Butchers, bakers and candlestick makers: Premium lenses for all
Almost anyone can be a candidate once they pass the psychology part of the premium process.
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What do premium surgeons and a nursery rhyme from 1798 called Rub-a-Dub-Dub have in common?
Believe it or not, the phrase “the butcher, the baker and the candlestick maker” in this famous rhyme denotes people of various trades or businesses, considered collectively, or simply anyone at all.
Recently, I attended a village board meeting with my attorney for my tax increment financing (TIF) to be approved. My attorney said I had to be patient as the board is made up of elected officials from all trades and not just savvy businesspeople in the banking business, for example, who truly understand the TIF process. He collectively referred to them as “butchers, bakers and candlestick makers,” and as expected, the vote was in favor of my dream practice for the near future. As a result, I took this reference and rhyme and put it to work in my approach to premium IOL candidacy. Basically, every one of all trades is truly a candidate for a premium IOL and premium result as long as they qualify medically (and psychologically).
A reproducible premium process for candidacy
No matter the trade or hobby, each patient is treated identical through the premium process to see if he or she qualifies for a premium IOL. A modified Dell lifestyle questionnaire is the initial step in “weeding out” candidates, as it answers questions ranging from the patient’s desire to be out of glasses to the type of daily activities they care most about (night driving, computer work, sewing, etc) to the self-characterization of their personality type (easygoing to perfectionist). Setting patient expectations becomes much easier with this in place ahead of time.
Critical diagnostic testing comes next in terms of determining corrected distance visual acuity, glare testing in terms of objective scatter index (HD Analyzer, Keeler, in our practice), OCT imaging of the macula (ruling out epiretinal membrane and age-related macular degeneration, for example), corneal topography/tomography (ruling out keratoconus and forme fruste keratoconus, and determining if cornea can be used to enhance later with laser vision correction, if needed), epithelial mapping (reinforces corneal topography/tomography evaluation), OPD III imaging (Nidek) to decipher corneal vs. lenticular astigmatism, angle alpha/kappa measurements, corneal higher-order aberration analysis, biometry with latest-generation IOL calculation formulae, full ocular surface evaluation including dynamic meibomian gland imaging, and measurement of ocular dominance. Slit lamp and dilated fundus examination completes the objective portion of the process.
Delivering the premium presbyopia IOL option
Currently, my practice prefers using PanOptix (Alcon) trifocal technology or Symfony (Johnson & Johnson Vision) extended depth of focus technology for our presbyopia-correcting IOL options. With both options, I aim for plano in the dominant eye and –0.25 sphere in the nondominant eye. Both of these platforms give excellent results, but we still do not have the full gamut of technology in the U.S. as other parts of the world.
The good news is non-diffractive technology such as the Vivity IOL (Alcon) gives extended vision for distance and intermediate with slightly less halos, glare and dysphotopsias than even its monofocal counterpart and may be an excellent choice in post-refractive patients and in patients with mild epiretinal membranes as this IOL seems to be more forgiving, per discussions with many of my European colleagues. The Eyhance IOL (Johnson & Johnson Vision) is showing similar outcomes with excellent distance and intermediate vision with low incidence of halos, glare and starburst as well. More recently, the Light Adjustable Lens (RxSight), now available in the U.S. and just introduced into my practice, brings the next generation of customization to premium cataract surgery. Although the patient may require two to three additional visits to the office to “lock in” the desired postoperative refractive error, the possible need for a LASIK or PRK enhancement postoperatively is essentially eliminated, thus reducing risk from another procedure and reducing net profit to the practice with the latter. An EDOF version of this technology is coming soon, which is exciting.
In the end, with our current and near-future premium IOL technology, almost everyone can be a candidate once they pass the psychology part of the premium process. And no matter if you are a butcher, baker or candlestick maker, all of our patients are potential premium IOL candidates.
- Reference:
- Jackson MA, et al. Clin Ophthalmol. 2020;doi:10.2147/OPTH.S237457.
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: mjlaserdoc@msn.com.
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