EyePod: Navigating the premium lens landscape from pipeline to practice

In this episode, Neda Shamie, MD, and Peter J. McDonnell, MD, discuss the benefits and challenges of implementing the many options from the premium lens pipeline into practice, emphasizing the importance of customization based on patients' lifestyles and expectations, while also addressing concerns and sharing their positive experiences with the evolving technology in the field.

The views and perspectives expressed are those of Dr. Shamie and Dr. McDonnell.

Audio transcript

Editor’s note: This transcript has been edited for clarity.

Sheryl Stevenson: Hi, everyone, and welcome to this episode of the Ophthalmology Times EyePod podcast series.

This is Sheryl Stevenson, group editorial director with the Eye Care Group here at MJH Life Sciences, and we are joined today by our co-chief medical editors from the West Coast to the East Coast.

Dr. Peter J. McDonnell is the director of the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore, Maryland, and Dr. Neda Shamie is a cataract, LASIK, and corneal surgeon and partner of the Maloney-Shamie Vision Institute in Los Angeles, California, as well as an adjunct clinical professor of ophthalmology at the USC Keck School of Medicine.

In this episode, Dr Shamie and Dr McDonnell discuss the benefits and challenges of implementing the many options from the premium lens pipeline into practice, emphasizing the importance of customization based on patients' lifestyles and expectations, while also addressing concerns and sharing their positive experiences with the evolving technology in the field.

Let’s take a listen…

Neda Shamie, MD: Hi, everyone! This is Neda Shamie, and welcome to another episode of Ophthalmology Times EyePod, where I have the pleasure of sitting here with Dr. Peter McDonnell, who's a colleague, a dear friend, and my mentor—all-time mentor—talking about different subjects that hopefully are of interest to you. They are most definitely of interest to us and very applicable and relevant to our day-to-day practice.

Today, we're going to be talking about premium lenses and how we can implement them in our practice, where the value is to our patients, and what our experience has been between Peter and I [me]. I'm hoping you'll take some pearls from this conversation.

Welcome, Peter. So nice to be here with you again.

Peter J. McDonnell, MD: Great to be with you, Neda. It's a great time to be an ophthalmologist, isn't it? With all the technology that we can bring to help our patients lead better lives including, so often, spectacle independence. The premium IOLs have done a great service to our profession and our patients, don't you think?

Shamie: I absolutely agree. I think, especially with the further advances and the most recent generation of these premium lenses, I forge ahead in my practice with real enthusiasm and offering my patients the lenses.

It's brought a lot of fun into what we do as cataract surgeons in that we are not only clarifying the vision, improving their vision, but also potentially impacting their quality of life by, like you said, offering options that could potentially get them out of glasses.

And a lot of our patients now are empowered with that information ahead of time. They come in expecting a premium offering. But it's also fun when a patient had no such expectation to be able to make that offer, and what a gift that could be to them.

So when I was training with you and I was your fellow...we were all excited because toric lenses became available. The challenge now with the premium lenses is that, unlike how it was 20 years ago where we really had only one option and it was pretty straightforward discussion, the chair time has increased.

And I think we still sadly don't see enough surgeons offer premium lens options, presbyopia-correcting lens options, to their patients partly because I think the feedback we're getting from our colleagues is that the chair time is more challenging for them; the discussion potentially is more confusing; and they're afraid of unhappy patients. Because when patients invest in premium lenses their expectations are higher and the chances of them being potentially unhappy is higher.

But I think you and I can maybe share our experience how it's added a lot of value to our practice. It's added a lot of value to how I interact with my patients. And it's kind of...it has put me on the map, in a sense. This is something I take great pride in is that when a patient comes to me, I spent a lot of time customizing the treatment plan to them. And that customization really comes down to trying to find what the best lens option would be for them.

McDonnell: Well, thank you for alluding to my age, how long I've been practicing, and that I antedate all this great modern technology.

But you're right on. To me, it's so fun to talk to people and say, Hey, what do you do for a living? What do you do for fun? Find out are they the avid golfers? Are they people who drive at night? Are they the Type A perfectionists? Are they the easygoing, fun people? What, what's their definition of 'wonderful' in terms of vision and then using our best knowledge and experience to match their hopes and goals and expectations with the technology available to us.

And so it really gets away from the one size fits all, all patients are the same sort of thing and lets us use all that judgment and experience. That's why we went to medical school.

I'll just say there are some docs who had negative experiences maybe early on and that's caused them to wonder do they want to continue offering these to patients. I think of some of the warning signs of maybe patients to avoid; people with some pretty advanced dry eye; maybe people with epithelial basement membrane dystrophy in the cornea that's going to cause corneal irregularity; maybe macular degeneration, looking and make sure there's not some macular pathology that would decrease contrast sensitivity.

So we definitely want to avoid particularly early on in our experience offering this technology to patients who are potentially borderline or bad candidates. But you're exactly right, matching the right lens to the right patient with the right expectations. It's just so rewarding both for surgeons and for patients.

Shamie: I agree.

And I think there are so many different options that could match your comfort level as a surgeon. And again, as we both alluded to, the quality of the technology has improved and the type of vision our patients are getting from the trifocal lenses that are available to us now is so superior to what the previous generations were that I really urge any surgeon who may have had suboptimal outcomes with the previous generation lenses to really consider the fact that these newer lenses are game changers.

They really are changing the way we approach cataract surgery patients and there's now small-aperture lens options. There are light adjustable lenses, nondiffractive, presbyopia-correcting lenses, extended-range lenses, trifocal lenses—a lot of different options, a lot of opportunity for education through Ophthalmology Times and other sources to really pick what fits comfortably in your hands as a surgeon.

I would really urge you to enter this field because honestly, as a cataract surgeon, you're going to fall behind. Patients will come to your practice expecting such offerings and you may lose that patient if you don't offer them a customized approach to treatment.

So with that, I am going to end our session here.

Hopefully, this was some enticement to really pursue more resources to engage in the premium cataract surgery field. And we're always here for help if you'd like more information.

Thank you, Peter.

McDonnell: Thank you, Neda.