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Adjustable IOLs will disrupt how patients decide, doctors deliver

Issue: February 2018

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David F. Chang

WAILEA, Hawaii — Surgeons will embrace adjustable IOLs due to customizable refractive results and optometry involvement in postoperative decision-making, according to David F. Chang, MD.

“In cataracts and presbyopia, it will transform the patient experience – how patients choose what they want and how we deliver it ... it will change the core of what we do,” Chang said at Hawaiian Eye 2018.

He said there are many barriers to greater adoption of premium refractive IOLs:

• Inability to achieve LASIK-like outcomes
• Side effects from multifocal and extended depth of focus (EDOF) IOLs
• Low surgeon confidence in achieving patient satisfaction
• Patient understanding of the value proposition
• Low patient word of mouth
• Low referring doctor advocacy

Adjustable IOLs will address these barriers, by transforming how patients choose and how surgeons and optometrists deliver throughout the process, according to Chang.

Chang quoted the author Clayton Christensen who studied why successful companies eventually fail. He found that companies that fail do not anticipate change in the way new technology will be used and incorporated.

“We are very good at corneal enhancement but we have the problem that many cataract surgeons don’t do it,” Chang said. “It’s an unexpected procedure and patients may perceive it as a complication.”

Imagine LASIK without enhancement, he said. There would be one shot to hit 20/20. There would be a reduction in patient satisfaction, surgeon confidence, optometric approval and patient word of mouth, he said.

“Patients have so much anxiety because we ask them to tell us what they want preoperatively,” Chang said.

With adjustable IOLs, surgeons can demonstrate to a patient monovision and preview different amounts of myopia.

“Surgeons will embrace it because we are setting expectations you can meet, like hitting the refractive target,” he said.

Preoperatively, there is no need for a final patient decision as the refraction is adjusted postoperatively.

“There is no need to under-promise and we can just defer the decision-making to postop, when an OD could help the patient find out what target they want. Optometry will like it because they will be involved in the decision-making,” Chang added.

The patient will understand the concept of customizing their IOL. Refractive counseling moves from preoperative to postoperative with a patient’s OD.

With adjustable IOLs, surgeons can achieve LASIK-like outcomes, without side effects and surgeons’ confidence will go up, he said.

“It’s shifting the refractive counseling from preoperative to postoperative and the OD will play a central role in refractive counseling and I think all of us will win, but most importantly the patient,” Chang said. – by Abigail Sutton

Reference:

Chang DF. Disruptive innovation and refractive IOLs. Presented at: Hawaiian Eye; Jan. 13-19, 2018; Wailea, Hawaii.

Disclosure: Chang is a consultant for RxSight, PowerVision, Johnson & Johnson and Zeiss.