Eyeworld

It is what makes some surgeons fore- go the technology altogether rather than have unhappy patients postop. Determining patient happiness There is a direct correlation between postop cylinder and percentage of patients with 20/20 uncorrected distance visual acuity (UCDVA). See Figure 1. What this data shows is a rather precipitous drop in 20/20 UCDVA. With only 0.5 D of residual cylinder, almost 25% of patients are not at 20/20. By 1.0 D of residual cylinder, almost half are not at 20/20. This is amplified substantially in the mul- tifocal patient. This also correlates to patient (dis)satisfaction. With no postop cylinder, 73.2% of patients are very satisfied, but almost 30% are unhappy with 0.5 D of postop cylinder, and 33% are unhappy with 1.0 D of residual postop cylinder. For practices that have implemented patient-reported outcomes, it is unacceptable for patients to be anything aside from "very satisfied." Figure 2 illustrates the respons- es from patients who are neither satisfied nor dissatisfied. As with the satisfied group, increasing postop cylinder amounts correlate with increased dissatisfaction. Of interest, however, was the finding that postop cylinder does not necessarily correlate with postop glare or halo. Regardless of post- op cylinder amounts, somewhere between 25% and 36% of patients have glare or halo. Improving outcomes Even 0.50 D of postoperative astigmatism lessens your chance of achieving 20/20, and it reduces satisfaction. We need to improve outcomes to improve satisfaction, and we need to evaluate advanced LVC modalities to achieve those improved outcomes. The 2014 ASCRS Clinical Survey found 84% of respondents use 20/20 uncorrected acuity as a baseline for successful surgery, but do not have a way to assess successful LVC out- comes. Our practice has not increased its advertising budget, but we are able to reach more potential pa- tients. Today's instant communi- cation via social media has expe- dited our decision to reduce our advertising spends while increasing our patient satisfaction rates and leveraging that. Our technology is, in fact, our advertising. Optical Express has coined the term "patient ambassador," general- ly translated as a patient who refers someone who then has surgery. The key for our practices is to identify these ambassadors. Optical Express has more than 200,000 patients in its database. The better a patient's postop vision, the more likely he/ she was to refer someone: 90% of patients who were super-ambas- sadors (more than 1 referral) were 20/20 and of that, 73% were 20/16 or better. By achieving a good result, word-of-mouth referrals will expand a practice's patient base. At 1 month postop, almost 16% of multifocal IOL patients who achieved 20/12 or 20/16 were ambassadors. But for patients with 20/25 outcomes, only 10% were am- bassadors. Translation: 20/25 postop results are no longer "good enough" to get multiple referrals. Surgeon care does play a role. Surgeons who provide outstanding results, do not have long wait times, and see patients at times convenient for the patient will have satisfied pa- tients. But the high quality of vision is really an important factor. Technology on the horizon Technology is improving. We currently use conventional, opti- mized, and wavefront-guided LVC. The next generation will include topography-guided and advanced wavefront-guided. We're seeing incremental but substantive improvements in both of these platforms. Topography-guided ablations provide an improved ablation profile based on corneal shape. By adjust- ing the postop corneal asphericity, the WaveLight Allegretto addresses corneal aberrations exclusively. This technology has improved dramat- ically and has potential benefits for post-cataract cases. It can treat primary eyes and therapeutic cases (keratoconus). It's particularly well suited for treatment on previously operated symptomatic eyes. In primary myopia, topography- guided results were excellent: 92.7% were 20/20 UCVA, 68.8% were 20/16 UCVA, and 30% gained 1 line above BCVA. Most impressive, however, is that 98% would have the surgery again. Advanced wavefront-guided treats entire eye aberrations while minimizing patient accommodation. This new technology increases the resolution substantially (see Figure 3), allowing us to capture nearly every eye. Using the iDesign LASIK we evaluated data from 8,905 eyes (4,721 patients) that underwent sur- gery between May 2012 and August 2013. At 1 month, the majority of patients are close to intended refrac- tive correction (cylinder). This is a very good technology. In fact, the R2 of 0.92 is really good. Visual outcomes are equally impres- sive, with 84% at 20/16 and 95% at 20/20. Technologies like these coupled with increasing patient demands for exceptional vision mean Snellen acuity of 20/20 is no longer the gold standard. As surgeons we need to go beyond that to ensure patient satisfaction and, therefore, practice longevity. Reference 1. ASCRS Clinical Survey 2014. Global Trends in Ophthalmology. Fairfax, VA: American Society of Cataract & Refractive Surgery, 2014. Supported by an unrestricted educational grant from Abbott Medical Optics Figure 3. Advanced wavefront-guided topography images Source: J. Vukich, MD

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