Everyone loves pearls — and not just those little nuggets oysters produce. Indeed, surgical “pearls” from ophthalmic experts are just as valuable, serving as succinct tips to help educate, inform and ultimately, improve outcomes. On Day 2 of the annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS 2022), delegates were treated to a session that covered “pearls” on a variety of topics important to cataract specialists. Below, we highlight My Top 5 Pearls for Explaining Cataract Refractive Surgery as presented by Dr. Richard Tipperman, Wills Eye Hospital, Philadelphia, Pennsylvania.
Pearl #1: Word Choice Makes a Difference
“Realize that your patients don’t understand a lot of what you’re telling them, even when you’ve spent a lot of time. So, the simpler you keep things the better,” began Dr. Tipperman. He explained that words like “monofocal” don’t mean much to patients and commonly used words like “standard, routine or conventional” pre-bias patients to believe that that’s a better choice.
“When people are faced with a limited subject area that they don’t know much about, they tend to want to default to the choice that everyone else picks,” he shared.
“I believe a much better choice for ‘monofocal’ is a ‘basic’ IOL,” he said. This term is easily remembered by the patient and confers that “you get what you pay for,” (i.e., no frills). “Most importantly, when you’re trying to educate people about their options, it allows you to compare what’s available with other lenses … and it’s important that everyone in the office use the same term.”
Pearl #2: Avoid the Premium
Dr. Tipperman also believes that calling elective IOLs “premium” is not helpful either: “‘Premium’ implies paying a higher fee for a service that may be a luxury, or something that doesn’t increase the value or utility.”
However, he said that people understand the concept of “advanced technology.”
“The nice division is you can compare ‘advanced technology’ lenses to ‘basic’ lenses and it’s easy for the patients to understand,” explained Dr. Tipperman.
Pearl #3: Set the ‘Expectation Bar’ Low
When you talk about ‘advanced technology,’ don’t start by saying “you’ll never wear glasses again,” said Dr. Tipperman.
Instead, he said that ophthalmologists should explain what life will be like with a ‘basic’ IOL: “What I tell patients is that a basic IOL will give you excellent distance vision — but everything from arm’s length on in will not be in focus unless they wear glasses or progressive bifocals.”
On the other hand, with an ‘advanced technology’ lens, vision will be better than what’s achieved with a ‘basic’ IOL.
“If that’s the bar you set, you’re going to be able to hit that every single time,” said Dr. Tipperman.
Pearl #4: Show Them the ‘Cockpit’
Showing patients their astigmatism and biometry/calculations can help them understand the complexity of the care they’re receiving and the “value proposition” for their services, continued Dr. Tipperman.
“If you show this to the patient as you’re talking about their choices, they realize the thought process, the technology and the work involved in trying to counsel them and pick a better technology lens for them … it doesn’t take anymore time, but it’s another way of driving home the value and the knowledge base that’s required to get them a good result,” he explained.
Pearl #5: Review the Potential for Glare/Halo
“You have to review the potential for glare and halo if you’re using any lenses that are going to try to correct presbyopia,” said Dr. Tipperman, adding that “things discussed before surgery are expectations; if they’re discussed after surgery, they’re complications.”
He said it’s helpful to show patients a picture of what these postoperative starbursts or glare could look like. “If you discuss this ahead of time … then they at least know that it was a possibility.”
Editor’s Note: ASCRS 2022 was held on April 22-26, as a physical show in Washington DC, USA. Reporting for this story took place during the event.
