The Patient's Perspective on Premium IOLs

Cataract patients weigh in on what mattered during their experience.

When Dick van der Struif, of Delft, Holland, was 10 years old, he suffered trauma to his right eye (a rogue snowball) that put him at an increased risk for cataracts. Now 47 years old, he is an assistant air traffic controller at the Hague airport, a job that requires a keen sense of vision. He does preparations for all flights on a computer screen and scans the skies to watch aircraft near and at the airport. When his vision declined enough to affect his job, he consulted with Giorgio Porro, MD, of Breda, Holland, who advised that it was time for cataract surgery.

However, due to the nature of Mr. van der Struif's work, the lens selection had a few more demands than the average cataract patient. “Dr. Porro made arrangements with an aviation medical specialist from the Ministry for Infrastructure and Environ ment. An order had to be made for a lens without color,” Mr. van der Struif explains. The Ministry, which oversees transportation in the Netherlands, only allows non-tinted IOLs in air traffic controllers, so he waited for a lens that met its requirement (AMO's Tecnis Toric) to gain its CE mark before going forward with the procedure.

Mr. van der Struif's story is a lesson in paying close attention to the patient's lifestyle when selecting a premium IOL. While surveying a patient's daily demands may seem like an obvious component of a successful procedure, there are many other crucial steps to consider to make a patient happy. What are they? To find out, Ophthalmology Management went straight to the source, talking to patients from across the country about what made their premium IOL experience ideal.

Explaining the Risk

Bob Bernoff, PhD, of Elkins Park, Pa., is the kind of sharp-witted patient some doctors would fear. “I'm a chemist, I don't take things lightly—especially when my vision is involved,” he asserts. Before getting a presbyopia-correcting lens (Bausch + Lomb's Crystalens), he did extensive research, reading technical articles penned for doctors.

Inflated expectations are a common problem in this era of Google, self-diagnosis and easily accessible medical information. Without a doctor to intervene and separate fact and fiction, it's easy for patients to be led astray by what the Internet has to say. Patients can come into the office full of apprehension over horror stories or, perhaps worse, expecting miracles and perfect vision as soon as they hop off the operating table.

Being upfront and honest about procedural outcomes may be the single most important part of ultimately making the patient satisfied. “My doctor did a very good job at preparing me and cautioning me that the outcomes vary and there is no guarantee for perfect vision,” says Dr. Bernoff. “He told me in advance there is a common side effect—a wrinkle in the capsule that requires a laser to smooth things out afterwards.” When Dr. Bernoff needed the postop touch up, he was prepared instead of disappointed by “imperfect” results.

“He explained to me, ‘Look, we can't tell for sure how this is going to end up for you—we have some people that end up not needing glasses.’ He also told me that the eye has to learn and work with the ciliary muscles to adjust.”

Don't be afraid to get technical with your patients. They'll appreciate the honesty, learn more from the experience and better understand, rather than be afraid of, what exactly is happening in their body. Dr. Bernoff said his doctor provided a video on the procedure to help educate patients, which he viewed before going in for an appointment with a technician for measurements.

Vocalizing examples of how a certain lens will alter day-to-day routines will simplify the lens selection process by allowing the patient to picture their postoperative life. A testimonial on Alcon's Web site from a patient named Richard describes how his doctor “explained the whole procedure to me and what I could look forward to.” The surgeon elaborated that implanting a standard lens would still require eyeglasses, while the Acrysof IQ Restor likely would not—a winning point for many patients. Another patient, Patricia, describes her inability to drive at night or confidently ride a bike due to high astigmatism, and the transformative effect Acrysof IQ Toric implantation created. “I noticed the difference almost immediately,” she says in her testimonial.

Word of Mouth

After hearing about his friend Dr. Bernoff's positive experience, Jerry Magill, a 66-year-old systems engineer, decided to look into the procedure for himself. He spends much of his day at the computer and had been warned by his doctor that cataracts were beginning to develop. Though the cataracts hadn't yet hit a critical point, Mr. Magill says he's “not the kind of person who waits around,” and went in to his doctor, Robert Bailey, MD, of Blue Bell, Pa.

His friend had passed on articles for Mr. Magill to read, and he felt confident that the same procedure and lens were right for him, too. Contrary to some sales pitch-oriented MDs, he says that, if anything, he was encouraging his doctor to go for a premium IOL rather than the other way around. “He would have just done the regular lens, but I was pushing.”

Postoperatively, Mr. Magill needed a laser touch up and still uses reading glasses occasionally. While he concedes that he was hoping to have perfect vision and not need any further treatment or readers, his doctor eased his worry over the expense of premium lenses at a follow-up appointment. Dr. Bailey gave him a pair of lenses to try on that showed what his vision would be if he had gotten the standard lenses covered by Medicare. The substantial difference made him confident in his decision.

