Communicating Value to Cataract Patients

Value is not about how much technology costs; it is about what it can do for patients.

By Walt Whitley, OD

It is incumbent upon us to stay informed on innovations in contact lenses, ocular surface disease, and advanced intraocular lens (IOL) technologies. We learn about the products and services available, and we understand the benefits they provide to our patients. Today’s contact lenses provide superior comfort and vision. Patients have improved quality of life when we address the underlying causes of dry eye disease with meibomian gland treatments. New multifocal and extended depth of focus IOLs provide improved spectacle independence.

TO THE POINT

Education is key for cataract patients. Arm them with information so they are prepared to speak with their surgeon.

Many of us wear and/or use the latest technologies. Yet some of us do not actually prescribe these products, fearing patients will deem them too expensive and object.

When it comes to IOLs, optometrists routinely discuss elective technologies that may cost patients several hundreds to thousands of dollars. We need to remember that it is up to our patients, not us, to determine whether a given cost is justified. As doctors, we make recommendations to patients based on the technology, the clinical science, and the individual patient’s condition and visual needs. Patients, in turn, must weigh the value associated with a procedure or product.

PRESCRIBE FROM THE CHAIR

Whether you are making a recommendation for an advanced technology IOL, toric or multifocal contact lenses, progressive spectacle lenses, or a meibomian gland treatment, a key component of optometry relies on optometrists prescribing from the chair.

We are uniquely educated on the products available to our patients—we attend lectures, symposia, and workshops to learn about them. As optometrists, we know many of our patients throughout their lives and across their varying visual needs. It is important that we evaluate the data and the available products and let patients know what is available to meet their expectations for their vision.

With a cataract patient, for example, I might discuss the Tecnis Symfony lens (Johnson & Johnson Vision). Patients receiving this implant have been shown to achieve great distance and intermediate vision, although for near vision they may need reading glasses occasionally.1 An extended depth of focus technology, this IOL offers patients a once-in-a-lifetime chance for increased spectacle independence. Our job is to set the stage and start the conversation. We let patients know that they can wear glasses less often, and that there is a toric version for astigmatic correction in appropriate patients.

Think about how much better patients’ experiences will be if they hear this information from their optometrist first. Do not let your patients enter a surgeon’s office uninformed. When they see for the first time the range of technologies and hear about their IOL options only from the surgeon, they will ask, “Why didn’t my doctor explain all of this?”

AN EDUCATIONAL JOURNEY

Cataracts are often called a journey for patients. When patients develop early lens changes, we can let them know why it is happening and what to expect. As their cataract journey begins, so does their educational one. Tell patients that, over time, they will develop a cloudy lens that will have to be removed. Assure them that you can do things along the way, such as prescribing multifocal contact lenses or progressive lens technology, to help maintain their best vision as the cataract develops. Down the road, when their vision is affected by the cloudy lens, it is then time to talk about cataract surgery.

Figure. Screenshot of patient-facing website for Tecnis IOLs (Johnson & Johnson Vision). Patients researching IOL benefits will find information on product websites; such information may inform their decision to choose one IOL over another.

And what a great time it is for cataract surgery! It is our job to make sure patients understand the many options that exist for treating astigmatism or decreasing their dependence on glasses. Get an idea of what your patients' vision goals are. Make sure patients understand that you will work with their surgeon to get the best results. Thankfully, the majority of patients do very well with proper patient selection, patient education, and realistic expectations. In the occasional instance when the patient may not obtain the optimal postoperative result, steps such as LASIK enhancement, IOL rotation, Nd:YAG laser treatment, or therapy for residual dry eye disease may be available to ensure that patients are satisfied with their final outcomes.

GIVE HOMEWORK

When I identify lens changes in a patient, I give homework so they can be prepared for their upcoming cataract evaluation with the surgeon. I ask the patient to read about the condition and the benefits of the various IOL platforms before his or her appointment (Figure).

When patients return for cataract workups, our technicians start them on the various cataract testings and evaluations that help determine if they are candidates for premium technology. A counselor discusses the costs of various options, showing useful comparison charts. This is analogous to what the optician in your practice does when he or she handles discussions with patients regarding frames or contact lenses. Your team educates patients on the options available.

OPTOMETRY IN A LEAD ROLE

Optometrists must be active in the complete care of cataract patients. If we do not take the lead role in educating our patients on their available options, the surgeon, or someone on his or her staff, will. Learn all you can about what today’s technology can do for your patients, and empower them to make informed decisions about their vision. n

1. Tecnis Symfony [package insert]. Abbott. 2016.

Walter O. Whitley OD, MBA, FAAO
• co-Chief Medical Editor, Advanced Ocular Care
• director, optometric services, Virginia Eye Consultants, Norfolk, Va.
• financial disclosure: consultant, Johnson & Johnson Vision
wwhitley@vec2020.com