COMMENTARY

Helping Patients Select the Best IOL

Robert H. Graham, MD

Disclosures

July 16, 2009

In This Article

Introduction

Mary is 72 years old. She doesn't mind wearing distance glasses after cataract surgery, but hates having to wear glasses to do needlepoint every evening.

Fred, who is 69 years old, is an avid traveler who wants to make sure he sees as well as possible when he drives at night.

Jack, who is 50 years old, has a passion for golf. He wants to be able to see his golf ball from when he tees up to when he scores his first hole in one.

Cataract surgery is one of the most common surgeries performed in the United States. According to the American Academy of Ophthalmology, over 1.8 million cataract surgeries are performed annually, improving vision in over 95% of cases.[1] How can we make an already good surgery even better?

In selecting the most appropriate intraocular lens (IOL), ophthalmic surgeons should keep in mind that there is no single "best" IOL for every patient. Active listening to the patients' desires for their vision after cataract surgery is critical in selecting the most appropriate IOL for any patient. Matching the strengths (and avoiding the weaknesses) of the various IOLs to the patients' needs and wants for visual functioning will most likely result in both patient and surgeon satisfaction.

As with any surgery, informing patients of risks, benefits, and alternatives is a necessary step prior to taking patients to the operating room for cataract surgery. As part of the informed consent for cataract surgery, patients should be informed of the various IOL options available. The patients' needs should be explored, and the IOL that best matches the patients' goals should be selected for implantation. Patients' active participation in the process of IOL selection should enhance their satisfaction with the surgical outcomes.

With the availability of premium IOLs, such as toric, multifocal, and accommodative IOLs, this process takes more time and effort than when only the standard monofocal IOL was available. However, surgeons who make these premium IOLs available may experience increased patient satisfaction,[2,3,4] thereby increasing surgeon satisfaction, practice growth through patient referrals, and practice profitability.

Unfortunately, the various types of IOLs can certainly be confusing for many patients when not properly educated. Explanation of the various options and their respective benefits and weaknesses, while stressing the differences between them, can aid in the process of understanding. Patients tend to be unhappy when their expectations are not met after surgery, especially if they have paid for a premium IOL. To ensure that the IOL selected will meet patients' expectations, it is necessary for the surgeon to inquire about patients' goals for vision after the surgery.

When learning about the various IOL alternatives, every patient, of course, wants the best one. The following analogy of a taxicab ride is helpful for patients' understanding. A passenger cannot get into a taxicab and simply say, "Take me on the best road." The driver would not know where to take the passenger, and the passenger would ultimately be unhappy. The destination is usually given to the driver, who then selects the best road to get there. Similarly, only when the patient tells the surgeon his or her visual goals can the surgeon select the best IOL to achieve those goals. Thus, just as all roads are perfectly good options depending on the destination, all IOLs are best, but they are best at different things.

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