‘Road’ to satisfying presbyopia surgery includes six stops, surgeon says

Surgeon outlines the necessary steps that physicians, their staff and patients should follow before the procedure to help make the ‘journey’ as smooth as possible.

SAN DIEGO – Considering presbyopia-correcting IOL surgery to be a six-step process that involves all aspects of treatment could help with overall patient satisfaction, a surgeon said here.

Stephen S. Lane, MD, spoke at a symposium on the fundamentals of presbyopia-correcting IOLs during the American Society of Cataract and Refractive Surgery meeting. He outlined what he called the “journey of the patient” as a six-stop process. By viewing the preoperative process of preparing a patient for surgery as stops along the “road” of the patient’s surgical “journey,” surgeons can often achieve better overall patient satisfaction postoperatively, Dr. Lane said.

“There are these stops along the road: 1) change the physician mindset; 2) educate your staff and develop the process; 3) educate your patients even before they come in to see the physician; 4) technical assessment of the patients’ physical candidacy and examination of personal vision preferences; 5) the surgeon’s exam and discussion of options; 6) finally, the direct hand-off to the scheduler/counselor,” he said.

Stop one: Physician mindset

Surgeons must be willing to accept and embrace change in their practice model, Dr. Lane said. Surgeons must switch from the Medicare model of treatment, which consists of high volume, high efficiency and low cost, to the patient model, which emphasizes high quality of personalized care that aims to meet patients’ expectations.

“The mindset of the presbyopic refractive patient is different from the traditional patient with cataracts,” he said. “They’re interested in lifestyle, not in the pathology. They’re happy to pay for an enhanced quality of life.”

Stephen S. Lane

An important shift should occur in the doctor-patient relationship, with the surgeon committing to delivering the best individualized treatment possible. This should start in the waiting room, Dr. Lane said.

“You need to create an office environment that exudes comfort and professionalism, where the patient hopes that they’re a candidate for some of these procedures as soon as they walk in,” he said. “This can be something as simple as the furniture, the art hanging on the wall and the magazines that you have on your shelves. Every patient who comes through your office should know that you perform IOL refractive surgery.”

The optimal office environment is uncluttered and stylish, he said. Small details, such as reading material in the waiting room, can be important, and internal marketing should begin in the waiting room. Wall art testimonials, “brag books” with successful cases and practice brochures should be posted throughout the office, so patients can learn about the practice before even entering the examination room. Dr. Lane said the overall impression created by these details is an invaluable marketing tool.

Stop two: Educate staff

The only way for an office to run efficiently is if every employee has a clear understanding of his or her role, said Dr. Lane, whose office has a flow sheet to prevent confusion among staff. By having the process written out, staff members know what their next step is or what they need to do.

Staff activities should be monitored to ensure that employees are performing tasks as needed, he said.

“You should develop a field guide, if you will, for your staff,” Dr. Lane said. “You have to talk to your staff and make sure the education is spread throughout every division, from your office to the front desk all the way to the back office. You should require that each of your staff members understands and is able to perform what their specific role is and understand what the process is, making this as smooth and seamless as possible.”

Stop three: Educate patients

Surgeons should send out brochures to patients before their first appointment to begin the education process and reduce the “shock factor” of various facets of the procedure, Dr. Lane said.

He also recommends providing the address of the practice Web site, which should include information about lenses and surgery.

Once patients enter the office, the front desk should provide them with a vision requirements survey so the patients can show what kind of visual outcome they desire before even entering the examination room, he said. Such surveys can assist in measuring a patient’s personality, desire and candidacy for the procedure.

Stop four: Technical assessment

The technician should assess a patient’s physical candidacy by collecting information such as lens measurements, amount of corneal cylinder, biometry and IOL calculation, Dr. Lane said.

Technicians should also test, in more detail than the preop survey, for patients’ personal vision preferences, he said. Staff should determine what is most important to patients, including if they want sharp vision at distance, intermediate or near, or if driving at night is important.

“All of this is information that should be passed onto the surgeon, and we can streamline our visit with the patient based on good information that we get along the way,” Dr. Lane said.

He also suggested the use of the IOL Counselor (Patient Education Concepts), which includes surgical and refractive error animations that can assist patients in understanding IOL implantation and final outcomes.

Stop five: Surgeon exam

Surgeons must be up-to-date on the latest IOL technology, Dr. Lane said. They need to know to what degree patients want to be spectacle-free and should be concerned about astigmatism and contrast sensitivity issues.

He also suggested that physicians speak to patients at length about the different lens options, including the mixing and matching of different lenses, and recommend the procedure that they think would work best, based upon the patients’ specific needs and desires.

“You have to provide specific lens recommendations based upon your interaction with the patients,” Dr. Lane said. “The patients want to know what you would do, and if you leave it too open-ended, the options can be confusing. So what you do is you introduce things, such as, ‘I would recommend this individual lens because you told me this is what you want, and this lens performs in this way.’”

He said the surgeon’s time with the patient is important because more chair time before surgery helps ease patient expectations, whereas chair time after the surgery places the patient and surgeon on the defensive because of possible complications.

“The more chair time you spend before surgery, the less you will spend after surgery,” he said.

Stop six: Office scheduler

Finally, “scheduling, finalizing and reassuring” the patient is the key last stop, Dr. Lane said. In a streamlined fashion, the surgeon should direct the patient to the office counselor or scheduler to arrange the day of surgery and lens that will be implanted. Schedulers and counselors should be clear on payment matters at this time, he said.

“You need to have finance plans available so that options exist that make it easy for your patients to have the surgery they desire,” Dr. Lane said. “Your process should not become one of the patient’s problems. This portion needs to flow quickly and easily.

“By following these steps, the transition to making lifestyle IOLs a significant part of your practice will be eased.”

For more information:

• Stephen S. Lane, MD, can be reached at 2950 Curve Crest Blvd., Stillwater, MN 55082; 651-275-3000; fax: 651-275-3099; e-mail: sslane@associatedeyecare.com.

• Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.