Key Considerations for Selecting a Premium Intraocular Lens

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EP: 1.Key Considerations for Selecting a Premium Intraocular Lens

EP: 2.Vision Outcomes with Light Adjustable Lenses

EP: 3.Deciding Between Multifocals and Light Adjustable Lenses

Sharon Richens, MD, FACS: Hello, I am Sharon Richens. I’m a cataract and refractive surgeon and the owner of Richens Eye Center here in St George, Utah. I was happy to be the moderator of a recent Ophthalmology Times Roundtable about premium lenses and how to expand them in your practice, how to present them to your patients. And I’m thrilled to be able to share some of the insights from that roundtable.

We began…by talking about what the key considerations were in selecting patients for premium lens technology. And the consensus was that you should never prejudge a patient as to whether they might be interested or might be able to afford or willing to pay for premium lens technology. Even some patients who [had] very strict managed care programs or even Medicaid had other resources or friends or family who were happy to help them achieve the best possible visual outcome.… The standard approach to the physicians involved was to present all…the options to the patients so [they] at least knew what was available and then leave it to the patient to let the physician know what they would be able to work with in order to achieve the best possible results.

With the multifocal lenses, the consensus was really being careful to ask patients about their visual needs as well as keeping an eye out for personality factors and of course for any visual pathology that would preclude them from using a multifocal [lens]. There was enormous excitement about the light adjustable lens but also a little reluctance because of the cost of implementation among some of the physicians, including some of the really well-seasoned physicians. And for some of them the concern was how to create coalitions among their neighboring physicians in order to access the technology. Individualizing the choice of premium IOLs [intraocular lenses] really came down to getting a best possible feel for the patient’s visual needs––of course with an eye to the ocular pathology, which the physician understands remarkably better than the patient––and really being able to explain that.

There was a lot of discussion about how to present these options to patients, and the…key question that came out was patients want to know what you would choose for yourself or what you would choose for a family member and why, and if for some reason that’s not appropriate for them, why would that be. For instance, if you’d chosen a multifocal [lens] for your mother, why might [that] not be a great choice for that patient? And if you [did] choose a light adjustable lens, what exactly [is] that all about and why would you choose [that]?

[Regarding] lifestyle benefits, it really comes down to a conversation about what that patient’s lifestyle is and how that might give them the best possible advantage. And [as for] the discussion over the entire life span, I thought [that] was important and frankly a little bit poignant. As some of our patients get older, it’s harder for them to maybe handle glasses or find glasses [or] remember [to bring their] glasses, and it’s a real advantage to be hands free. With regard to reasonable expectations, there was a real emphasis on considering expectations both short term and long term. Of course the goal is to make the patient’s vision as perfect as possible at the time of surgery and [think about] what their life expectancy is. And one of the considerations among physicians, of course, is if you do your very best possible surgery and the refraction is not perfect––the vision is not 20/20 or, God willing, 20/15––what will you do to close the gap and what should the patient expect from you to close the gap, both in terms of logistics, if you’re planning to do LASIK [laser in situ keratomileusis] or PRK [photorefractive keratectomy], but also cost. Is that cost bundled or is that separate? And that conversation had in advance makes things much easier if, in fact, you were not able to achieve 20/20 in spite of your best efforts. [Regarding] long-term expectations, of course, we all know that eyes are going to change a bit with age. And sometimes there are factors you can predict based on that patient’s eye already or family history and sometimes you really don’t know. And giving a patient reasonable expectation of that helps really improve the practice’s relationship long term with that patient and everybody that they might know, including their family.

Transcript is AI-generated and edited for clarity and readability.