Co-Management

5 Key Things to Do When Co-Managing Premium IOL Patients

By Marc Bloomenstein, OD, FAAO

Sept. 18, 2019

Premium IOLs can vastly improve the post-surgical satisfaction level of patients, enhancing quality of life. Co-managing these patients with surgeons, including educating patients on the new and improved IOL designs, can be a practice-builder, resulting in greater patient loyalty and a greater likelihood of referral to friends and family.

For conventional cataract surgery, which is almost wholly covered by Medicare, the co-managing OD can expect to receive about $90 per eye. For premium IOLs, torics and multifocals, the doctor may receive between $400-$600 per eye. Most co-managing surgeons will pay the OD a fee based on the level of difficulty in the follow-up care demanded by premium IOLs.

Co-management by the OD typically includes pre-surgical consults, as well as post-surgical follow-up visits.

Here are five things my two-location, 3-OD, 1-MD practice does to ensure post-surgery success.

Educate Patients On How Cataracts Are Affecting Their Eyes
The number one thing optometrists need to do is start to address the changes associated with lens aging earlier, long before the patient is ready for cataract surgery. We know that accommodation is affected first, followed by visual acuity and quality of vision as the lens becomes increasingly rigid and opaque. I explain to patients that cataract surgery gives us an opportunity to address all these changes at once to provide them with a sustained improvement in their quality of vision.

Secondly, I think it’s important to have a discussion about lifestyle. Before we can educate patients about IOL options, we need to consider what they like to do with their time, where they hold their phone or reading material, and what their expectations are for their vision and lifestyle post-surgery. Then it becomes easy to have a conversation about how we are now able to seamlessly incorporate a new implant that can suit their lifestyle needs, and maybe even get them out of glasses.

Set Expectations for Post-Surgery Vision
We are fortunate that modern cataract surgery has low complication rates. Today’s IOLs, including multifocal and extended-depth-of-focus (EDOF) IOLs, have minimal side effects. We just don’t see the kinds of severe glare and halo that occurred with early presbyopia-correcting IOLs.

That said, when you work with patients before cataract surgery, you are setting expectations. When you don’t, anything unexpected becomes a complication. So, I tell patients they may notice some glare and halo at night after surgery, but that most patients find it is similar to glare and halo symptoms they already have, and that those symptoms typically improve over time. We also need to make sure patients understand what an IOL can and cannot do, including the possibility of the development of a secondary cataract.

No implant will give them back 20-year-old vision. But with extended depth of vision (EDoV), or multifocal IOLs, we can give them a broader range of vision with minimal trade-offs. If a low-to-moderate myope opts for standard IOLs targeted for distance, they also need to understand that they will lose the ability to see up close like they do now when they remove their glasses.

Explain the Value-Add of Premium IOLs
I prefer the term “lifestyle lenses” to IOLs. I might put it this way:

“Yes, patients do pay out-of-pocket for these lenses, but it is a once-in-a-lifetime opportunity to have a large portion of the refractive procedure (the lens removal) covered by insurance. If you want to see your TV screen and a tablet at the same time, standard IOLs don’t do that.”

What I impress upon the patient is that, after surgery, they will look through their new lenses every minute of the day for the rest of their lives: “So much more of what we do visually today demands good near and intermediate vision that I think it is at least worth considering paying for lenses that make it possible to see at a range of distances without glasses. Why not give yourself the best technology available to suit your lifestyle? These lenses are new and exciting, and there is a cost associated with that.”

Counsel Patients Through Anxiety of Multifocal IOLs
Some patients may be hesitant to opt for premium multifocal IOLs because they are concerned that their eyes will not adapt, or they will otherwise be uncomfortable.

I don’t like to over-complicate the discussion with the patient with a lot of technical details about the IOLs, but I can tell that with newer EDoF lenses in particular, we are able to achieve a seamless range of vision that doesn’t have sweet spots or distortions. Perhaps one of the most important things for patients to know is how satisfied others have been with an IOL.

So, for example, I like to share that more than 94  percent of patients implanted with the Tecnis Symfony EDoF IOL say they would choose the same lens again.1

Be the Patient’s Post-Surgery Cheerleader
Our contribution post-operatively is often to be the patient’s cheerleader. I never say, “Oh, you are only 20/25.” Instead, I remind patients of how far they have come and how well they are doing. It is important to address how they are functioning binocularly, rather than just the visual acuity in the operated eye, and help them deal with their changing vision as they neuroadapt or wait for the second eye to be operated on.

 

Reference
1. Cochener B, Concerto Study Group. Clinical outcomes of a new extended range of vision intraocular lens: International Multicenter Concerto Study. J Cataract Refract Surg 2016;42(9):1268-75.

 

Marc Bloomenstein, OD, FAAO, is a partner with Schwartz Laser Eye Center in Phoenix, Ariz. To contact him: mbloomenstein@gmail.com  

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