Providing a good education will help patients choose premium lenses

At this writing, a large majority of the eligible cataract patients in our practice elect to have a premium implant. Like a number of other practices that were early adopters of these lenses, we have clearly seen a “snowball” effect, where happy patients refer their friends and family to us specifically for these premium lenses. Our unusually high “conversion rate” has been a direct result of our constant effort to improve the way we educate our patients preoperatively. We believe that observing the following 10 “commandments” or recommendations will contribute to your success in patient conversion.

John A. Hovanesian

Paul M. Karpecki

Commandment 1: Believe in the technology. Through experience and many, many happy patients, we have learned that we would eagerly recommend a premium implant to any close friend or family member. Every member of our staff has been extensively trained in the benefits of presbyopia correction and shares in this enthusiasm from his or her heart. Patients can easily tell the difference between a sales pitch and a genuine, personal recommendation. If you have even 10% reservation in recommending a premium lens, it will be apparent to your patient, and you may not be ready to manage the greater expectations these patients are likely to have.

To determine if you believe in the procedure consider doing some of the following: Meet with or talk to patients who have had the procedure; observe surgery and some patient follow-up visits to witness patients’ response; go into surgery and observe the first patients you comanage; suggest that an appropriate staff member with cataracts consider the procedure to then better educate patients.

Commandment 2: Understand the importance of the discussion. Selecting a lens implant is a life-changing decision for our patient, and the cost is high. If information is presented too quickly, the patient, confronted with the stress of such a decision in the context of a frightening upcoming surgery, may just “opt out” by default. If asked, many will say, “I don’t mind wearing glasses. I’ve done it all my life.”

For this reason, we do not begin our discussion by asking whether the patient is interested in a premium implant. Instead, we take the time to explain the benefits of a high-tech lens in understandable terms to every single patient. We schedule extra time for this discussion for patients who we expect may be ready for cataract surgery.

Commandment 3: Match the technology to the patient. Before meeting the doctor, we ask each patient to fill out a questionnaire that rates his or her visual disability and determines his or her needs for distance, intermediate and near vision. We also rely heavily on recommendations from the primary care optometrist who has been prescribing corrective eye wear in past years.

If you are working with a surgeon who uses more than one type of premium implant (toric, multifocal, accommodative), make a recommendation to the surgeon as to which lens you think would best fit the patient. An 80-year-old who spends most of her time watching TV and reading the Bible might be a better candidate for a multifocal lens (Alcon’s Acrysof ReStor, Tecnis Multifocal), while one who uses a computer and drives after dark is probably a better fit for an accommodative (Bausch + Lomb’s Crystalens) implant. Patients who have had monovision experience usually do very well with an accommodative implant.

Commandment 4: Let the doctor do the educating. Use a number of educational tools – brochures, videos, consent forms and our website – available to patients before their consultation. The first verbal discussion about implant choices, though, is with the doctor. This ensures reasonable expectations and allows customizing the education process to the patient’s needs. It allows information to come from the most trusted source.

Commandment 5: Keep it simple. Rather than presenting Crystalens, ReZoom, ReStor and Tecnis Multifocal to patients, make an individual recommendation. In many cases we do not even mention the brand name of the lens because it simply is not important information. We like to say, “There’s a new standard in cataract lens implants that has been emerging over the past 5 years – to use a ‘high-tech’ implant designed to correct not only your cataract but also your vision. These implants cannot guarantee a life without glasses, but they are designed to give you a much better ability to both drive and read without glasses.”

We speak in terms of activities rather than Snellen acuity or distance, intermediate and near vision. We talk about driving (including at night), computer (dashboard, grocery aisle, sheet music, cell phone) and newspaper (stock page, crossword, sewing) vision. Patients appreciate this context.

Commandment 6: Know the technologies. With the online availability of technical information, patients are increasingly asking specific questions about lenses and technologies. To be an effective educator, the doctor must know not only the technology he or she recommends but others as well. Patients appreciate a candid comparison. If you do not explain it, patients will think you are not aware of these new technologies and, worse yet, may think you are not progressive.

Commandment 7: Work with surgeons who offer excimer laser or piggyback IOL enhancements at no charge when needed. This, along with a surgeon who is a good communicator, helps ensure your patient will have a satisfactory result, even after a refractive “surprise.” Do not mention the availability of no-charge enhancements before cataract surgery, however. Enhancements are needed in less than 10% of cases, and some patients may request enhancement when it is not necessary, putting you in an uncomfortable position of having to explain why you are withholding an entitlement.

Commandment 8: Be clear and unapologetic about limitations. We tell patients: “Don’t expect perfect. If you compare what you have to perfect, you may be disappointed, whether you are talking about your lens implant, your car, your computer or your spouse. If you compare vision to an old-fashioned implant, the difference is huge. Ninety percent of people can pass a driver’s test without glasses, but you may need glasses to feel comfortable reading road signs at night. Ninety percent can read a newspaper, but if you are going to read it cover-to-cover, you might prefer to wear reading glasses. Expect to need glasses for some things, like prolonged or fine-print reading.”

Commandment 9: Be clear and unapologetic about extra costs. Patients need to know the approximate cost of their lens choices and that financing is available (most surgical practices offer financing through third parties such as Care Credit). Patients should understand that nearly everyone wants a high-tech lens, but not everyone can afford it. We explain: “The good news is that the biggest costs are covered by your insurance, including the operating room, anesthesia fees, fees for surgery, nursing, supplies. All those add up to about (surgical charges including anesthesia and surgery center fees) per eye, covered by insurance. A high-tech implant adds about (upgrade charge for presbyopia correcting implant) per eye that is not covered by any insurance. It is optional. Not everybody chooses it. About 75% of our patients choose these implants, and our staff can tell you about financing options that make it as affordable as a few dollars a day.”

Commandment 10: Tell what you would do for your sister or mother. It is important for the patient to understand that even though the benefits of a presbyopia-correcting implant are greater, he or she will still be happy with an “old-fashioned” monofocal lens. Patients appreciate hearing that the doctor would choose a presbyopia correcting implant for himself or herself.

Educate yourself and make the effort to educate patients thoroughly about premium implant choices, and your practice will be rewarded with many happy patients who become ambassadors of goodwill for the new, exciting technology that is changing the future of cataract surgery.

For more information:

• John A. Hovanesian, MD, FACS, is a member of the Primary Care Optometry News Editorial Board and can be reached at Harvard Eye Associates, 24401 Calle De La Louisa, Suite 300, Laguna Hills, CA 92653; (949) 951-2020; fax: (949) 380-7856; e-mail: drhovanesian@harvardeye.com. Dr. Hovanesian has no direct financial interest in the products mentioned in this article. He is a paid consultant for AMO and Bausch + Lomb.
• Paul M. Karpecki, OD, FAAO, is clinical director of Corneal Services and Ocular Disease Research for Koffler Vision Group and a member of the Primary Care Optometry News Editorial Board. He can be reached at 120 N. Eagle Creek Drive, Ste 431, Lexington, KY 40509; (859) 227-7781; fax: (859) 263-5694; e-mail: paul@karpecki.com. Dr. Karpecki has no direct financial interest in the products mentioned in this article. He is a paid consultant for Bausch + Lomb.