The FDA has issued more than 30 labeling approvals since the excimer laser’s introduction onto the US market in 1998. By and large, refractive surgeons have used either wavefront-optimized (Alcon) or wavefront-guided ablation profiles, and there is no shortage of comparative literature. Widening the field, the FDA recently approved topography-guided and high-definition wavefront aberrometers. Discussing the relative advantages of available technologies with patients can be challenging.
TAILOR THE MESSAGE
Patients seeking refractive surgery are generally far more interested in their candidacy and the procedure’s safety than they are in the technical aspects of various laser platforms. Millennials, I find, are primarily interested in their schedules and, therefore, prefer to know if they can have surgery and get on to their next activity. Moreover, in my experience, refractive surgery patients want a recommendation rather than a description of multiple options from which they must choose.
For these reasons, at my practice, we strive to simplify the refractive consultation. Instead of discussing the comparative aspects of the laser platforms, we recommend the procedure and technology that we deem to be the best for a given patient and then discuss their merits. The type of laser ablation chosen is based on the patient’s optical profile or the correction limits of the platform. Technical discussion is reserved for specific circumstances such as highly aberrated eyes or therapeutic applications. Our approach is similar when making a selection within a class of IOLs. Our choice of IOL is often based on the cornea’s aberration profile, which we typically do not discuss with the patient.
DROP THE MENU
In the past, we sought to differentiate among excimer laser platforms for patients, discussed the potential for improved outcomes, and cited FDA data on the merits of advanced technology. Our counselors would use a price-stratified menu of different laser platforms, much like discussions of premium versus insurance-based IOL technologies. Over the years, however, we have moved toward a vision-goal scenario instead of a technology menu. This approach has proven much more intuitive for our patients, as long as the terminology is meaningful to them.
George O. Waring IV, MD, talks with Gary Wörtz, MD, about today’s management of presbyopia.
USE MEANINGFUL TERMINOLOGY
We offer whatever technology we feel best suits an individual’s needs. When educating patients, we use language that will be meaningful to them in terms of speed, accuracy, outcomes, comfort, experience, and safety. For example, a surgeon may explain that high repetition rates are “faster” and estimate the amount of time the laser may be used. The ophthalmologist may discuss topography- and wavefront-guided technologies in terms of “customization” or treating nuances specific to an individual’s eye. Patients respond well to this approach.