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Redefining perfect vision benefits patients and surgeons
Testing LASIK patients beyond 20/20 shows that their surgery was a success, making them more likely to share their good experience with family and friends.
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Dutch ophthalmologist Herman Snellen developed the famous chart with 11 lines of block letters in 1862, and while it has been modified some over time, it has been the standard for measurement of visual acuity ever since. Line six was originally defined to represent the size of a letter the average person could read from a distance of 20 feet. Over time, this mark of average visual acuity has become known as “perfect vision.”
Aggressive testing
In 2008, Steven Schallhorn, MD, and colleagues published a report showing that 88% of patients achieve 20/16 or better at 3 months after LASIK surgery performed with the CustomVue LASIK platform (Abbott Medical Optics). When I reached out to Schallhorn to find out how he was getting such great results with the same system I was using, it became clear that he had instituted a whole new way of testing vision.
Louis E. Probst
To demonstrate results better than 20/20, patients have to be tested beyond 20/20. New visual acuity charts use LED or LCD lighting, providing crisp images that are far more precise and allow a more accurate reflection of visual acuity. The first step to pushing patients beyond 20/20 is to remove the disadvantage of old visual acuity charts that may be dim, out of focus or have dust on the mirrors. Newer charts give patients a much better chance of an accurate visual acuity test.
The most important step is to push patients to see just how far down the chart they can read. I start patients at 20/80, then move down to 20/60 and gently work down to 20/20. I make it clear that patients have read the 20/20 line, their vision is excellent, and their LASIK surgery was a success. I refer to the additional testing as a bonus, that they may see better than 20/20, and anything beyond 20/20 is a perquisite. Once I started pushing patients to their best visual acuity in 2009, 92.8% of 11,724 LASIK patients with CustomVue had 20/20 or better uncorrected visual acuity and 34.8% had 20/15 or better UCVA.
Since acquiring the iFS laser (AMO), 98.9% of 94 patients achieved 20/20 or better, 95.7% achieved 20/16 or better, 51.1% achieved 20/12.5 or better, and 9.6% achieved 20/10 or better UCVA.
Patient satisfaction
Because our society has latched on to the concept of 20/20 equals perfect vision, patients who achieve 20/20 are often satisfied. They feel relief that their money was well spent and their procedure was a success. However, we have all had patients who are 20/20 after LASIK and are disappointed. They feel their vision is just not as crisp and give vague comments about the quality of their vision. I believe this is likely due to the fact that their vision before surgery was better than 20/20. In aggressive preoperative testing, 77.7% of 94 patients had 20/16 or better best corrected visual acuity and 20.2% had 20/12.5 or better BCVA. If a patient was able to see 20/16 corrected before LASIK surgery, it becomes understandable why 20/20 may not feel so perfect to them.
Data show that among patients who achieved 20/16 UCVA, merely 0.7% of 38,520 patients were dissatisfied with their vision, and 1.6% of patients who achieved 20/20 UCVA expressed dissatisfaction (Figure 1). While the majority of patients who achieved 20/20 are happy, patients who obtain 20/16 or 20/12 feel that they are special, their vision is better than most, and they are so enthusiastic they often become ambassadors for your practice. The patients who now have 20/16 vision feel like a superhero and are ready to share their great experience with all of their friends and family.
A solid patient base and an excellent reputation are keys to growing a practice. Direct-to-consumer marketing can cost as much as $400 to $500 per patient, and many practices have determined that the return on investment is not worth it. The least expensive form of marketing is patient referrals, and ensuring that your patients are overjoyed with their results is the best way to make them want to tell every person they know where they had LASIK surgery. An analysis of more than 200,000 patients at Optical Express showed that those most likely to accept the invitation to become an ambassador were patients with the highest UCVA outcomes. The analysis also showed that patients who recorded higher perceived levels of care by the surgeon and those who paid slightly less were also more likely to recommend the surgeon to other people. This is a compelling reason to change how you test and report visual acuity scores.
Perception matters
I believe that the statement “going to reduce dependence on contacts and glasses” is fine for a consent form, but my patients come to me expecting to see better than they ever have. We are delivering that to the majority of patients. By testing them beyond 20/20, patients’ impression that their vision is great after surgery is verified and quantified. The bottom line is that a lot of our patient satisfaction and professional success comes down to perception, and we are selling ourselves short by not telling our patients just how well they can see.