BLOG: Astigmatism awareness aids adoption of advanced implants
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If you ask patients what they know about astigmatism, most won’t be sure whether the word starts with an A or an S. It’s a confusing term and an even more confusing concept.
Isn’t it strange that we spend so much of our effort correcting astigmatism while our patients don’t even know what it is?
We asked patients who were preparing for cataract surgery whether they knew if they had astigmatism. Roughly half of 3,500 assessed patients were confidently aware of having astigmatism. The remaining half were split between those who knew they had no astigmatism and those who had no idea.
Why does it matter whether patients know if they have astigmatism? Among cataract patients preparing for surgery, awareness of the presence of astigmatism correlated strongly and positively with the likelihood to upgrade to a premium procedure (toric or multifocal toric lens or incisional keratotomy). This may be because the process of educating astigmatic patients is much easier. Most who know they have astigmatism can more easily comprehend the value of fixing it.
But the importance of astigmatism awareness goes well beyond this. Most patients are aware because astigmatism is part of their eyeglass or contact lens prescription — their “manifest astigmatism.” Yet the need for surgical astigmatism correction is not based on manifest astigmatism but on a combination of keratometry, posterior corneal astigmatism and surgically induced astigmatism, which generally reveal more, not less, astigmatism than a manifest refraction. Overall, 70% of patients undergoing surgery are predicted to have more than 0.5 D of astigmatism, and we know that satisfaction with surgery correlates strongly with correcting astigmatism to less than 0.5 D.
This means patients have a vested interest in knowing they have astigmatism well before surgery becomes necessary. Currently, one-quarter of patients coming for cataract surgery aren’t aware that they have astigmatism, yet they have it and they need to be educated on treatment options to have a satisfactory treatment outcome.
There’s an actionable lesson here. In the course of primary eye care, all patients who have any degree of astigmatism should probably be notified about its presence, whether they choose to wear corrective lenses in their daily life or not. The awareness will prepare them for a conversation about surgical options when the time arises. For some, the preop evaluation will indicate no need for surgical astigmatism correction. For most others, they’ll be better prepared to appropriately consider surgical options when the time comes. We like to educate as many primary eye care providers as possible to help their patients be aware of astigmatism, however small the amount. Better prepared patients become better educated consumers in the increasingly complex health care climate, and better educated consumers generally have better outcomes.
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