Eyeworld

62 | EYEWORLD | APRIL 2020 ATARACT C "A lot of times, if you don't talk about the technology, even if you don't think the patient is a good candidate for a certain type of lens and you don't offer them that lens, they are going to call you back or ask you about it after the surgery. … Have that discussion with the patient and explain whether you think they are or are not a candidate. … If you don't mention them, they'll think that it was looked over or you didn't know about it." Patients opting for an advanced technology lens have higher expectations, which Dr. Parikh said puts more pressure on the surgeon. "A lot of it is not lowering their expecta- tions but making sure the patient's expectations are realistic from the beginning," she said. "For every step of the process patients need to be prepared ahead of time. Then some of the anxiety on their part is a less, which in turn will lower the surgeon's anxiety." For some final takeaways for those getting started with these IOLs, Dr. Gupta said make sure the patient has realistic expectations of the IOL's capabilities, don't use them in patients with ocular surface disease, and develop a com- prehensive skillset to troubleshoot any postop issues. "If you're going to start doing these lenses, you may want to learn how to do PRK, for example, so you can touch up any refractive misses. Or you might want to know how to do an LRI at the slit lamp if there is any residual astigmatism," she said. "Have your tool bag ready to troubleshoot. I think that if you can handle most things, you should be confident that you're going to make the patient happy." to be scrubbed in and will step in at any point if needed, the company has a resident program where they don't have to pay the out-of-pocket fee for the premium lenses," Dr. Parikh said. For those new to using presbyopia-correct- ing lenses, Dr. Parikh said, they first have to be comfortable with the cataract surgery itself. "If you're not comfortable and confident with the cataract surgery itself, it's hard to dis- cuss the next step, the premium lenses, and be able to offer them with confidence," she said. "A resident doing their first 10–20 cataract cases should not be doing premium lenses." After that, it's important to have an under- standing of the different presbyopia-correcting lens options, how they work, and the nuances of patient selection. Both Dr. Gupta and Dr. Parikh said the conversation with the patient is the most important part. "[Patients] have to understand what the lenses can offer and what things they might have to give up because there are trade-offs with premium lenses," Dr. Parikh said, adding it often takes more than one conversation with the patient. Dr. Gupta offered advice on honing these communication skills. "I find that listening to how other people speak to patients about premium technology is helpful. When I was in fellowship, I was comfortable with implanting the lens and over time learned who the most optimal candidate was, but some of the best teaching I had was listening to how my attend- ings talked to patients. Sometimes we are so fo- cused on the medical aspects … that we forget that part of selecting these patients is listening to them and educating them," she said. "One simple thing is to observe yourself. Record yourself in a patient conversation. … Reflect on how you're coming across to the patient and learn more about how you communicate so you can improve your communication skills." Dr. Parikh had two specific pieces of advice when it comes to the patient conversation and presbyopia-correcting IOLs: 1) discuss all IOL options with the patient (even if they're not a candidate) and 2) be sure to set appropriate expectations. "There is new technology coming out every day, and google.com is the first thing the patient is going to do before coming to you," she said. continued from page 60 Contact Gupta: preeya.gupta@duke.edu Parikh: neeti.parikh@ucsf.edu Relevant disclosures Gupta: Johnson & Johnson Vision, Alcon Parikh: None "If you're not comfortable and confident with the cataract surgery itself, it's hard to discuss the next step, the premium lenses, and be able to offer them with confidence." —Neeti Parikh, MD

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