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The Challenging Referral

It's been quite a few months since the latest presbyopia-correcting IOLs were approved. By now most of us have mastered our patter and can discuss them confidently with our patients. Readers who know me best acknowledge that I am full of it and can shovel the same with the best of them, but I am vexed by one group of patients. I haven't figured out how to handle the patient sent in by a friend who did great with cataract surgery in days gone by.

"Would you like to reduce your dependence on eyeglasses after cataract surgery?" I ask attentively. "Oh, yes, more than anything" replies the patient.

"We have lens implants that can do that," I continue. "Oh, I know," the patient interrupts." I smile, as I picture a credit card passing my way.

Then, suddenly, my dream crashes. "You operated on my sister Mary four years ago and her husband Tom the year before that and neither one of them wears eyeglasses. That's the operation I want."

I struggle for words. "Yes, Mary and Tom did very well, but they were the exceptions and were very lucky. Most patients with standard implants still need to wear eyeglasses. However, if you pay thousands extra, I can put in a lens that gets about 85% of patients out of glasses."

I pause, hoping the patient will bite. No such luck.

She hesitates, turns a bit red and spits out, "Let me see if I have this right. Mary and Tom paid you nothing extra and they don't have to wear glasses, and you want me to shell out gobs of money and I still might have to wear glasses? Something doesn't smell right, Doc. Give me the same operation they had so I can throw away my glasses, too, and I'm not paying you an extra dime!"

Admittedly, this puts me in an awkward situation, but the patient is quite correct. We have successfully under promised and over delivered for many years. How do we continue to over-deliver when faced with over expectations for vision restoration?

The under-over solution

We can only do what we have always done with other things. We have to fairly assess the potential benefits of presbyopia-correcting implants, under-promise in our recommendation, and then over-deliver in our performance. In time each of us will learn how to use multifocal IOLs in our practices just as we have with every new development. They're nothing to get all freaked out about. They are just the newest tools in the ol' toolbox.