Partnering With Primary Eyecare Providers in Premium IOL Care
Careful relationship-building results in highly educated and satisfied patients.
By David B. Chaffin, M.D.
As any practice that's entered the era of premium IOLs has learned, success simply isn't possible without first-rate patient selection and education. It's crucial to determine ahead of time which patients have visual needs and goals that a premium IOL can fulfill and the personality and understanding to accept the potential trade-offs. No matter how flawless the surgical procedures or how accurate the intended post-op refractions, if patients end up with a visual result they personally didn't expect, the practice has let them down.
To keep this from happening at our practice, we've built in an extra layer of patient screening and education. But we didn't buy more equipment, add staff members or extend our schedules. Instead, we partnered with the primary eyecare providers, i.e., optometrists, in our area.
| Optometrists are uniquely positioned to understand their patients' personalities, visual needs and expectations. This connection allows them to determine … which patients are likely candidates for premium IOLs. |
In accordance with all legal requirements, we work together with a network of optometrists to provide comprehensive care for cataract patients. The optometrists diagnose cataracts and educate patients about the available IOL options. We perform the surgery and return patients to their primary eyecare providers as soon as they're ready. As a result of this relationship, we're better at preventing problems related to inappropriate patient expectations, our patients experience a higher level of satisfaction, and more of our patients choose premium IOLs.
Here, I explain why and how this system works for us. You may find that it can be effective for you as well.
WHY PARTNERING MAKES SENSE FOR US
We are a tertiary care, surgical referral practice located in Reno, Nev. The population of Reno is approximately 275,000. However, close to three-quarters of a million people live outside the city and are spread out in lower-density population pockets. As in other geographically expansive areas, optometry practices provide the bulk of the eye care, and patients must travel long distances for surgical care.
Many of our cataract surgery patients travel 70 miles one way to reach us, and some patients are 400 miles from the nearest ophthalmologist. In this situation, partnering with primary eyecare providers is the only way to deliver quality, continuous care efficiently. What we've learned, however, is that it's also extremely helpful in regard to premium IOLs.
| Key Points for Setting Patients' Expectations In general, the primary eyecare providers we partner with have developed their own effective materials, styles and methods for educating patients on premium IOL technology. However, we also provide them with materials and strategies that we use in our practice. For example, we distribute a sheet called "What to Expect After You Have Cataract Surgery With Multifocal Lens Implantation." Patients sign and date the sheet before surgery to indicate that they understand the following points: ■ Do not evaluate your vision until you have had surgery in both eyes. It is very difficult for your brain to accept the difference in the vision between your two eyes until they can work together and adjust to your new vision. It is important to proceed with the second surgery even if you are not completely satisfied with the vision in your first eye. ■ If you have astigmatism, it may be necessary to refine your vision with LASIK treatment or another refractive modality following or during the surgery. ■ Your near vision will be closer than you remember it before surgery. Expect to bring things closer to read comfortably. You are in the habit of wearing glasses. Don't be tempted to pick them up to help you, just work with your new eyes and adapt with them. ■ Your vision in the intermediate range may not be as sharp in the early postoperative days as it will become over the next few months. Have patience! You will need to get closer to your computer until your eyes adjust to your new vision. ■ Your distance vision should improve with time, but if it worsens, it may be necessary to perform a treatment called a YAG laser after your surgery. This is normal after cataract eye surgery. YAG laser is a painless procedure that, if needed, will also help to improve your vision. ■ You may initially see some glare and halos around lights early after surgery. These should improve over the next few months and are a normal symptom of healing from eye surgery. ■ Best results from cataract surgery with multifocal lens implantation may take up to 6 months. It is normal for it to take time for the eyes to completely heal and for you to adjust to your new vision. — David B. Chaffin, M.D. |
HOW OUR PARTNERS HELP
Because optometrists provide the majority of routine eye care and ocular health exams in our area, they get to know their patients very well, often over a lifetime. Because of these relationships, the optometrists are uniquely positioned to understand their patients' personalities, visual needs and expectations. This connection allows them to determine — very effectively — which patients are likely candidates for premium IOLs and which patients would be better served by a different option.
