Navigating Self-Pay

Set appropriate expectations with premium IOLs

Promote these lenses for cataract patients, but beware overselling their capabilities.

By Kurt D. Weir, MD

Promoting premium intraocular lenses (IOLs) with cataract patients requires you to walk a fine line. While you want to present this option and its benefits, you must not oversell the product, and you cannot promise to meet unrealistic patient expectations. While premium IOLs help restore youthful, functional vision, patients must grasp that these lenses are not a perfect fix that will completely free them of glasses.

This rings true especially for many baby boomers nearing the prime age of cataract surgery. These individuals tend to have a more demanding mentality than some of our older patients — they want it all, and they want it all now. However, they need to know premium IOLs’ limitations.

We previously offered patients multifocal IOLs with the promise of “eliminating” the need for glasses, which is how all of industry presented this technology. However, patients complained of poor intermediate vision and diminished sharpness of vision at all powers. We eliminated these issues by offering a 100% light-focusing technology and setting appropriate patient expectations. While surgeons have multiple premium IOL options available to them, Crystalens (Bausch + Lomb) is my choice as I’ve found it provides my patients with high-quality vision over an expanded range of vision with low visual disturbances.

Here, I explain how to talk to your patients about premium IOLs and how to set the appropriate expectations for this technology. (Some statements are tailored toward my presentation of Crystalens technology.)

SELLING PREMIUM IOLS

Present the alternative

For me, the conversation with patients starts after I determine whether they have any degree of astigmatism. Even the smallest amount usually requires a distance prescription in glasses.

From here, I tell the patients, “Your eyes are healthy, and we’re going to remove the cataracts. Since your eye is healthy, we expect to get you a wonderful return of vision. Depending on what we do with technology, we could possibly even greatly reduce your need for glasses.”

Then, I present the option of a basic lens vs. a premium lens. We explain that they could opt for a basic lens that their insurance would fully cover. However, they need to know that the basic lens won’t address astigmatism, meaning they should expect to still be 100% dependent on glasses. We tell these patients that they can expect to need glasses at distance, intermediate and for reading.

From that point, I ask whether they would accept that result, or whether they were hoping to get more out of their surgery. Some patients accept the basic lens, either because they can’t afford to spend out of pocket or they just don’t mind wearing glasses. The more common response during this point in the conversation is a desire to reduce their dependence on glasses or contact lenses.

Offer an upgrade

Once you know what the patient wants, discuss premium IOLs. I explain that “this is the best lens technology we have in ophthalmology, and this is what I recommend every day. If this is something you can handle financially, this is always going to result in a better visual outcome with cataract surgery.” This is an effective approach, because the surgeon’s recommendation has a lot of power with patients. They see you as the expert and want you to advise them on what will provide the best vision.

Next, go into detail about what patients can expect with premium IOLs. Explain that you can offer them great distance vision and tremendous intermediate vision — the technology’s sweet spot. Then, define what distance vision and intermediate vision means, so you don’t leave any uncertainties. For example, explain that intermediate vision is approximately arms’ length, such as the car dashboard, computer or the prices on grocery store shelves.

DON’T OVERSELL

Magicians need not apply

Once you’ve explained the benefits, you must ensure the patient knows what not to expect with the technology. I’ve found the best way to tell my patients is to say, “This is a man-made technology, and no man-made product is as good as what you were born with. It’s a good technology, but it’s not magic. It won’t let you see like you are 20 years old again, and it won’t allow you to throw your glasses in the trash — you will need some degree of readers, especially for very small print, in dim light or when threading a needle.”

Once you deliver this message, patients become more accepting of a less-than-perfect result. At that point, many will say, “I don’t mind wearing reading glasses,” and you know the patient properly understands premium IOLs’ capabilities. But, if you over-deliver postsurgically, you’ll have an ecstatically happy patient, which is much preferable to under-delivering and having an upset patient.

Avoiding the unhappy patient

No matter how well you describe premium IOLs to patients, it’s human nature for them to hear what they want to hear and expect what they want to expect. Therefore, you will still face unhappy patients. If a patient presents to you after the procedure complaining of the results, define the problem, which might be more significant than, “I didn’t realize I’d still need to wear reading glasses.”

If the patient isn’t seeing well at a distance, there may be residual astigmatism you haven’t corrected, or you may have missed your refractive target. Take the time to educate the patients on why they notice issues and help them to realize the complaints are fixable. Explain that it’s a process, and enforce patience. I say, “I’ll make the decisions to get you where you want to be, but, as the surgeon, you need to trust me that I’ll do what is necessary to maximize your visual outcome.”

Handouts and questionnaires

To complement the premium IOL presentation, we send information packets to cataract patients prior to their appointments. This packet includes a questionnaire that helps establish whether they would be interested in upgrading to a premium IOL while setting the stage for proper expectations. In addition, patients receive an information sheet that explains the premium lens technology (See “Patient Lens Options for Cataract Surgery,” page 34 and “Lifestyle Questionnaire,” right.)

This plants the seed while educating them before they even see us. It also is efficient because it shortens the conversation with patients when they aren’t hearing this option for the first time. In addition, educating patients prior to the appointment gets them excited about the process of regaining youthful vision. Both benefits and limitations are properly addressed and reiterated during the appointment.

SEEING RESULTS

Benefits for patients and practice

In my practice, patient upgrades to premium IOLs approached 40% in the last five years. Also, we see a lot of referred business — not just from optometrists and other referral sources, but also from our patients who tell their friends and family. The referrals specifically ask for the premium lenses, which is the best situation for surgeons. This allows us to shorten the technology discussion and focus on ensuring they have the appropriate expectations. Conversely, as much as we appreciate word of mouth, not overselling limits word of mouth from unhappy patients. Most people are simply more likely to share a negative review than a positive review, so we try to avoid that as much as possible.

Any practice can be successful with premium IOLs by presenting proper expectations and taking the time to discuss the technology with patients. This success turns patients into walking billboards who are motivated to talk to others about your practice. OM