Eyeworld

SEPTEMBER 2019 | EYEWORLD | 49 R before. Our technicians continue the discussion with a lifestyle questionnaire, and if patients see one of my optometrists before seeing me, presbyopia- or astigmatism-correcting options are discussed, if appropriate. Dr. Donnenfeld: I agree completely that there needs to be multiple touchpoints. That is a fundamental concept here, but I don't think it matters that much whether or not those multiple touchpoints occur before or after the consultation. There are many different ways to skin this cat. We don't have touchpoints before the patient sees me—there is some marketing material in the office—but I feel very strongly that I want to make the recommendation to the patient of what I think is best for them before they have any preconceived concepts. We do a thorough preoperative exam, as all of us do, then speaking with the patient, looking at the data that I have, which includes topog- raphy, OCT, ocular surface evaluation, I make a recommendation to the patient of what I think is in their best interest. I talk to them in simple terms. I don't talk about technology, I talk about visual results and what they want, and if they're a good candidate, I go through a description of how we can give great vision with glasses all the time, great vision with glass- es for reading, or great vision all the time with no glasses. I go through the risks and benefits. After I do the consultation and leave the room, the patient talks to my technician who goes over it a second time. Then they go to the surgical counselor and they get the options a third time. So we do it a little differently than what I've heard here, but it's the same effect. It's multiple touchpoints. At the end of the day, it's about keeping the concept simple, not overloading with information, and allowing the patient to make a good decision that they understand. The final aspect is to bring family members into the room, if possible, because patients don't re- member. Having that extra family member there is sometimes incredibly beneficial in helping the patient make a good decision. Dr. Vukich: Often patients won't make a deci- sion at the time of their initial visit. They'll want to talk to family members or take some time to think about it. Do you change your preopera- continued from page 46 Contact information Chang: dchang@empireeyeandlaser.com Donnenfeld: ericdonnenfeld@gmail.com Maloney: rm@maloneyvision.com Solomon: Kerry.solomon@ carolinaeyecare.com Thompson: vance.thompson@ vancethompsonvision.com Vukich: javukich@gmail.com Waring: georgewaringiv@gmail.com Wiley: drwiley@clevelandeyeclinic.com Relevant financial interests Chang: Johnson & Johnson Vision, Carl Zeiss Meditec Donnenfeld: Alcon, Allergan, Johnson & Johnson Vision, Novartis, Carl Zeiss Meditec Maloney: None Solomon: Alcon, Allergan, Bausch + Lomb, Johnson & Johnson Vision, Carl Zeiss Meditec Thompson: Alcon, Johnson & Johnson Vision, Bausch + Lomb, Mynosys Vukich: Johnson & Johnson Vision, Carl Zeiss Meditec Waring: None Wiley: RxSight, Alcon, Bausch + Lomb, Johnson & Johnson Vision, Carl Zeiss Meditec tive testing for a premium channel patient vs. a patient who may be undecided? Dr. Donnenfeld: No, all my patients get the identical workup regardless of what lens they choose. Everyone in my practice gets a dry eye workup, a topography, a biometry, and an OCT of the macula. Even if they don't choose a pre- mium channel, I want them to have a premium result. Dr. Thompson: I'm the same way. Everyone gets the same workup because a lot of them don't know what they want by the time they get to the doctor, so the only way we can go through all their different options is to know the status of their whole eye. We do the same workup on everyone. It's labor intensive when you want to offer both a refractive component and a therapeutic component. Dr. Chang: When the patient first comes in, we don't know what they want. Due to compliance concerns, we do not perform the same workup on all patients. We do perform biometry before any drops go into the eye, thus preserving the ocular surface for best keratometry measure- ments. Our biometer has a swept-source OCT, and the resultant images provide invaluable in- formation to determine the options reasonably available to the patient. If they decide to move forward with a premium option, we bring them back for repeated and additional testing on a separate day. This saves on the upfront time and effort. Dr. Thompson: When are you doing a cata- ract workup? Do they get charged a refractive consult or are you using that technology mainly as a screening tool? Dr. Solomon: In my practice, we do a biometry when they come in. If they are going to have basic therapeutic, that's all that they get, and for those that want to enter into a refractive pack- age, we bring them back and they have several touchpoints along the way, then there is a fee as part of the package for all of the testing.

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