Furthermore, the optometrist-patient relationship lends itself to early education on IOLs. As soon as it appears that patients will need cataract surgery at some point in the future, our partner optometrists begin educating them about appropriate options. They give patients pamphlets and newsletters to read, direct them to Web sites (theirs and/or ours), and at the next visit answer any questions that arise. They explain potential side effects and what to expect and can keep the conversation going over the course of several visits before their patients need to see us for surgical consultation.
By the time patients arrive at our practice, they have a thorough understanding of the various IOL options. They have reasonable expectations regarding their surgical procedure and what the IOLs can and can't do for them. In addition, compared with patients who weren't referred to us through our network of optometrists, more of them are ready to proceed once we examine them, conduct our discussions and make our final recommendation. I've been somewhat surprised by how many of our senior patients have downloaded forms and information from the Web sites to which they've been directed.
The early and thorough education they receive makes them much more comfortable deciding on a premium IOL especially. It's a big decision, and they appreciate the fact that they've had plenty of time to learn about it.
OUR RESPONSIBILITIES
Our partnership strategy centers on education in another way, too. Typically, the first step for interested primary eyecare providers is to attend one of the continuing education seminars that we offer. Any and all are welcome to attend the Board of Optometry-accredited programs, which we make available approximately four times each year. We also offer more advanced courses for those who have an interest in more hands-on patient care. Some optometrists are able to obtain continuing education (CE) credits for participating in these programs as well, but many attend even if they won't receive CE credit.
The more advanced courses, their level of interest in the subject matter and their impressions of the care we provide prompt some primary eyecare providers to seek out a formal partnership with us. We agree to partner with those who are committed to providing the highest level of care. It's usually clear that this is the case when we visit their practices and see that they've created modern facilities based on the highest tier of diagnostic equipment. To work with us on premium IOL cases, they should have a topographer and the necessary tools for refraction, diagnosing cataracts and monitoring for potential post-op problems, such as infection or inflammation. TPA certification is also a must.
For our part, we must pay meticulous attention to detail in every aspect of our surgical procedures and IOL implantations. Obviously optometrists have no interest in working with unhappy surgical patients or managing complications that could've been avoided.
Once we're convinced that a primary eyecare provider is on the same page as we are regarding patient care, including a commitment to thorough patient selection and education, we can formalize the partnership according to the relevant laws and regulations.
A WIN-WIN-WIN SITUATION
The partnerships we have forged with 40 to 60 primary eyecare providers confirm that they are highly trained professionals who want the best for their patients. In line with that mindset, they want to expose their patients to premium IOL technology, even though it may mean reduced use of eyeglasses and contact lenses. In doing so, they maintain satisfied, loyal patient populations.
| New Addition to Premium IOL Category Earlier this year, the FDA approved the AcrySof® ReSTOR® aspheric IOL (Alcon) for use after cataract surgery in patients with and without presbyopia. This is the first FDA-approved presbyopia-correcting IOL that incorporates aspheric optics into its design. Specifically, the approval was for the addition of a prolate surface to the anterior ReSTOR optic, making the optic shape more equiconvex. The lens was designed by placing the AcrySof ReSTOR lens onto the AcrySof® IQ (SN60WF) aspheric platform. In addition, the anterior edge thickness was reduced an additional 4% compared to the original ReSTOR lens. In clinical trials, the AcrySof® IQ lens design has been shown to improve contrast sensitivity, night driving and visual performance by reducing corneal spherical aberration compared to a spherical monofocal lens.* I have implanted approximately 50 aspheric AcrySof ReSTOR lenses to date with good results. The lens adds crispness to distance vision, and patients have been more accepting of their vision between surgeries. This typically means they are also more eager to proceed with implantation in the second eye. It's possible that the aspheric component of the lens makes binocular summation a less important factor. Overall, the new lens has been raising my patients' level of satisfaction with their premium IOL experience. With the possible exception of someone who's had hyperopic LASIK and resulting negative spherical aberration, any patient who's a good candidate for a ReSTOR presbyopia-correcting lens would also be a good candidate for the new aspheric ReSTOR IOL. — David B. Chaffin, M.D. * AcrySof® IQ IOL Package Insert SN60WF. |
The combination of our skills with theirs has allowed us to give patients a healthy and smooth surgical experience resulting in the best vision possible.
David B. Chaffin, M.D., specializes in cataract and refractive surgery at Chaffin Eye Center in Reno, Nev.
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