Yari has questions for Thomas Kohnen, MD: Master ‘easy’ IOLs before premium lenses

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Hi, I'm Yari, and I have questions. And I'm here with Dr. Kohnen, and he has answers. Let's see if they match. Hi, Dr. Kohnen, thank you for joining me today.

Thank you. It's nice to be in Boston.

Yeah, have you enjoyed the meeting so far?

Yeah, it was really nice. Weather was not perfect but that's good for a meeting.

Yeah, exactly. Lots of people stayed. So, I have a lot of questions about premium lens technology, and more importantly, how are you as clinician talking to patients in your practice and how do you offer them? Do you offer premium lenses to every patient or just a selection? You know, how do you do that?

It's funny that you asked that question, actually, what we have done, I think over the last three years, every patient who comes into the Department of Ophthalmology in Frankfurt, where I'm chairman, actually gets information about Premium IOLs. And it's really a question which is coming from my heart, and the reason why I do this is very simple; Because if I don't do it then people can sue me.

Oh, that's fair. Okay.

So, what we do is we offer technology... We let them know, because I think as a physician, it's my responsibility to let everybody know that there this opportunity. In Germany, we have that co-payment system, where everybody who has cataracts gets the opportunity to upcharge and get this IOL. So that's one group of patients, so we offer it to everybody. Now, in my consultary, that was general, about my whole university clinic, but where I see my private patients usually, they come as a special request usually. They know that I'm known for this, that I'm doing it, and they come to the department, and I tell them, "Okay, what's your needs?" And then we select an IOL. Can be a monofocal lens but rarely. I'm doing maybe from 10 IOLs, I would do nine presbyopia-correcting IOLs.

Got it, and so, you mentioned that that was a change from 3 years ago, so-

I would think, 3 to 5 years, you know, over that time.

What were you doing before?

Well, before we had, you know, the opportunity only to do it to special patients because during that time the system changed a little bit.

Got it.

That was for us, a very flexible system so everybody can afford that, because previously, if you have a premium IOL, the patient had to pay the whole thing out of pocket and did not get the part of cataract surgery reimbursed by the insurance company. And that is in my opinion a very good system.

 Yeah, so when you talk to patients about the different type of lenses and you know, the risks and the benefit, are there certain ways in which you present the technology to them that you find to be helpful so they understand why it would be worthwhile to invest in their vision in that way?

Yes, what I do is, we have a system where basically the optometrist — we don't have optometrists — but the opticians in our department, they start examining the patients and then the staff, plus the residents, I'm also in a teaching process, so they prepare the patient a little bit. They have specific brochures where they say, you know, this option, that option, that option and they have talked already a little bit… So then when I see the patients, at least they have some information, and then I start a little bit again and say, “What are your needs?” I come right to the points and then I can make selections to IOL.

Oh, that's great. How do you make sure your team is saying the same thing? Do have regular meetings? Do they have specific education they go through? How do you make sure you're consistent?

Yes, we have a lot of meetings in the clinic. We have a lot of … They see me also presenting, and I let the faculty present, and the residents do research in this area. So, with this, they are all on the same page. Eventually, they have the same thinking on which direction they go, because I teach them every day and then they talk in this direction. So yeah, we talk the same line.

That's great. So, what advice would you have for colleagues? You know, everyone that's joining us today that has used premium lens technology or maybe has not and is thinking about it; To move to that state of confidence that you can offer to every single patient? What advice would you give to people that are maybe not where you're at today to get to there?

I would think if somebody, you know, does a monofocal lens, and he wants to go in this — first of all, I think he has to one day — I would start with very easy IOLs. Easy IOLs usually in my opinion are, for example, non-diffractive EDOF lenses because they offer a little bit more than a normal monofocal lens. We don't have to discuss the monofocal enhance. That's not much of a difference to a normal monofocal lens. There are aspheric lenses that have the same outcome as an enhanced monofocal lens, it's known in the literature. But I'm talking about presbyopia correction so that you can see at distance and intermediate. I only use a non-diffractive EDOF anymore, because the diffractive EDOF have optical systems which I can save. So, there's an easy in, and then the next step would be to go into trifocality. But they are a little bit more difficult to handle because you have to ... The post refractive error you have to handle, and you have to handle the disturbances, which some patients have. And that requires maybe a little bit more experience. So, I would go for the non-EDOF technology and start from there and then go the next step.

That's great. Start easy and build confidence …

For yourself. I mean, the thing is, as a physician, you have to tell... The patient expects that you tell him actually the outcome. And if you don't know the outcome, how can you do this? So, you have to build confidence, and you have to see the patient post-operatively. Maybe follow him for a week, a month so that you know what the answer is and what the patient tells you. Because if you do this, then you can say, not even just to say that I have implanted this and this in this patient, but you can say, if we get that lens, most likely, you will see very good at distance, very good intermediate, you don't need glasses for working on the computer. But you have to know it yourself, otherwise, you cannot talk about it.

Makes sense. Perfect. Well, these have been great answers, and I have one final question for you. It's going to be my hardest hitting, most challenging one. What kind of music do you listen to when you're doing surgery?

I don't listen to music when I do surgery, because I concentrate. I think that's not good, but I hear a lot of music when I do my sport, I do a lot of sports.

Oh great.

And my favorite over the last 2 or 3 years, and I listen to a lot of them, is Coldplay.

Oh nice. Good choice.

And I was in the concert in Frankfurt. It was amazing. I have seen Genesis and The Rolling Stones in Germany and Supertramp, all types of music. Coldplay, they were in Frankfurt, and they gave four concerts in a row. So, Friday, Saturday, Sunday, Monday. And I had tickets which I bought in COVID time, I took my wife, and it was fantastic music event.

Fantastic. Well, rock on. Well, thank you so much. I think your answers really addressed my questions, so I appreciate that. And I hope everybody enjoyed this; Thank you for being with us.

Thank you.