As the innovations in the toric and presbyopia-correcting lens market continue to provide cataract and refractive surgeons with more options for their patients, many are looking at how they can best incorporate them into practice. Though they typically cost more out of pocket, a number of surgeons have indicated that reaching patients and growing a premium intraocular lens (IOL) practice isn’t terribly difficult in a time when most patients demand access to options. When these lenses end up being the best option for the patient, they bring the added benefit of increasing patient satisfaction and driving revenue—a win all around.

Neda Shamie, MD, a cataract, LASIK, and corneal surgeon with Maloney-Shamie Vision Institute in Los Angeles, says that many patients come into the office having done their research and expecting premium IOLs to be made available to them. Dr. Shamie says that as with other areas in their life, they rightfully expect to have access to choices in their surgical journey.

“As surgeons, it’s important that we demonstrate knowledge and expertise with the advanced options available,” she continues. “With premium lens choices, the patients are assured that we are not taking a cookie-cutter approach to their surgical care, but rather customizing the patient’s needs with the treatment options available. With multiple lenses available in multiple categories, we can strive to find the ideal match.”

In fact, Dr. Shamie says that in viewing her role as a “matchmaker,” she approaches IOLs with a mindset of what is best for each individual patient—finances aside.

“A lot of practices start by offering the ‘basic’ package and then building upon that,” she explains. “They’re factoring cost into the equation and starting from the bottom up.”

But, Dr. Shamie says they’ve “flipped that model,” by focusing on what’s best—regardless of cost.

“We first hear the patient’s story about how they use their eyes, with a focus on their visual demands, then look at their ocular health and measurements, and finally share what we believe to be the best match with financials completely removed from that conversation,” she says.

“Often, it’s not the most expensive option that is considered the best match—it could be a standard lens with laser. But we have found that when we truly focus on what’s best for the patient, regardless of cost, we’re able to get the best results. By focusing on the patient, we build rapport and credibility. We can always step down to second-best if cost is a barrier to that top choice.”

The key is to choose the lens that is best for the patient, regardless of the price. Though the presbyopia-correcting and toric IOLs stand to be a revenue driver, in the environment of declining cataract surgery reimbursements, adoption must align with the patient’s best interest.

Daniel H. Chang, MD, cataract and refractive surgeon at Empire Eye & Laser Center in Bakersfield, CA, and president and founding member of the nonprofit Advanced Center for Eyecare, says that the primary goal should always be patient satisfaction and safety.

“We must not lose focus of making choices that are best for the patient,” Dr. Chang says. “If we choose a presbyopia-correcting lens and the patient has unwanted side effects, we may end up with a dissatisfied patient.”

Carrie Jacobs, COE, executive vice president of operations for Chu Vision Institute in Bloomington, MN, says that they take the same approach of “never prejudging a patient” and limiting their options. With this approach, they present all possible options to the patient while counseling on what they think is best for their specific needs.

“We make our recommendations based on eye health, and come from the school of thought that everyone deserves to be educated on all of the options,” she says.

Educating the Patient

Jacobs says that with all of the options available, education is more important than ever­—though it can take up a significant amount of chair time.

However, when the pandemic pushed the practice toward virtual consultations, they found that this opportunity for “pre-education,” ahead of the cataract consultation has created better-informed and less overwhelmed patients. The practice has since worked hard to develop a virtual consultation team that is now a standard part of their patients’ cataract journey.

“An added benefit of performing these virtual consultations has been that the patient has more time to process all of the information that we’re presenting while at home,” Jacobs notes. “It can be exhausting to be presented with all of the different options during the in-office exam.”

The Chu Vision team is also using the virtual consultation as an opportunity to discuss the financial options—including what insurance will cover and what it will look like to choose the premium route.

Because some patients can have sticker shock at first, Jacobs says that being able to process this information at home and weigh the options all before even coming into the office has been better for everyone.

