Making the upgrade decision

Key Points

Too often, physicians fail to appreciate the trade-offs inherent in the "default" of monofocal vision for our aging patients. When they are wearing reading glasses or bifocal/trifocal spectacles, the brain first must select whether to look near or far. Patients cannot perceive multiple distances simultaneously, which can have a detrimental effect on the ability to make quick visual assessments, especially when combined with slower reaction times.

Peripheral vision may also be limited with glasses. By comparison, multifocal IOLs offer the advantage of a stable and full visual field at all times.

Present the options

My philosophy is always to recommend the lens that I believe is the best option for the patient and then take as much chair time as he or she needs to help the patient understand and make the decision. I explain that there is an out-of-pocket cost, but leave the discussion about price and financing to a staff member. That conversation with staff only happens after my examination and discussion with the patient.

We have seen a tremendous response with this approach: More than 50% of our patients now choose a premium IOL. Ultimately, the number one factor in patients converting to a premium IOL is the surgeon's confidence in the technology-and when that is based on visual outcomes and patient satisfaction, everyone wins. I have found that a patient's decision to upgrade to a premium IOL is largely dependent on the surgeon's confidence in recommending these lenses. As multifocal technology has improved, outcomes have improved dramatically, giving me great confidence in recommending this option to patients.

A recent study demonstrates the excellent visual acuity and high rates of spectacle independence that patients achieve with one of the lenses we most frequently implant (Tecnis Multifocal IOL, Abbott Medical Optics).

We evaluated the results of patients undergoing cataract surgery at Atlantis Eye Care with implantation of a one- or three-piece model of the presbyopia-correcting IOL in one or both eyes. To be enrolled in the study, patients had to be at least 1 month postoperative and have had an uneventful surgery, without complications or adverse events. Subjects with known ocular pathology (other than cataract) or systemic diseases that could affect visual acuity or increase risk were excluded, as was anyone who required ocular medications other than our typical post-cataract regimen. One hundred consecutive eyes meeting these criteria were evaluated.

A study follow-up visit was scheduled at least 30 days after surgery. At this visit, we measured uncorrected visual acuity at far, intermediate (28 to 32 inches), and near (14 to 16 inches) distances, best-corrected visual acuity under photopic conditions, and manifest refractions. Patient questionnaires were also administered.