Client income level no barrier to premium IOL conversion

High-volume surgeon implants premium IOLs, including new extended depth of focus lenses, in patients with a range of financial options.

Issue: February 10, 2017

For Pulin A. Shah, MD, discussing the cost of premium IOLs with patients who do not have a lot of disposable income is far from complicated.

Shah is a high-volume cataract, refractive and cornea surgeon at the Ochsner Medical Center in New Orleans, where he said a large percentage of patients are low income. Even so, Shah sees a 40% conversion rate of patients opting for premium IOLs or for monofocal IOLs implanted using femtosecond laser technology. He partially attributes that rate to two things: not scaring the client with out-of-pocket costs and focusing the client-physician discussion on reasonable expectations.

Among the options Shah offers are versatile toric lenses for astigmatic patients.

“The great thing about toric lenses is that they come in such a wide range of powers that we can correct small amounts of astigmatism or very large amounts of astigmatism,” Shah told Ocular Surgery News. “What those patients can expect is basically good uncorrected distance vision, so when I speak to patients about options, I break it down into simple outcomes.”

Offer options, discuss outcomes

For most patients, the first option Shah offers is manual cataract surgery with implantation of a standard IOL, which is normally covered by medical insurance, but patients should expect to wear spectacles after surgery.

For patients who want to reduce or eliminate the need for glasses, however, Shah offers a range of monofocal, multifocal and toric premium IOLs to achieve better distance and/or near vision, via packages described simply as distance correction or distance/near correction. Those packages include premium IOLs as well as technologies such as femtosecond laser treatment and intraoperative aberrometry. The out-of-pocket cost for the variety of options ranges from about $1,200 to about $2,500 in Ochsner’s area.

New on the scene is the extended depth of focus Tecnis Symfony IOL (Abbott Medical Optics), which leads to better visual acuity at near, intermediate and far distances. The FDA approval of the Symfony in July 2016 included a toric version of the lens as well.

Set expectations

Many of Shah’s patients are in their 60s, 70s and 80s, and have the means to pay for premium IOLs, he said. In other cases, patients may opt for health care financing. Ochsner partners with a company that provides interest-free health care financing over 12 to 18 months, Shah said.

Notwithstanding the advantages of premium IOLs, Shah is frank with his patients about what to expect.

“Every lens does have some optical aberrations,” Shah said. “Glare and halos are more common and greater in patients with multifocal or extended range of vision lenses. So I always talk about those things up front with patients, and I let them know that’s one of the compromises they’ll have to make in order to have this greater range of vision without glasses.”

Whatever option the patient chooses, however, Shah said he makes sure the cost and benefits are clear. For those interested in premium IOLs, he explains the out-of-pocket costs and the long-term benefits.

“And most of them, I think, see the value in advanced technology cataract surgery, especially when we show them a video,” Shah said. “We try to use videos and digital technology to help make tangible what they’re going to be experiencing.”

According to Shah, patients can expect good uncorrected distance vision in more than 90% of premium cases.

“I also think it’s important when you speak to patients about what outcomes to expect that you don’t overpromise. You want to underpromise and overdeliver,” he said. – by Joe Green

For more information:
Pulin A. Shah, MD, can be reached at Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121; email: pshah@ochsner.org.

Disclosure: Shah reports he is a speaker for Abbott and Alcon.