Eyeworld

74 | EYEWORLD | JUNE 2022 R EFRACTIVE by Liz Hillman Editorial Co-Director About the physicians Rosa Braga-Mele, MD Professor of Ophthalmology University of Toronto Toronto, Canada Richard Davidson, MD Professor and Vice Chair for Quality and Clinical Affairs UCHealth Sue Anschutz-Rodgers Eye Center University of Colorado School of Medicine Aurora, Colorado Zarmeena Vendal, MD Founder and Medical Director Westlake Eye Specialists Austin, Texas E very patient deserves to know about the different IOL choices that are available for different visual outcomes, regardless of their status or candidacy for these options, said Rosa Braga-Mele, MD. Having a holistic view of IOL offerings, she continued, includes informing the patient of all the options and having a portfolio of lenses that can suit a range of refractive outcomes. Dr. Braga-Mele, Richard Davidson, MD, and Zarmeena Vendal, MD, discussed how they've taken a holistic approach to IOL offerings in their practice and shared tips for onboarding new technology, why they inform patients about all IOL choices even if they're not being recom- mended specifically, and more. Dr. Davidson said his practice was an early adopter of advanced technology IOLs. He said that patients who have received these IOLs, es- pecially those that work to lessen the effects of presbyopia, are some of his happiest patients. "I know there is still a large percentage of surgeons who are not using these IOLs, but they really should be," he said. There are several factors that could be hold- ing surgeons back, Dr. Davidson continued. 1) They are concerned about missing the target. Dr. Davidson admitted that you might need to do a LASIK or PRK enhancement, but he said with good patient selection and biometry, that num- ber should only be around 1–2% of these cases. 2) He said some residency programs are not exposing trainees to the technologies enough to help them be comfortable offering them. 3) Some physicians might be uncomfortable asking patients to pay out of pocket. "It's unfortunate because patients are willing to pay," he said. "Patients will pay a thousand dollars a year for glasses, and you're asking them to pay for a lens that could change their life forever. You're offer- ing incredible value, and you're offering incred- ible improvement in their quality of life. There are certain doctors who are uncomfortable with this conversation, but if you're doing it the right way, you don't have to go into numbers. You can say this is an uncovered expense, and an IOL counselor will go over this." Dr. Vendal said it is an exciting time to be practicing ophthalmology. "The surgeon's toolbox for cataract surgery is bigger than ever before," she said. "As sur- geons, we should never practice as a one-stop shop. We need to know how to work with each one of these lenses and customize the patient's experience based on which one suits them and their lifestyle needs. For example, a patient may want the most glasses-independent choice possi- ble and be willing to tolerate some nighttime ar- tifact in their vision while another patient may have a concurrent eye condition that requires a non-diffractive option and be comfortable wear- ing reading glasses for some near activities. "Each advanced technology IOLs shines in certain areas, and it should be our goal to understand the inner workings/nuances of each lens so that we can match it best with certain patients," Dr. Vendal added. When getting started, Dr. Davidson said to choose one lens. "Maybe it's the same brand you've used as a monofocal lens. Then find the best patients. There are a lot of patients who don't have other pathologies besides cataract," he said. Dr. Davidson said that while his practice of- fers many different advanced technology IOLs, the surgeons within the practice often only offer two or three. "You have to do what makes you most comfortable. It can be challenging to keep all these lenses as a consignment, so there are logistical issues, but I would argue that each of these lenses has distinct advantages. You have to figure out what works best in your hands; for example, a lens that works best in my practice may not work as well in someone else's. … If you get great results with one, offer one. But if you can identify the advantages of certain lenses, you'll find patients who fall into certain categories and line up better with certain lens- es," he said. Dr. Braga-Mele said there are patients who choose to go with the standard lens because it's what they want and/or what they can afford, "but they deserve to know about all the choices so they can make an informed decision." "There are those who want the monofocal aspheric, and whether it is distance vision that they want, monovision that they want, or they are low myopes and want to be low myopes A holistic approach to refractive IOL offerings

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