“We have found that tackling this conversation head-on and being as transparent as possible builds patient trust,” Jacobs adds. “We walk them through the financial discussion in a compassionate way, but we ensure all details are covered.”

Dr. Chang has also removed the financial discussion from his chair time. For example, he talks about presbyopia-correcting IOLs in light of their functional and safety benefits—and he focuses on which lens is best for the patient’s specific needs.

“If I think a presbyopia-correcting lens option is best, I may mention that there may be an out-of-pocket component, but I will leave it at that and defer the rest of the conversation to my surgical coordinator,” Dr. Chang says. “My job is to prepare the patient for the expected outcome from a clinical standpoint, and I find that when I bring money into the conversation, it distracts the patient from considering what may be truly best for them.”

Dr. Chang also has specific discussions with patients on the trip-and-fall risk associated with the use of bi-focal glasses to correct presbyopia. He recently published a literature review that highlights the association of bi-focal glasses and monovision on the risk of tripping and falling.¹ That is why his approach to the IOL conversation often hinges on safety.

“My conversation is centered on treating presbyopia at the time of cataract surgery to minimize the need for bifocal glasses,” Dr. Chang says.

Investing in Staff Education, Too

Jacobs says that when it comes to success with the premium lens market, all staff should be well-educated to prevent missed opportunities.

“It’s easy to focus on the clinical team, but any touchpoint within the practice is an opportunity to talk about premium lenses,” she adds. “At every staff meeting, we talk about the patient journey and the ways in which premium lenses can enhance it. You never know when the front desk or someone else is going to get a question.”

Dr. Shamie agrees, noting that the phone team is well-versed in the benefits of the premium IOL options so that they can address initial questions and help encourage patients to seek consultation.

“Premium lens education stems from the front to the back here,” she adds. “We don’t push, but we do feel it is our responsibility to truly inform patients of the whole gamut of options available. Along with that, we want our staff to take pride in knowing that our patients are offered the most customized options available.”

A Win All Around

While there’s no question that premium IOLs can help the bottom line, the surgeons we spoke with agree that the best benefits come from patient satisfaction.

“I think the biggest way that premium IOLs help practice revenue is by putting us on the map as the premium practice to go to,” says Dr. Shamie. “If you don’t offer premium lenses, you will be seen as outdated and limited in your options to patients—which can limit credibility. The most significant contribution to our bottom line has been that premium lens offerings have made me recognizable as a premium-level surgeon. Even at times when the conversion rate is low, I’m still seeing that patients appreciate we aren’t limiting their choices—and that has abundant possibilities for the growth of the practice.”

Jacobs adds that with today’s cataract patient being a “savvy consumer,” practices should assume they’ve already done their research and they know what’s out there.

As a result, marketing premium lenses on digital platforms, including the practice’s website and social media channels, is important. Even if patients don’t end up choosing these options, they might specifically seek you out because they see they’re offered.

Dr. Shamie believes that the best marketing efforts are multipronged. Her practice does outreach to referring doctors so that they’re aware of the IOL options available. They’re also participating in some local media, and focus on keeping their information fresh on digital platforms. It all positions the practice as one that remains on the cutting edge as a means of offering patients “the best,” she adds.

It’s something that she believes everyone can benefit from.

“These days, no cataract surgeon should be hesitant to embark on the premium lens journey,” notes Dr. Shamie.

“While previous generations of these lenses might have had visual aberrations, which could present challenges, the optics are so optimized now that the outcomes are impressive and truly life changing for patients,” she continues. “If you’re easing in, start with a toric lens implant or a lens that offers extended range, which will provide less visual aberration at night. There’s always a place to ‘step in’ to this market. But don’t start losing potential surgical patients because you aren’t taking the leap. This is most definitely the future and patients are already demanding it.” ■

Reference

1. Chang DH. Multifocal spectacle and monovision treatment of presbyopia and falls in the eldery. J Refract Surg. 2021;37(S1):S12-S16.