Common Myths in Presbyopia Correction

Patient education and clear communication allied to rigorous surgery hold the key to delivering consistent visual outcomes with a high level of patient satisfaction in presbyopia-correcting intraocular lenses, according to Florian Kretz MD.

“The ESCRS clinical research survey showed that 59% of patients are not well educated or know nothing at all about refractive IOL options. Those are the patients we all need to target, and this is where many of our problems stem from,” he explained. “The key is to tailor the information we provide so the patients can understand and use it. We need to encourage them to ask questions about the possibilities of the technology and clarify any misconceptions they might have concerning refractive IOLs.”

Dr Kretz said it was vital to invest time to build empathy and develop a good relationship with the patient. “It is very important to understand the patient’s needs, lifestyle, hobbies, visual tasks, desire for spectacle independence, aversion to photic phenomena, and any comorbidities.”

Discussing some common myths in terms of patient communication regarding refractive IOLs, Dr Kretz said it was a mistake to try to present the patient with as many IOL options as possible.

“While it’s important to inform patients about their available options, do we really need to tell them about every optical design, or is it more important to discuss what their individual needs are, and then use this information to help guide them in their choice of lens?” he said.

He stressed informed consent as a critical part of the preoperative consultation. “The patient can tell you their needs, but you need to explain the risks involved in specific choices. You need to be able to make a confident recommendation to them and explain the rationale behind your recommendation,” he said.

Dr Kretz also advised against promising perfect results.

“There is no perfect result in optics because everything is a compromise. We have to set very realistic expectations for our patients—and that is dependent on the optic and the eye itself,” he said. “We can talk about depth of field, visual quality, and dysphotopsias, but the main message in lens surgery is to under-promise and try to over deliver.”

On discussing costs with the patient for the refractive IOL, Dr Kretz said matching prices with local competition is not necessarily the most effective strategy.

“It may be useful in the beginning. However, the most important thing is to give the patient a cost-benefit analysis, using simple examples from daily life where they may pay extra for particular products. And presbyopia-correcting IOLs do give patients a real benefit, so there is justification for the co-payment to patients.”

Dr Kretz said his own policy is not to reimburse patients in the event of an unsatisfactory outcome.

“I never give refunds to my patients because we perform surgery and we have counselled the patients extensively beforehand,” he said. “I believe it is very important to understand why patients are unhappy. Most of them have visual complaints about the refractive outcomes, or some of them may have physical discomfort with dry eye or stinging sensations from eye drops. But these are all issues that can be detected in the preoperative evaluation, and the patient can be advised what to expect. And most of those issues can be resolved with further treatments.”

The essential principle is to convey to the patient they will be taken care of and there is a solution available to resolve their problem, he added.

For patients with residual refractive error after surgery, Dr Kretz said his preferred approach is to prescribe glasses in the initial phase and then consider other possible treatments.

“We also have very good options with laser correction for lower power errors, piggyback IOLs, and, in the worst case, an IOL exchange. But with presbyopia-correcting IOLs, patients may be happy to use glasses just for distance vision,” he concluded.

Dr Kretz presented at the Independent Medical Education (IME) symposium at the ESCRS Winter Meeting in Frankfurt.

Florian Kretz MD, FEBO is medical director of the Augentagesklinik Rheine in Rheine, Germany. Mail@Florian-Kretz.de