Dr. Bernoff and Mr. Magill demonstrate the importance of word of mouth. One happy patient breeds more business, meaning it is crucial to ensure that if any glitches occur along the way, they need to be addressed. Providing complimentary laser touch ups, being accommodating with follow-up appointments and offering steady encouragement about future improvement will keep patients on a positive note when discussing the procedure with their friends, and potential future patients.

Talking the Talk

Talking patients into choosing a lens that you feel most comfortable implanting may seem like a good plan, but don't be surprised if they sense when an approach is isn't balanced.

Jack Hurley of Stuart, Fla., was referred to Alan Aker, MD, of Boca Raton, Fla., three years ago when his cataracts needed to be removed. Mr. Hurley was relieved to find a doctor who didn't aggressively promote or denigrate any particular IOL. He says that over the years he became familiar with what cataracts were and a few different types of lenses. He had heard some negativity from other doctors about the Crystalens because it hadn't been available for very long. Not so with Dr. Aker, whose office provided copious literature on the lens. Mr. Hurley appreciated his gentle positivity that advocated the lens without pushing for it. He has been nothing but happy with the lens since the procedure.

Mr. Hurley was shocked when he accompanied his wife to get new glasses and listened to her doctor speak critically about specific premium IOLs. Meanwhile, his sister had a standard lens implanted a year and a half ago and has experienced continual trouble. Mr. Hurley hopes she'll soon have Dr. Aker put in premium lenses and solve her vision woes.

“I think there's a lot of skepticism around the country,” Mr. Hurley says. “Some of these doctors are extremely negative, saying there are all sorts of problems and issues with certain lenses, but it's because they don't have experience with the new lenses and just fall back on standard lenses. They just aren't informed.”

But do cataract surgeons who are enthusiastic proponents of premium lenses appear to be chasing the dollar? He says in Dr. Aker's case, not in the slightest. A friend with cataracts that Mr. Hurley referred to Dr. Aker had the Crystalens implanted in one eye. Upon preop examination revealing a small bump in the other eye, Dr. Aker insisted on a standard lens.

“He told her, ‘I can put a premium lens in there, but I'd be wasting your money.’ He is clearly not after the dollar,” says Mr. Hurley.

Calm Nerves Through Trust

Cleo Schroeder, of Hillsborough, Ore., says the best thing about her cataract surgery experience was the confidence she gained from the staff. The 73-year-old breast cancer survivor needed routine ophthalmic check-ups because of her tamoxifen use, so she had been visiting the practice for four years prior to having a multifocal (AMO's Tecnis) implanted by Mark Packer, MD, of Eugene, Ore.

“Having a relationship with a clinic beforehand is very good. Going somewhere for annual exams and developing confidence with the doctor makes it much easier to let them operate on your eye for cataract surgery.”

After the initial appointment, the practice sent her home with paperwork that clearly outlined everything that was reviewed with Dr. Packer so she could digest the information at home and make sure she understood all the details.

As to be expected, Mrs. Schroeder was nervous prior to the procedure, saying that though Dr. Packer explained how everything would work, she still wasn't relaxed. Luckily, the entire staff was well trained in emotional support.

“They kept assuring me that this was a usual procedure and they did a lot of them. Everyone was good about being encouraging. All the girls at the surgery center were so calm, confident and cheerful—it really helped me,” she says.

Dr. Packer had explained that her vision could take up to a year to stabilize since the brain needs a chance to adapt. In the first few months, she was anxiously anticipating perfect vision, hoping that it would already be better, but because of her doctor's confident demeanor, she trusted his input and waited. Her vision continued to improve over the following nine months, at which point she was advised to do a quick laser touch up. Her vision has been perfect ever since.

Mrs. Schroeder calls Dr. Packer “one of the most cheerful, upbeat doctors I've ever encountered,” and says his entire staff follows suit. “If I ever have questions, someone steps up and addresses it right away. The office always makes you feel important, not like some places that make you feel lucky to get an appointment.”

Nancy Novak of Santa Barbara had a bit of a head start gaining trust with her doctor, Doug Katsev, MD—after all, her daughter is one of his surgical technicians. While every patient can't be afforded this luxury of assurance, any doctor can approach a patient with a calming attitude that establishes confidence. Ms. Novak said she felt comfortable accepting Dr. Katsev's lens recommendation of a Tecnis Multifocal thanks to the practice's “casual and relaxing” atmosphere. “I felt the whole procedure was very easy—I would recommend it to anyone,” she says enthusiastically.

The emotional environment of your practice may not seem like a top priority in comparison to state of the art devices and top-notch staff, but it can make all the difference. Bedside manner is nothing to shrug off. OM