Patients undergoing cataract surgery in 2024 have the distinct advantage of having surgeons with more tools available to them than ever before. Along with a multitude of IOL options, almost the entire surgical experience can now be tailored to the patients’ preferences, expectations and individual visual goals. Choices may include type of anesthesia (oral sedation only, IV sedation, topical drops only, peribulbar or retrobulbar block, general anesthesia), femtosecond laser-assisted vs manual cataract surgery, surgical environment (hospital, ASC or office-based suite) and immediate sequential bilateral cataract surgeries vs the traditional delayed sequential cataract surgeries.
The plethora of customization options may be a double-edged sword, though, in that the number of choices may quickly overwhelm a patient if they are all presented at once. Many practices have developed strategies to improve communication with patients and begin building rapport even prior to the surgical consultation, often beginning with web-based animations and videos to lay a framework for what a typical cataract surgery entails. By initiating the thought process prior to the consultation appointment, patients are empowered with the knowledge to make the best decisions for their surgeries, and surgeons can lead an efficient and goal-directed conversation to tailor the patient’s surgical planning toward their desired visual and refractive outcome.
In this article, I will highlight several ways to incorporate patient-facing technology to enhance efficiency and improve patient understanding of the process and available options.
EDUCATE PATIENTS PRIOR TO THE CONSULTATION
Many digital tools exist that offer the capability to send an e-communication prior to the consultation visit to share links suggesting educational content such as videos or brief articles. Some such options include Ocular Innovations (Clarity Technologies) and Rendia (Rendia, a PatientPoint company), which I have utilized for many years in my practice. Patients receive a simple link via email or text message that takes them to a pre-selected playlist of videos that begin to prepare them for their cataract consultation and eventual surgery.
These platforms offer a variety of videos including simulations or animations of basic eye and cataract anatomy, an overview of the steps of cataract surgery and can even highlight specific IOL technology offered by a given practice. Some practices also share with patients a short “getting to know you” style interview with the surgeons themselves, so that patients can enter their appointment already feeling somewhat familiar with their surgeons.
These platforms allow practices to customize the list of videos that are sent to patients prior to their visit. From a large database of videos, practices can curate a standard playlist of video content or customize based on individual physician preferences. Once the desired suite of videos is compiled, the software generates a single hyperlink that can be sent via text and/or email directly to each patient. Patients appreciate that these platforms allow videos to be viewed from any device, without needing to download a new app or create an account. Pre-appointment communications allow the in-person visits to commence with less preliminary conversation about, for example, what a cataract actually is and facilitate more streamlined discussion about visual goals and expectations. By providing a visual representation ahead of time, we find there is substantially less confusion about the basics of surgery, which allows more focused dialogue at the visit itself.
ENGAGE PATIENTS DURING THE CONSULTATION
Some practices, including my own, also employ patient educators or refractive counselors to meet with the patient at several steps along the way. The refractive counselor’s goal is to engage patients in a conversation about their lifestyle, typical visual tasks, pertinent past medical and ocular history, and introduce the available lens implant technologies that might help that particular patient achieve their visual goals. Patient educators may also function as financial counselors to provide information regarding payment options if patients elect for services that are not covered by medical insurance, such as upgraded lens implants or femtosecond laser astigmatism correction.
Rendia offers a computer simulation program, which allows the refractive counselor to “dial in” various refractive errors and vision correction options to demonstrate different anticipated visual outcomes to a patient. For example, an animated scene of nighttime driving can show a patient how their vision might look with a distance monofocal lens implant (Figure 1) vs a toric IOL or a diffractive multifocal IOL or other.
This gives patients a visual representation of some of the common “pain points,” such as absolute presbyopia with monofocal IOLs (dashboard is not in focus) or the halos around oncoming headlights they may experience with a diffractive IOL. Another visual scenario we like to show patients presents a view of three different devices: TV (distance), laptop (intermediate) and smartphone (near) (Figures 2-4). This is a practical way of demonstrating advantages and disadvantages of each IOL option in a common everyday scene.
We find that the ability to make adjustments in this simulator in real-time while patients watch is very useful in highlighting the differences in anticipated visual outcome with different lens implant options. This concept has been even further expanded upon by GreenMan to develop a virtual reality (VR) headset, using the patient’s own pre-operative biometry, to create an interactive VR simulation of several visual environments for the patient to “experience” different vision correction and IOL options (Figure 5). If in-person counselors are not available, most patient education video platforms can be set up to show a playlist of pre-selected videos for patients to view on a tablet while their pupils dilate or at another appropriate point during the consultation.
SCHEDULE A SECOND ‘PRE-OPERATIVE’ VISIT
A typical cataract consultation may take several hours from check-in to check-out and includes a comprehensive assessment of eye health. After the consultation, there may be other diagnoses to explain, such as dry eye and ocular surface disease, glaucoma, macular degeneration or diabetic retinopathy, and these must be considered as factors in surgical planning. It can be overwhelming for patients to process any new diagnoses and consider their future implications and at the same time be expected to make a once-in-a-lifetime decision (sometimes with a substantial financial commitment) for their vision correction surgery.
For this reason, many surgeons have found it helpful to schedule a second “preoperative” visit 1 to 2 weeks prior to surgery, which allows a period of time for patients to process what they learned during the consultation, consider their lifestyle and visual needs with regard to the available IOL technology and return with any questions or additional information they want to provide to the surgeon. This may be an opportunity for additional, more specific video content to be shared with the patient, such as a more in-depth look at the different categories of IOL implants (astigmatism reduction, extended depth of focus, multifocal/trifocal, presbyopia correction) or types of refractive surgery (PRK, LASIK, ICL) that they may be a candidate for. This is also an appropriate time to treat any pre-existing ocular surface disease and potentially repeat biometric measurements or corneal topography and tomography if planning for an advanced technology IOL or if the patient has a specific refractive goal in mind.
Some surgeons may prefer for the patient to meet again with the refractive counselor to review videos or the vision simulator as they prepare to finalize their surgical plans.
SHARE VIDEO LINKS BEFORE AND AFTER SURGERY
Practices and surgeons can customize video links to share with patients just prior to and after cataract surgery. These might include reminders about perioperative care, follow-up visits, proper eyedrop administration, and reviewing typical healing time and common symptoms in the recovery process. These links can be accessed by the patient more than once if they need to refresh their memory or listen back to a certain topic. Pre-empting common questions and concerns with a detailed and polished video presentation can reduce the telephone call burden on office staff and provide patients the confidence that their questions and concerns have already been addressed.
CONCLUSION
As technology expands and more surgical options become available to cataract and refractive surgeons, new technologies continue to be created with patient education in mind as well. Today’s cataract surgery patients are well informed and have high expectations for their visual outcomes after cataract surgery. For many successful practices, interaction with the patient begins even before they check in on the day of their surgical consultation visit, and continues throughout the process and into the post-operative period.
Utilizing video and web-based technologies to begin building rapport and providing educational materials ahead of the in-person visit begins to set the foundation for a truly customized surgical experience, from start to finish. Refractive counselors or patient educators can facilitate conversations about the various types of IOLs utilized in a given practice, and even use tools to simulate anticipated visual outcomes to help guide patient decision making. Taking advantage of the available technologies empowers patients to make the best choices they can make for their vision correction surgeries. OM
