Patient education has increasingly become an important requirement for cataract surgery practices — but it’s not easy to do well and efficiently. A decade ago, we could perhaps rely on a short video in the waiting room describing cataracts and cataract surgery. But today, with the plethora of options for patients — from femtosecond laser correction of astigmatism to premium IOLs and sustained-release technologies that reduce postoperative drop usage — patients have a lot to absorb to make decisions before surgery.

A recent survey suggests that most patients lack even basic information about cataract surgery. When TRUE Global Intelligence surveyed more than 6,000 adults in six countries in 2020, 70% said they are familiar with cataracts and 85% know that surgery is the most common treatment option. But among those diagnosed with or experiencing symptoms of cataracts, only 30% of Americans surveyed said they would be very likely to undergo cataract surgery. Fear and concerns about the effectiveness of surgery were the most commonly cited reasons for avoiding surgery.

In my practice, I have found that it is ideal to start the patient education process early and allow patients to learn about cataract surgery options at their own pace and in the comfort of their own homes. Most importantly, I want them to feel supported and informed — never rushed or pressured.

We have long used Rendia education videos and our own YouTube videos on our website. Recently, we also began using askPAM (Patient Advocacy Manager), a new service from J&J Vision. With this service, patients send a quick text or scan a QR code that we provide. They don’t have to download anything or find a specific website — they just click “yes” to opt in to receive a series of videos from me. The videos include short explanations about what cataracts are, IOL and surgical options, treating astigmatism, surgery day and post-surgery care (Figure).

Of course, askPAM isn’t the only option for generating “push” or automated outreach to patients. A number of other industry-supported and subscription services operate similarly, including MDbackline, Patient Pending and Surgiorithm. Explore several of these to see which is the best fit for your practice.

Here are five ways a video-based education system has benefitted our practice.

1. IT REDUCES CHAIR TIME.

Depending on your practice workflow, how patients come to you and how many times you typically see them before cataract surgery, you may want to push out educational videos before patients ever cross your threshold. In my practice, we direct patients to the videos after they have had an initial exam with biometry, topography and macular OCT. That way, I know whether to educate them on astigmatism correction and whether they have any pathology that limits their candidacy for presbyopia correction.

We typically discuss lens options, scheduling and financing 1-2 weeks after the biometry visit. That second visit used to be a 30-minute appointment devoted primarily to me answering patients’ questions and staff helping them work through the decision process. Now, significantly more patients come in prepared to make a decision at the beginning of this appointment. The videos they watched at home have already answered a lot of their questions, so the one-on-one conversation is shorter and more productive.

Although efficiency wasn’t my primary goal in adopting a patient education system, this reduction in chair time has been a very positive outcome, especially during the pandemic when elderly patients would prefer to spend less time in medical offices.

2. PATIENTS ARE BETTER EDUCATED.

Even though we now spend less time talking to patients about their options, I feel that they actually have a much deeper understanding of cataract surgery, our goals and their choices. By moving the education portion outside the exam room, we ensure that patients can digest the information at their own pace, where they feel comfortable and are receptive to learning. They can watch the videos multiple times and share them with other family members to get their input on the decisions. That has been very helpful throughout the pandemic, when we have restricted the number of people who can accompany our patients to their appointments, but it is also helpful for patients whose adult children might live far away.

In contrast to the days when we used to send out packets of printed information in the mail, we know that patients are engaged with the digital education material because we can track metrics like the number of opt-ins, number of videos viewed and duration of views. According to J&J Vision data, 73% of patients given access to the askPAM program opted in to receive the videos, and 98% of those who viewed them over a 2-week period found the videos helpful or very helpful.

3. OUR CONVERSION RATE IS STEADY OR GROWING.

I’m not a fan of the term “conversion rate,” as it implies selling or marketing — which isn’t at all what we do. But, I do believe in informed consent. To me, that means patients need to truly understand their options before surgery so they aren’t disappointed afterwards.

Using an automated, digital patient education program is a good way to ensure that all patients — not just those perceived as affluent — receive the same opportunity to choose astigmatism or presbyopia correction. Because of this, the percentage of my patients who choose a premium option has remained at about 80%, even during the pandemic.

In my experience, this rate has more to do with good education than with affluence. When patients truly understand the tradeoffs, most of them don’t want standard cataract surgery with glasses. But, if they lack a basic understanding about cataracts or their surgical options, the option that is covered by insurance seems like the best choice. Similarly, if they feel confused or overwhelmed, it is easiest to default to the standard.

4. PATIENTS ARE MORE CONFIDENT.

Patient testimonials have been invaluable when it comes to inspiring confidence. For example, in one video, we featured a patient named Kathleen, a lei-maker here in Hawaii. She talked about being able to see the flowers more clearly and being more comfortable driving on her own. Those very specific examples she shared really resonated with patients, far more than our clinical descriptions of “near” and “intermediate” vision did.

In contrast to most major consumer items, cataract surgery is a one-time “purchase” that can’t be returned or exchanged. It can be a life-altering opportunity, so whether a patient decides to go with a standard, insurance-covered lens or full correction of astigmatism and presbyopia, we want them to feel confident in that choice. I don’t want patients to worry that they may not ask enough questions or — worse yet — find out after surgery that they could have had the opportunity to get rid of their reading glasses but didn’t even know about it. Ultimately, satisfied patients who feel they made the right choice are the best advocates for your practice.

5. WE GET MORE REFERRALS.

Thanks in part to this confidence, we get more word-of-mouth referrals from prior patients. An education process that is comfortable for patients plays a major role in their overall experience with surgery. If patients feel poorly informed or pressured, they may not recommend your practice even if they have a great visual outcome.

One of the things I like best about our patient education system is that the QR code and videos can be shared broadly by patients. Not only can they share them with family members who influence their decisions before surgery, but after surgery they can also share with their friends when the topic of cataract surgery comes up in conversation, simply by pulling out their smartphone. According to the AARP, 81% of those aged 60-69 and 62% of those 70 and older use smartphones, and the number has been growing dramatically each year.

There are many sources of good, educational video content to share with your patients. Thanks to new technology services, it is easier than ever to incorporate this content into your practice so that patients are fully informed in an efficient manner. OM

About the Author

Carlton K. Yuen, MD is in practice at Aloha Vision Consultants in Honolulu, Hawaii. He served as chairman of the department of ophthalmology at Kuakini Medical Center and chief of the ophthalmology division at Hawaii Medical Center West. Email him at dr.yuen@hotmail.com.

Disclosure: Dr. Yuen revealed a relationship with J&J Vision.