Eyeworld

50 | EYEWORLD | WINTER 2025 R EFRACTIVE OPENING DOORS by Liz Hillman Editorial Co-Director About the physicians John Berdahl, MD Vance Thompson Vision Sioux Falls, South Dakota Eric Donnenfeld, MD Ophthalmic Consultants of Long Island Garden City, New York Vance Thompson, MD Vance Thompson Vision Sioux Falls, South Dakota N ailing outcomes with presbyopia-cor- recting IOLs is important for many reasons—one of them being patient expectations, as they are paying out of pocket for an advanced-technology lens. But even when you've had an excellent surgery, postop complaints can trickle in, and the possible causes for the dissatisfaction are diverse. Providing reassurance to the patient and identifying and managing the cause are para- mount to maintaining a positive patient experi- ence. "Multifocal IOL patients are the happiest patients in my practice, but rarely we do have patients who are unhappy, and it's the unhappy patients who we remember," said Eric Donnenfeld, MD. "Dealing with unhappy pa- tients is the key to having a successful refractive cataract practice." "Presbyopic IOLs have improved markedly over the last several years, so the risk of unhap- py patients is diminishing. But the corollary to that is that patient expectations have increased," Dr. Donnenfeld added later. Even though EyeWorld has covered this top- ic before, John Berdahl, MD, said it continues to be important. "We're constantly improving refractive accuracy and dry eye management, so new challenges—like vitreous opacities—are becoming more prominent. And the treatment landscape keeps evolving, especially in dry eye. Each iteration of discussion helps us refine care and anticipate what's next," he said. Step 1: Listen and identify "My first step is always to really listen, validate their feelings, and make sure they know I gen- uinely want to help," Dr. Berdahl said. "Patients can tell if you're rushing them, so I set the tone early by showing I'll take the time needed to solve their problem." Dr. Berdahl said the patient's history often gives a strong clue as to what the source of dissatisfaction could be, but he also goes through the most common culprits systematical- ly. "Residual refractive error and ocular surface disease are by far the most frequent issues, but I keep in mind that less common factors—such as posterior capsular opacification (PCO), vitreous opacities, or even neuroadaptation—can also play a role," he said. Dr. Donnenfeld said other team members will often hear the patient is unhappy with the lens before he does. He has empowered them to be able to order the appropriate tests—au- torefraction, refraction, OCT of the macula, and topography—that could elucidate the problem. "Why do I do that? Because when I walk into the room, I want to be able to tell the pa- tient, 'I know why you're unhappy, I know what the problem is, and this is how we're going to go about solving it,'" he said. "In the past, when a patient was unhappy, I'd walk in and be a little blindsided, and I would not have an answer for them because I wouldn't know what the problem was. Now, I want to know what the problem is before I walk into the room. … That reassures the patient that I understand there's a problem, I know exactly what it is, and I'm going to take the appropriate steps to solve it." Vance Thompson, MD, begins an appoint- ment with an unhappy presbyopia-correcting IOL patient by reviewing with them the things that were covered preoperatively. He makes sure to discuss these possibilities with patients in preop appointments so there are no surprises. "[This includes] that there is a healing process, and it is important to remember that if there Unlocking patient satisfaction after presbyopia-correcting IOLs What's new? Dr. Berdahl said temporary glasses is one of the newer strategies he's been using for these patients. "A temporary pair of glasses early on has become one of our best tools—it shows patients that their vision can be crisp, eases their fear, and buys time while the eye stabilizes. If later they need an enhancement or if PCO develops, we have confidence moving forward because we know glasses gave them good vision," he said. Dr. Berdahl and Dr. Donnenfeld shared that they're both also leaning more into vitrecto- my for vitreous opacities.

• Cover