The cataract consultation is one of the most pivotal moments in surgical care. It sets the tone for the patient experience, builds trust, and lays the groundwork for informed decision-making. More than reviewing imaging or lens choices, this is the conversation where expectations are aligned, anxiety is eased, and patients are empowered to take part in their care. Getting it right requires leadership, empathy, and clarity. In this month’s RWO Corner, we explore some of the subtle but powerful lessons in consultation—insights that may not seem important but can make all the difference.
Set the Stage With Clarity
A great consultation begins before the slit lamp. Dr. Keith Skolnick, a board-certified ophthalmologist in South Florida, begins by inquiring who referred the patient and if they will be co-managed. He then proceeds to ocular and systemic history: Does the patient have a history of trauma, glaucoma, or prior ocular surgery? Do they wear contact lenses, and if so, are they accustomed to monovision? Are they a low myope who prefers reading without glasses? Are they in need of dialysis, or do they have diabetes?
As the patient dilates, they view a brief informational video about femto-second laser-assisted cataract surgery (FLACS). Dr. Skolnick uses fundus photography to visually explain their retinal and optic nerve health, sharing corneal topography and using terms like “astigmatism” to engage patients with familiar language.
“It’s not a lecture, it’s a conversation,” he explained. “I go through their anatomy and make sure that they are engaged early on.”
Speak in Terms Your Patients can Understand
When discussing intraocular lenses (IOLs), Dr. Skolnick begins by asking the most important question: “What kind of vision do you want? Distance, near, or both?”
Ask them to explain what they want for their vision, not what they have or had in the past. This subtle shift centers the conversation on their lifestyle and priorities rather than on their chart.
Give your patients real-life examples that resonate:
- Monofocal means seeing near or distance. Reading glasses may still be needed if distance is chosen.
- Multifocal or trifocal lenses aim to provide both near and distance vision, similar to progressive glasses.
- Monovision involves setting one eye for distance and the other for near, which may work well for patients who have used this with contact lenses.
Set Realistic Goals
Dr. Skolnick noted that he avoids promising a certain outcome, and instead emphasizes realistic goals. “I never tell patients they will be free of glasses. I say, ‘The goal is to reduce your dependence on them.’ That distinction builds trust,” he said.
If a patient is fixated on being 20/20, remind them: the goal is usable, satisfying vision.
Help the Undecided
Many patients feel overwhelmed; the secret is to get back to the way they live and think. Ask how they imagine using their new vision in their daily life. Dr. Skolnick considers it a success when a patient walks out saying, “I need to figure out whether I want monovision or distance.”
They don’t have to know anything about optics; they just need to be clear about their decision.
Conclusion
Every ophthalmologist develops a unique style of consultation—whether it is the relatable, tech-savvy approach of newer graduates or the seasoned insight of experienced surgeons. There is something to learn from everyone, and your leadership style will continue to evolve. Growth comes from sharing those lessons and keeping the conversation alive. OM
Want to keep the conversation going? Join us on Friday, October 17, 2025, for RWO After Dark: The EPCOT of Ophthalmology at AAO in Orlando. Just as the cataract consultation sets the stage for surgical success, RWO After Dark is designed to set the stage for professional growth, offering insights that may shift how you approach your next patient conversation! Space is limited—reserve your spot at RealWorldOphthalmology.com.
