How to Talk to Patients About Refractive Cataract Surgery

“Say no more, doctor. I agree completely.”

Don’t you wish that was every patient’s response to your refractive cataract surgery recommendation? Unfortunately, the real response is usually more like “I need some time to think about it.”

You know that hi-tech IOLs are on a whole new level when it comes to improving a patient’s vision. But how successful are you at expressing this to your patients? If you’re not getting as many “yes’s” as you’d like, rethink how you present the refractive option to patients.

Start with Small Talk

Avoid jumping straight into a clinical conversation—spend some time warming up the patient. Bonding with the patient and establishing rapport helps patients feel more comfortable and open to your suggestions. Be sincere and don’t rush. “Learning about people takes true interest in them and time to learn about them,” says David Hardten, MD, who spoke about patient communication at a previous AAO conference.

Conversation Starter

Before you present any cataract surgery options, you must determine the patient’s goal. A pre-visit questionnaire can greatly simplify your discussion, Hardten points out. He gives this example:

1. How interested are you in seeing distance without glasses?
• I prefer no glasses.
• It’s not important. I don’t mind wearing glasses for distance.

2. How important is it for you to see up close (i.e. reading) without glasses?
• I prefer no glasses.
• It’s not important to me. I don’t mind wearing reading glasses.

3. What if you could have glasses-free vision for distance (i.e. driving) during the day and glasses-free near vision in most situations? Would you tolerate some halos and glare around lights at night, and be willing to use glasses in some situations?
• Yes.
• No.

Once you know what the patient wants—and patients themselves may need time to think about that—you can tailor your discussion around their particular goals. Now, follow these eight guidelines, courtesy of John A. Hovanesian, MD, another AAO presenter, for patient conversations that will grow your refractive cataract surgery revenue:

Guideline 1

Get all practice staff on board—and excited about—the technology of refractive cataract surgery. That includes physicians. In most cases, you won’t be able to successfully recommend technology that you’re just not that into. Patients will pick up on those clues in your voice and body language. “Take the hesitation out of your voice,” says Hovanesian.

Guideline 2

Discuss all surgical options with all patients. For example, sometimes imaging suggests that with enough refractive accuracy, you can correct a patient’s presbyopia with a monovision lens. But don’t underestimate how important a discussion is for the patient. “Understand that even patients who you don’t think should have a presbyopic IOL may have similar desires [to those you think should] and also deserve a discussion about options,” notes Hardten.

Tip: Don’t ever ask a patient how they feel about wearing glasses. If a patient doesn’t mind wearing glasses, why would they pay extra not to wear glasses? You’ve likely taken premium IOLs out of the running.

Guideline 3

Educate the patient about how refractive cataract surgery differs from standard cataract surgery. Use layman’s terms.

Hint: don’t ever use the words spherical aberration.

Example: The goal of standard cataract surgery is cataract-free vision. We remove the cataract and replace it with a clear lens. If you currently have vision problems that are corrected by glasses (like astigmatism or farsightedness), you’ll still have those problems and you’ll still need glasses to correct them.

The goal of refractive cataract surgery is to get as close as possible to glasses-free vision. It does everything that standard cataract surgery does, plus it corrects your vision problems and minimizes reliance on eyeglasses.

Guideline 4

Understand the patient’s perspective. They often want a guarantee of the results, and you can’t give them that. Explain that the goal of refractive surgery is to get their vision to the best it can possibly be, and that you won’t know how close you got to that goal until well after surgery. Be clear about limitations and complications.

Try this: If a patient asks about their chances of still needing glasses, tell them “Most people can do most things most of the time without glasses,” suggests Hovanesian.

Guideline 5

“Offer more than one type of implant, but talk only about the implant you recommend,” advises Hovanesian. When offering hi-tech IOLs, avoid comparing them to perfect vision. “When you’re comparing to perfect, you’re going to be disappointed, whether it’s your lens implant, your car, your computer, or your spouse,” quips Hovanesian. Instead, compare them to standard implants. And keep it simple. Don’t bother with brand names or a ton of specs—patients don’t care.

Guideline 6

Physicians and staff should be matter-of-fact when discussing price. Some patients will have ‘sticker shock,’ others won’t. If you act apologetic about the price, patients will assume you’re charging too much or the refractive option isn’t worth the money

Guideline 7

When faced with the choice between standard and refractive cataract surgery, patients often ask for their physician’s opinion. You don’t want them to feel bad about opting for standard, so let them know that there are no “bad” choices, and to choose the option that will best fit both their vision goals and their budget. Make it personal, Hovanesian recommends. Say something like “People ask what lens I would choose for myself and there’s no doubt in my mind … “

Guideline 8

Follow up, before and after surgery. Some patients simply won’t make a decision right away. Contact them after their visit to answer additional questions they may have.

Sample Script: “Many of our patients like to take some time to do their own independent research, and there’s a lot of misinformation out there. Is there anything I can clear up for you?”

After the procedure, “keep in touch with the patient until you know they are happy,” Hardten advises. Remember, this could be a month or more. “Happiness breeds happy referrals,” he adds.

Tallking About Cost

Patients typically want a detailed, written explanation of costs, with a clear breakdown of what’s covered by insurance and what’s not. Point out that insurance (usually Medicare) covers the majority of the cost no matter which option the patient chooses. That includes the cost of standard cataract surgery and lenses, along with associated fees like anesthesia, facility fee, and post-op care.

Make sure the patient knows that if they choose the refractive option, their insurance will still pay up to the amount of standard surgery, but payment for upgrades is out-of-pocket. Reiterate that refractive cataract surgery is optional, and not every patient decides it’s for them. If your practice offers financing, this is the time to let the patient know. Remember to use an ABN for Medicare patients.


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