Patient personality factors into multifocal IOL satisfaction
Key takeaways:
- Try to pick patients with the right personality for multifocal IOL surgery.
- Manage dry eye, document promises and embrace a “therapeutic alliance” with patients to improve their journey.
ORLANDO — Surgeons need to understand the personality traits of patients with presbyopia to set proper expectations for multifocal IOL surgery.
According to Gary Wörtz, MD, at Telling It Like It Is, ophthalmologists should identify ahead of time patients who may be difficult to please.
“Agreeable patients tend to be the most satisfied,” he said. “They would be happy with 20/30 vision and 1 D of astigmatism. They’re going to be happy with pretty much everything.”
Ophthalmologists must also consider the neurological burden of vision and help patients understand the role of the brain regarding vision.
“I tell people that about 98% of people have multifocal brains and about 2% of people don’t,” Wörtz said. “We’re not going to know which percentage you’re in until after surgery, and if you can’t adapt to this, we’re going to come up with a solution for you.”
Document the promises made to patients and inform them that adaptation is a journey that often takes up to 6 months or a year. Patients should be told about the likelihood of halos, reading challenges in low-light situations, dry eye and the possibility of future enhancement surgeries.
“I think we need to be treating dry eye before surgery, during surgery and after surgery. Just make sure that you have a plan for that,” Wörtz said. “If there’s a reason that a patient is unhappy, we need to identify that reason and treat it, whether that’s with additional surgery, managing the ocular surface or IOL exchange.”
Wörtz overviewed options to correct “refractive misses” and encouraged ophthalmologists to consider LASIK, contact lens trials to test satisfaction with vision and, in some cases, PRK for patients with myopia. He warned against performing YAG capsulotomy too early because “if you need to exchange that lens down the road, it's going to make your life or someone else’s life a lot worse.”
Wörtz emphasized the importance of embracing a “therapeutic alliance” with unhappy patients by openly acknowledging their feelings.
“See them more frequently, hold them closer, and I say exchange within 6 months if you know the lens is the problem,” he said.
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Wörtz G. From chaos to order: Managing the unhappy presbyopic IOL patient. Presented at: Telling It Like It Is; Feb. 13-16, 2025; Orlando.
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