Connection points help guide patients through IOL selection process
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Educating cataract surgery patients about lens options while also efficiently obtaining needed preoperative information can be a heavy lift.
It is important to have a deliberate and intentional system in place for communicating with patients and selecting the best technology. In our practice, there are four structured connection points to guide patients through their IOL choices.
First, patients receive a pre-appointment welcome email that includes reading material and a video about cataract surgery. I want patients to be able to peruse this material for the first time in the comfort of their own home — a nonclinical, nonintimidating environment. The video includes testimonials from real patients talking about their experience with presbyopia-correcting, toric and standard monofocal IOLs. I deliberately chose to invest in filming these videos in our practice rather than relying on promotional industry videos. Watching the doctor speak from the exam lane in the video (Figure 1) gives patients a sense of trust and familiarity when they have the same experience in person.
Source: Dain Brooks, MD
During the cataract evaluation, I examine the patient and talk to them about my lens recommendation because it is important that patients hear directly from the surgeon what is recommended and why. The third connection point takes place at the same visit, when the patient meets with a counselor to go over costs and insurance coverage. There is no pressure to make a decision at this visit. Patients come back for a second preoperative biometry appointment after they have had some time to process their lens choices. At this visit, they meet with the counselor again to make a final lens decision.
To ensure the best outcomes, we assure that the ocular surface is optimized, and we use multiple biometers and lens power formulae, typically Barrett Universal II and Hill-RBF, although I may use others in long or short eyes or those with a history of corneal refractive surgery.
Surgeon conversation
I never try to talk someone into a presbyopia-correcting or other premium lens but instead just describe the likely outcomes. Lens recommendations are based on the anatomy and physics of the eye, the patient’s personality, visual needs and expectations, and the lens technology itself. To give some insight into their personality, I often ask patients how meticulous they are and how easy they find it to relax or adapt to change. I am careful to be direct and specific about outcomes, especially with younger patients who have healthier crystalline lenses, monovision contact lens wearers, low myopes who will give up near vision with a monofocal lens, and those with more demanding personalities.
When a patient is interested in spectacle independence and is a good candidate for a presbyopia-correcting IOL, I tell them that we have excellent options now. My own outcomes data demonstrate that 98% of patients I implant with the Tecnis Synergy IOL (Johnson & Johnson Vision), for example, do not typically wear glasses at any distance. I explain that most people have a prescription after surgery, but we want it to be as low as possible so they do not require glasses. If they are in that 2% who need a little bit of help, I can offer surgical and nonsurgical options. We talk about the potential for night vision symptoms and how it may take a few weeks or even months while their eye is healing before they may have equally crisp vision at all distances.
Anytime there is a diagnostic finding that limits the patient’s lens choices, I share those findings, too. For example, if a patient has keratoconus, I say, “Because your cornea has this unique shape, I think a basic lens is going to be the best option, and your optometrist may still continue to fit you with contact lenses after surgery. You might have some friends who don’t require glasses or contacts after surgery, but the technology they got won’t work as well in your eyes.”
Postoperative considerations
My optometrist and co-author, Rebecca Miller, OD, sees patients for their postoperative day 1 visits and reminds them about the healing process and expectations of the implant. If we have educated patients well, there are not any surprises or regrets.
With the Tecnis Synergy lens, I choose both IOL powers at the same time, aiming the closest to plano outcome for each eye. However, at times, I will often choose the plus refraction closest to plano in the dominant eye and the minus refraction closest to plano in the nondominant eye, depending on the circumstance. Routinely, before operating on the second eye, I ask, “Do you feel like you can see well with this lens implant?” Assuming the answer is “yes,” I ask them to read a sign across the room and a line from the consent form to me. I ask, “If I could make one of these two distances a little sharper, would you rather that be up close or far away?” Because we have a large consignment of IOLs, I sometimes make a day-of-surgery lens power adjustment to accommodate their preferences (Figure 2). Patients appreciate the chance to give feedback, and they appreciate our expertise and customization.
Everyone in our practice feels confident in the process and in the outcomes we achieve, and they convey that confidence to patients. It is essential to the process that we connect with the patient at each of our four structured conversations, as well as postoperatively.
- For more information:
- Dain B. Brooks, MD, and Rebecca Miller, OD, can be reached at Brooks Eye Associates, 9955 Gillespie Drive #100, Plano, TX 75025; email: dbrooks@brookseyemd.com; rmiller@brookseyemd.com.
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