: Increasing conversion rates for premium IOLs

Using a practice-wide approach to patient lens education, surgeons can experience an increase in premium IOL requests.

Current-day multifocal lenses offer many new benefits for patients, such as excellent image quality in all lighting conditions and less dependence on glasses. Patients are highly satisfied with their visual outcomes, and the resulting happy referrals can help build the practice.

Surgeons also experience the dual benefit of treating the pathology while providing an opportunity for potential freedom from glasses. A practice-wide team approach is effective to increase the adoption rate for this underutilized technology.

Surgeon and patient factors

The underutilization of multifocal lenses is multipronged. Three of the major factors are surgeons who are fearful of multifocal technology, surgeons who are not cataract refractive surgeons and patients’ financial constraints in the current economic times.

Elizabeth A. Davis, MD, FACS, emphasizes educating patients early and often about premium lenses to allow plenty of time for discussion. Image: Shari Fleming Photography

Some surgeons still harbor concerns about side effects such as glare and halo that occurred with previous multifocal technology. These surgeons do not appreciate the significant improvements and the reduced side effect profile of current-day multifocal technology, such as the Tecnis multifocal (Abbott Medical Optics). This is my primary presbyopia-correcting lens, and I have not yet had to remove a lens for glare or halo issues. The predictability of the lens is excellent and the performance is equal to the typical Tecnis monofocal three-piece lens.

Cataract surgeons who are not refractive surgeons are often uncomfortable with the patient-surgeon conversations regarding the opportunity to reduce dependence on glasses and contact lenses, as well as the added out-of-pocket expense with multifocals. Also, their offices typically are not set up to evaluate and counsel patients effectively for multifocal lens procedures. On the other hand, laser vision correction surgeons have the confidence that they can achieve optimal refractive visual results even if an enhancement is needed to treat residual refractive error or astigmatism.

Patients’ monetary concerns also contribute to the underutilization of multifocal lenses. Often patients express interest in the technology but shy away due to concerns over the cost. Other patients recognize that this is an important quality-of-life issue with a limited window of opportunity. Conversion will most likely increase once the economy recovers. In addition, as more advanced lens technology becomes available in the future, non-refractive cataract surgeons will likely receive increasing patient requests for presbyopic lenses.

Increasing conversion rates

Our practice has been working to increase multifocal lens technology offerings to patients, and we have discovered that a practice-wide effort is most effective. The multifocal lens conversation can start with the referring optometrist, who introduces the fact that the patient has a choice concerning lenses. This initial conversation gets patients familiar with the premium lens concept so they can start thinking about their visual needs. When the patient calls to make the appointment with the cataract refractive surgeon, a counselor speaks to them regarding the procedure and then sends a packet of information regarding lens options and vision correction to their home.

Patients come to their surgical consultation educated about their options, the benefits, potential side effects and additional cost. They can focus on asking the surgeon any specific questions they might have regarding their visual needs. Finally, the counselor schedules the patient for surgery and completes the discussion. This approach, in which the entire practice is involved in appropriate counseling of patients, reduces the amount of time the surgeon must take to educate patients about lens options.

Patient education about multifocal lenses is an evolving learning process for surgeons and staff. For example, we have introduced some concepts to the patient using an iPad. While patients are waiting to see the surgeon, they may be given an iPad with videos that go through information on lens options and vision correction. The more ways — paper, video, personal interaction, etc. — used to discuss the issue, the easier it is for the surgeon to educate and counsel patients effectively without excessive chair time. This approach requires effort to educate the staff and referring doctors so the practice can work as a team, but it is worth it.

Functional vision

In our practice, we discuss the concept of functional vision and visual outcomes in simple terms. We break it down to three levels when we ask patients:

• Would you be satisfied staying in your bifocals?
• Would you like to see in the distance without glasses (and wear reading glasses for near vision)?
• Would you like to reduce dependence on glasses for both distance and near?

A discussion centering on functional vision in terms of activities with and without glasses makes sense to patients. Most importantly, they want to know their expected visual outcome. Based on the exam, the patient’s needs and the details of the specific case, the surgeon decides which tools (including preoperative and intraoperative diagnostics, as well as the type of lenses) will be used at the time of surgery to achieve the desired outcome. While the surgeon has a multitude of options with regard to machines and procedures, that information is often too overwhelming for the patient to digest. Instead, the focused conversation on functional vision with the three options is easiest for the staff and patients to discuss.

Early and often

Providing patients with information and counseling early in the process allows them to have more time to consider the information, discuss their options with family members, formulate questions and make their decision. Even though they might not have heard about their multifocal lens options before, patients who hear the message from several people — including their long-time family eye doctor, the optometrist, counselors and surgeon — become familiarized with the concept more readily. That is why it is so important to have the entire staff on board for the educational process. Remember, though, to keep it simple for both the staff and patients. If you do, patients will leave having had a satisfying experience that meets their desired visual outcome.

• Elizabeth A. Davis MD, FACS, can be reached at Minnesota Eye Consultants, 9801 Dupont Ave. South, Bloomington, MN 55431; 952-567-6067; email: eadavis@mneye.com.
• Disclosure: Dr. Davis is a paid consultant to Abbott Medical Optics.