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Cover Stories | Feb 2009

The Patient’s Experience With Refractive IOLs

Focusing on the eight Es involved in guiding a patient to choose a premium IOL.

When examining the patient's experience with refractive IOLs, it is important for surgeons to remember that the patient is making a buying decision based on a desired outcome. This process is not dissimilar to other significant uses of discretionary income. The outcome that is being purchased, however, is not a depreciable asset but an investment in himself that will yield a daily return through improved quality of life. This article discusses the buying process and pinpoints the important elements of the decision-making process so that surgeons and their staff can more effectively guide patients' experience and help more of them choose a refractive IOL.

Ophthalmologists are accustomed to focusing on the big E on the Snellen chart. This article focuses on the Es of the patient's experience: ease, employees, education, everyone, environment, economics, excitement, and evaluation.

Surgeons should make the decision to choose a refractive IOL simple and easy to understand. Electing to have a surgical procedure is not straightforward for most patients, especially when the choice is complicated by consent forms, brochures, educational materials, and pre- and postoperative instructions. In addition, there is the maze of third-party coverage, copayments, deductibles, and co-insurance that patients need to consider. Often, surgeons overcomplicate the explanation of refractive IOLs, the specific functional details of each design, and their benefits and risks. After a few hours, patients experience information overload that may result in something like mental paralysis.

There are two fundamental questions for the patient: (1) What daily lifestyle activities bring joy to my life? and (2) Would I more thoroughly enjoy the activity without glasses? There are tradeoffs that a patient may face such as halos or rings around lights in order to experience the visual freedom of life without glasses. The patient must first establish an emotional connection to the benefits of spectacle independence before he can effectively evaluate such tradeoffs. Simplifying the decision by reviewing the aforementioned two questions will bring into focus the value the patient places on spectacle freedom, which will provide a basis for further evaluation.

It is hard work to make the decision-making process easy. It requires all of the surgeon's employees to have a thorough knowledge of the lenses, their pricing, their benefits, and the tradeoffs associated with cataract surgery and refractive IOLs. Surgeons and employees should choreograph and script each step of the course. Furthermore, whereas the surgeon leads the patient through this process, each staff member helps direct the patient from one segment of the process to the next. As with any guide, knowledge of the terrain is extremely important to ensure the patient gets to the desired location or, in the surgeon's case, the decision point for a refractive lens.

Most patients have heard of LASIK and are also familiar with a wide range of cosmetic surgeries. The majority, however, have not heard of a refractive IOL. Patients typically arrive at a practice for an evaluation with little knowledge of cataracts, astigmatism, and IOL options. Surgeons should utilize all possible methods and materials to increase patients' education in these areas before they even sit down for an examination. Directing patients to a practice's Web site is the least expensive means for delivering educational content such as videos, answers to frequently asked questions, testimonials, and information on lens choices. Surgeons should provide patients referred by other physicians with a complete packet of educational materials prior to their examination. Information regarding refractive IOLs is available if a savvy patient goes online, but surgeons should control the information presented and ensure their patients are appropriately educated before an examination. Surgeons should also turn any time spent waiting by the patient into an educational session. Whether in the lobby before the examination or during dilation, the patient should have ready access to videos, brochures, and other educational material refractive IOLs.

Often, surgeons predetermine a patient's interest in a refractive IOL before they have educated the patient on its benefits or evaluated his lifestyle interests. Obviously, not all patients are clinical candidates or able to afford the procedure. Surgeons should allow each patient the opportunity to decide if a refractive IOL procedure is right for him. The surgeon may determine that the patient does not meet the clinical selection criteria or that the price may be a barrier, which the patient cannot overcome, but surgeons have an obligation to educate patients about the best technology available. At a minimum, the surgeon will have educated another patient who might share the news of the advanced technology with a spouse, neighbor, or friend.

The patient's decision-making process begins with his first encounter with the surgeon—whether on the phone, via the Internet, on the sidewalk, or in the practice's lobby. In an increasingly competitive market for elective medical procedures, refractive cataract surgeons' offices are comparable to medical spas and the offices of cosmetic dentists and cosmetic surgeons. I encourage physicians to walk through the entire experience as a patient to really understand the facilities, personnel, and processes and to identify areas that need improvement.

Surgeons should discuss the cost of elective refractive IOLs in terms of a lifelong investment (ie, a potentially spectacle-free lifestyle). For example, surgeons should help their patients envision themselves picking up a book anywhere and at anytime to read to their grandchildren without searching for their reading glasses. Comparing the investment in a refractive IOL with other discretionary spending such as travel can quickly demonstrate that the dollar-per-day expenditure is extremely low, given that the yield from the investment is for life.

Do patients leave their evaluation for refractive cataract surgery excited? Most patients who schedule LASIK cannot wait to tell their friends they are undergoing the procedure. Why should the refractive IOL procedure be any different? If patients are not leaving the practice excited, then the surgeon has not effectively educated them about the benefits they will soon experience. Surgeons need to help patients envision a future of freedom from glasses, whether it involves surfing, playing tennis, or simply putting on eye makeup. As patients realize the lifestyle benefits they will enjoy every day, their enthusiasm will build. Ultimately, patients should burst out of the office to tell their friends and family that they are about to undergo cataract surgery with a refractive IOL.

The postoperative visit is not the end but the beginning of a patient's experience without glasses. The visual benefits achieved through a refractive IOL procedure may not be immediate. In addition to the postoperative visits, quality assurance calls from the refractive counselor at 1, 6, and 12 months allow surgeons to obtain subjective data from the patient that they might not have received from the reerring doctor or during the postoperative visits. This is the time to reinforce the buying decision through affirmation that the patient is enjoying the lifestyle benefits discussed in the initial examination. It is also a great time to ask the patient for referrals. If the patient is dissatisfied for some reason, surgeons will be aware and can address the problem immediately.

In summary, if surgeons can focus on the Es and create an experience that effectively moves patients through the buying decision, physicians will find that their patients more often opt for a refractive IOL. In today's economic environment of decreased discretionary spending and frugality, surgeons can actually experience growth in refractive IOL conversions by helping patients through a sound buying-decision process that considers the long lasting value of investing in an improved quality of life. Now, ophthalmologists have the opportunity with refractive IOL technology to provide patients with an investment opportunity that will yield a daily dividend.

James D. Dawes, MHA, CMPE, COE, is Chief Administrative Officer for Center For Sight in Sarasota, Florida. Mr. Dawes may be reached at (941) 480-2105; jdawes@centerforsight.net.

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