Eyeworld Supplements

I also take the time to explain to them what I think would be the worse option for them. With a diffractive lens, if they can't accept it, they will likely need explantation, whereas with an accommodative lens, after 6 months, if they have a complaint, they will likely only need occasional reading glasses. Dr. Ang: I usually discuss with them the possibility of different targets for each eye. I base the second eye on the refractive outcome of the first eye. I tell them not to expect the same vision, but that when both eyes help each other out, they will achieve a greater range of vision for far and near. I usually target the second eye at least –0.5 to –0.75 so that we provide a little bit more near vision. I also talk to them about capsular fibrosis. I tell them that whichever lens we use, there is a chance that as the eye heals the capsule will thicken. That way, they aren't surprised and upset that we need to perform another treatment such as a YAG capsulotomy later on. I think the YAG laser is an important part of post-op care for our premium IOL patients. Dr. Dick: Setting patient expectations can be useful, but I would rather listen to what a patient wants, explore the patient's needs—what he does, what his job is, what kinds of tasks he per- forms every day. What are his inter- ests? What about driving? Driving is a task for which the Crystalens AO is better suited than multifocal IOLs. We have a questionnaire that patients fill out while they are waiting —it is our own questionnaire that we developed at our clinic. At our clinic, we offer a wide range of premium IOLs in addition to the Crystalens AO. The questionnaire allows us to evaluate the patients' desires and psychology first with basic questions that I will not need to repeat later on. Then we make recommenda- tions, presenting them with the pros and cons of each IOL, and we guide them to the decision that best suits their wants and needs. In the end the choice is up to the patient, but we do everything we can to give them the ability to make a completely informed decision. Dr. Kent: We always try to under- promise and overdeliver. I counsel my Crystalens AO patients on the antici- pated outcome, and I follow them for 12 months. I tell them that they can expect to have good distance vision, good intermediate vision, and can read good print in good light. But if they have small print or are in bad light, they'll need some low power readers. Enhancing satisfaction Dr. Lindstrom: Sometimes, in spite of all that counseling, patients will come back dissatisfied with their vision. Having looked at my own data, I've found the amount of additional depth of focus that I get with the Crystalens AO is about 1.25 D versus a monofo- cal, so that when I have a Crystalens AO with plano sphere, the add required for best near acuity is on average +1.25 and with a monofocal it is +2.50. With patients who are disap- pointed, I sit them down and simulate what their near and intermediate vision would be like with monofocal lenses by placing a –1.25 diopter loose lens in front of their eye. This can give patients insight into the benefit they have achieved. What do each of you do with patients who are unhappy with their near vision? Do you find yourself performing enhancements, making one eye more myopic? Dr. Yogi: We target mild myopia in the non-dominant eye. I target –0.25 in the dominant eye and –0.5 in the non- dominant eye. I think my patients are very happy with this performance, and surprisingly, the most satisfied patients are the younger ones. I've had some experience with patients 30 years old, 40 years old, and they are young workers, they use computers a lot, and like Dr. Fernandez said, they use smartphones. They are really happy with the Crystalens AO, and I think this is better than a multifocal option because they are drivers. So young patients with cataract are very satisfied with the Crystalens AO, too. Dr. Fernandez: I think an unhappy patient results from a mistake in the decision-making process; it's our responsibility to communicate the pros and cons of a lens to a patient, to find the perfect solution. I do some- thing similar to Dr. Lindstrom's loose lens trick, but I do it before surgery. The key to a happy patient is the decision-making process and commu- nication before the surgery. Dr. Ang: LASIK is probably the best trick we have. I do hyperopic LASIK if a patient is too hyperopic. I think corneal strategies are our best tricks. Dr. Fernandez: If we are going to operate on a patient's cornea, to manipulate a spherical aberration using a laser platform, I think that the Crystalens AO is the best option for that patient. Dr. Dick: Patient satisfaction with the lens is extremely high. In our experi- ence, patients have been dissatisfied with other lenses, but not with the Crystalens AO. We've had excellent performance with the lens. Dr. Kent: There is a small proportion of patients who do not read as well as I'd hoped they would. In the small proportion of my patients who find they still require occasional low power March 2012 9

• Cover