Presbyopia Correction Technology: Approaching the Patient Conversation

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7 min read

In this episode of Interventional Mindset, Dr. Wiley discusses how ophthalmologists can optimize patient communication around presbyopia correction technology.

With two decades as a cataract and refractive surgeon, Dr. William F. Wiley, MD, has been educating patients on the ever-advancing technologies available to them, including introducing the concept of presbyopia correction through intraocular lenses (IOLs) during refractive cataract surgery. Here, he shares his top tips for effective communication.

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5 strategies for educating patients on presbyopia-correcting technology

First, he recommends taking a multi-tiered approach, spanning over weeks (or months). Trying to inundate the individual with the majority of information at one time can be challenging for both the physician and the patient. When it comes to education, Dr. Wiley believes the sooner you can start the discussion, the better.
There are several tools a clinic can use to educate patients on technologies and techniques, starting well before the day of surgery.

1. Host seminars.

The Cleveland Eye Clinic, where Dr. Wiley serves as medical director, hosts seminars that are open to interested parties on numerous ophthalmic topics, including cataract surgery. The group meetings are held in community centers, recreational facilities, churches, etc.
During the seminar, the educator presents a slide presentation offering an overview of cataract surgery and outlining the various IOL options. Dr. Wiley feels meeting patients in a non-clinical group setting not only garners a different level of comfort and trust but sparks interesting dialogue.
He notes that some of his patients have attended several seminars and have subsequently asked family and friends to join them. Beyond providing patients with useful information and a forum to ask pertinent questions, this is an excellent source of word-of-mouth marketing for a practice, making it a win-win situation for all.

2. Send out literature.

Arm individuals with information by sending them patient handouts, pamphlets, or other educational resources prior to their evaluation/appointment.
This allows prospective patients to develop a general knowledge of cataract surgery and presbyopia-correcting technology on their own time and to put together a list of inquiries prior to arrival.

3. Engage staff in pre-appointment counseling.

Have a staff member reach out prior to the appointment to gauge both the patient’s understanding and their expectations.
Alongside explaining the surgical options, have staff ascertain their top priority list of visual needs, what they expect to get out of surgery, and what are their short-term and long-term goals.

4. Adopt educational software.

Dr. Wiley and his staff utilize Surgiorithm, an innovative, personalized software solution that can aid in both education for the patient and preparing the surgical team to understand the patient’s expectations from a lifestyle and financial standpoint.

How to use Surgiorithm

Patients who are scheduled for cataract surgery are first registered into the Surgiorithm system. Next, they receive an introductory call/text and an email link allowing them to access the online education program.
Once they have clicked the link, they are given the opportunity to fill out a personalized questionnaire that assesses their surgical goals based on lifestyle, finances, current vision, and expected post-operative vision. The interactive survey then offers a report that shows a comparison of the available IOL packages.
It also directs them to educational videos prepared by the practice for the various surgical scenarios, such as multifocal lenses, astigmatism correction, post-laser in situ keratomileusis (LASIK) procedures, etc.
Based on the patient’s answers, the practice receives a report revealing their preferences and vision goals (i.e., near, distance, or both) as well as a predictor—in the form of a color-coded number—on how likely the individual is to request or accept a premium IOL. Having this information beforehand prepares the surgeon with the ability to further personalize his approach.
According to Dr. Wiley, the software has proven incredibly helpful in understanding exactly what the patient is looking to gain from the surgery, which, in turn, guides the surgical approach.

5. Utilize telehealth platforms

Telehealth is another useful technological advancement to employ. Especially in the case of a patient who is being referred by an optometrist, it is beneficial to meet through a telehealth appointment or video meeting to have a face-to-face interaction prior to the first in-office encounter.
Patients are often more relaxed in their home environment and can easily have a family member in attendance to offer support or take notes if need be.

Doctor-patient discussions

When aiding a patient in the decision-making process for a given IOL, Dr. Wiley keeps the discussion as simple and straightforward as possible. He begins by explaining the basic principle that when a cataract is removed, it is replaced with a new lens.

Clinical pearl: Avoid using the product brand names (i.e., TECNIS Symfony), which can be confusing, opting instead for simplified terminology such as “multifocal lenses.”

He then breaks it down into the three different levels of lens technologies in the following manner:
  1. “If you have a basic-style surgery, you will continue to wear glasses similar as you do now, for both near and distance vision.”
  2. “There is also a lens that provides high-quality distance vision by treating astigmatism, meaning you would likely only need to wear reading glasses.”
  3. “A third type has either a bifocal or multifocal ability built into the lens which can provide distance, intermediate, and near vision.”

Patient education on multifocal lenses

In addition, Dr. Wiley always makes certain to offer the caveat to multifocal lenses by stating that, in return for a full range of vision, there may be some sacrifices, in particular, glare while driving at night.
Therefore, it follows that multifocal IOLs are likely not the best choice for those whose lifestyles or occupations involve nighttime driving or other after-dark activities. This often disqualifies pilots, police officers, and truck drivers, for example.

Clinical pearl: Focus first on the patient’s goals and choose the lens that best matches those goals.

In summary

Too much information doled out at one time can be overwhelming and create anxiety, which might lead a patient to have a more difficult time making informed decisions. Consequently, think of patient education in the longer term.
Start the dialogue about the actual procedure and talk about the available len options earlier by continuing to supply information at regular intervals through different mediums up until the surgery. Avoid high-pressure sales tactics in lieu of quality individualized information tailored to the patient’s goals.
Taking this proactive extra step is another way to integrate an interventional mindset into your surgical practice.
William F. Wiley, MD
About William F. Wiley, MD

William Wiley, MD, is a board-certified ophthalmologist who has pioneered many eye procedures in the Northeast Ohio area. Dr. Wiley is the Medical Director of the Cleveland Eye Clinic. Dr. Wiley was one of the first in the area to offer his patients all-laser LASIK as well as laser-assisted refractive cataract surgery.

Dr. Wiley participates in many clinical research studies, and because of this, he is often able to offer his patients technology that is not yet widely available in most clinics in the United States. He was one of the first in the country to implant RxSight’s Light Adjustable Lens (LAL) post-FDA approval. Dr. Wiley was the first in the area to implant the iStent and Hydrus MIcrostents for glaucoma. He was one of the first in the area to implant the Tecnis aspheric, Rezoom, Panoptix, and Vivity Multifocal Intraocular lenses available for cataract surgery. To date, Dr. Wiley has performed more than 50,000 cataract and refractive surgical procedures.

Dr. Wiley performed cataract surgery on a 1.5-pound Golden Lion Tamarin Monkey named Ana at the Akron Zoo in 2017. Ana was the smallest mammal on record in the world known to have had cataract surgery.

William F. Wiley, MD
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