BLOG: Patient motivation key factor in success with extended focus IOLs
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In our experience, many referring optometrists are comfortable recommending toric IOLs for their patients, but they may be gun-shy when it comes to extended focus IOLs.
Extended focus (EF) can be used as a catch-all term when discussing multifocal IOLs, trifocal IOLs, extended range-of-focus IOLs, extended depth-of-focus IOLs or any other proprietary name a company has come up with. All of these presbyopia-correcting IOLs find their own balance between quality of vision, depth of field and dysphotopsias.
There are, of course, many factors that define a good or bad candidate for these lenses, but when fitting multifocal soft contact lenses, we have already become very familiar with one of the most important factors: patient motivation. (Failure of multifocal soft contacts may hint at a poor EF IOL candidate; if this information is known, consider sharing this on your cataract referral.)
Despite any manufacturer’s literature, each of these EF IOLs have inherent compromise, so when electing such a lens the patient must be willing to take the good with the bad. To be less dependent on glasses, is the patient willing to tolerate dysphotopsias, such as glare, halos and star bursting? How about a mild reduction in sharpness, quality of vision and contrast sensitivity or the continued need for glasses for some tasks, especially some near work?
This point is important to stress: The patient must understand that they will be glasses-free for more of the day with EF IOLs but will likely never again be glasses-free or achieve the vision they enjoyed in their 20s. Reading glasses will still have some role in their day but will hopefully be over-the-counters that are only needed on occasion or for certain tasks.
As providers at surgical centers, we cannot overstate the importance of such a conversation starting in the referring provider’s chair. We have about half an hour of exam time to ascertain a patient’s personality, desires, hobbies and expectations, but their primary optometrist has likely known them for many years. A referring optometrist noting they recommend — or, perhaps even more importantly, noting they do not recommend — EF IOL for a patient can be invaluable.
And while it doesn’t take too long to determine if someone is “type A” — patients that tend to be somewhat critical, exacting and unwilling to compromise — people are, of course, more complex than this. We would all love for every patient interested in EF IOLs to be easygoing and positive, but this is unrealistic. Once a patient has expressed interest in these specialty lenses, it becomes our role to property educate and begin managing patient expectations.
As we delve deeper into different IOL designs in the next post, we’ll see that a patient’s career, hobbies and even their physical build can help dictate the best lens for them. But in addition to the more personality-based aspects of IOL selection, a good EF IOL candidate also needs overall good ocular health. This historically means no corneal disease, such as Fuchs dystrophy, epithelial basement membrane dystrophy or keratoconus, and no macular pathology, such as epiretinal membranes or a macular hole. Other contraindications would be amblyopia or a monocular cataract. Post-LASIK patients or those with small pupils should be approached cautiously. (Most of these are relative contraindications and should be assessed on a case-by-case basis).
Watch for our next installment as we explore more extraocular considerations when recommending an EF IOL and important factors for deciding which model is right for a particular patient.
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