BLOG: How to tell patients they have a cataract
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Most patients know about cataracts, but they might not fully understand what they are.
Patients can be caught off guard by a cataract diagnosis. Having a streamlined approach to this conversation can ensure patients are empowered to be active in their care.
Here are five easy steps:
1. What is a cataract: Simplify the diagnosis.
2. What to expect at the surgery center: General procedures and steps of the process.
3. Lens choices: Provide a foundation by outlining categories of options, ie, monofocal, multifocal, extended depth of focus and toric.
4. Surgical options: Traditional or laser assisted. Inform patients that with either method, cataract surgery is extremely successful.
5. Recovery and expectations: Postoperative drops, restrictions.
Diagnosis
To simplify the diagnosis, I say that the natural lens is what allows light into the eye for vision. With age, the proteins in the lens break down, causing it to become cloudy over time, making vision blurry or hazy. Cataracts form and progress at different rates; when they start affecting vision, we initiate discussion of removal.
Maybe they have begun experiencing glare and halos at night — typically the first symptom — or some functional and visual limitations. I let them know that the cure is a simple surgery that takes about 5 to 7 minutes to perform, and I say that I will send them to one of my surgeon colleagues for the procedure.
Lens options
I inform them that there are a variety of implants from which they can choose to replace the natural lens to provide excellent postoperative vision. I say they have a decision to make in terms of the technology: Some implants treat astigmatism, some correct for distance and near vision, and some offer a fuller range of vision. I make sure to say that some of the lenses have an increased out-of-pocket expense.
Recent IOL entrants in 2021 include additions to the Johnson & Johnson Vision Tecnis family with Eyhance monofocal and Eyhance Toric II. The next-generation monofocal IOLs have a shape that is designed to slightly extend the depth of focus and provide better image contrast in low-light environments with a new delivery system.
I encourage patients to start thinking about their visual goals for surgery. Do they hate reading glasses, or do they not mind wearing them for up close and small print? I say there are a range of options, and the surgeon will help them select the best approach based on their lifestyle. With the availability of improved IOL designs, and I let them know that it is a great time to be a cataract patient.
Goals for surgery
It is important to talk with patients to establish goals. This can be accomplished by asking three questions.
1. How interested are you in seeing distance without glasses?
- I prefer no glasses.
- It’s not important. I don’t mind wearing glasses for distance.
2. How important is it for you to see up close (ie, reading) without glasses?
- I prefer no glasses.
- It’s not important to me. I don’t mind wearing reading glasses.
3. What if you could have glasses-free vision for distance (ie, driving) during the day and glasses-free near vision in most situations? Would you tolerate some halos and glare around lights at night and be willing to use glasses in some situations?
- Yes.
- No.
Reference:
- Eyhance DFU. The TECNIS Eyhance IOLs are designed to slightly extend the depth of focus compared to the TECNIS 1-Piece IOL, Model ZCB00 as measured in bench testing. Data on file.