Patient selection important in advanced IOL cataract surgery
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When selecting and counseling patients for advanced IOL cataract surgery, Richard Tipperman, MD, weighs patient temperament and expected results, and works to manage patient expectations throughout the process.
When examining the patient, Tipperman looks for conditions including subtle anterior basement membrane dystrophy or subtle, but clinically significant, dry eye disease by examining Placido mires rings.
“Rings are raw data, check them,” Tipperman said at the virtual American Academy of Ophthalmology annual meeting. “Everyone always looks right at the color topography, but the mires contain a wealth of information.”
Tipperman said that it is important to discuss reasonable expectations with the patient and to emphasize what vision would be like with a monofocal lens, not what vision would be like without ever wearing glasses again.
“You do need to explain to patients the potential for unwanted optical images, especially glare and halo in nighttime driving with advanced technology lenses,” Tipperman said. Using pictures can help show patients that everything will still be in focus and they will still have functional vision, Tipperman said.
Patients who demonstrate a “sense of entitlement” should send up a “red flag” that they may be difficult to care for, he said.
“Although, obviously you can still obtain good clinical results for these patients, it can be much more of a challenge for both you and your staff,” particularly if the patient is unhappy in the postoperative period, Tipperman said.
Setting patients up for success postoperatively comes from reminding patients that near distance vision recovery often lags behind distance vision.
“What this does is set them up for success, so they come in at a 5- or 7-day visit and say ‘Doc, I’m already doing a lot up close, the vision is really pretty good, I am very happy,’” Tipperman said.
Finally, Tipperman says that verbiage is important.
“Use the term ‘basic IOL’ to describe monofocal cataract surgery. If you describe this surgery as standard or routine, it can imply that this is the more common or favored approach and a better approach for them,” Tipperman said. “Conversely, I think the term ‘advanced technology IOL’ is much better than ‘premium IOL,’” Tipperman said.
Advanced technology IOL does a better job of conveying the functionality and features of the IOL rather than just being a luxury purchase, Tipperman said.
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Tipperman R. Patient selection and education for advanced technology IOLs: My top 6 pearls. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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