Eyeworld

EW CATARACT 78 March 2015 What's my line?: Pearls for effective patient communication no pair of glasses that you can wear at all after surgery, and you will have to always be wearing a contact lens in your unoperated eye in order to see with 2 eyes at once or to have depth perception. This is why you have a decision to make. Basically we have 3 options: "Number 1: If you have always been happy with glasses then we can choose to make the eye with the cat- aract nearsighted to match the other eye. This will solve your immediate problem of blurred vision due to cataract but will not help you to see without glasses any better than you have before. Even when the other eye develops a cataract, that eye will need to be made nearsighted to match the first eye. Unless you opt for additional refractive surgery in the first eye (3 surgeries rather than 2), you will always wear glasses for nearsightedness. This is the most conservative choice as it does not require any surgery for your eye that has no cataract until it is necessary, and it is hard to predict when that might be. "Number 2: Knowing you will need to wear a contact lens most of your waking hours, especially if you have been doing this anyway and were comfortable with it until now, we can plan to aim for no distance glasses (emmetropia) in your cata- ract eye now. This means you may have 2 contacts for your unoperated eye—one for distance with readers as needed over the contact (leaving the other eye bare). When you like, you can also have a contact lens for in- termediate or near vision giving you blended vision with less dependence on glasses for most daily tasks. If you like this idea but aren't accustomed to a contact lens, we can have the unoperated eye fit with a contact now so you can see if it is manage- able and then make your decision." If the patient has been using the cataractous eye for near as part of a monovision contact strategy for years, I will aim for –1.75 in the cat- aract eye rather than emmetropia as long as the patient knows he or she will need a contact in the unoperat- ed eye for distance from then on. "Number 3: We schedule both the cataract surgery in the one eye and a refractive surgery in the good vision eye." I discuss LASIK vs. refractive lens exchange as appropri- ate. "Assuming all goes well with the Lisa Brothers Arbisser, MD Adjunct associate professor, Moran Eye Center, University of Utah, Salt Lake City I prefer to discuss this eventuality ahead of time with the unilateral cataract ammetropic patient. I start by saying the following: "We have some choices that I must explain so we can plan to- gether for your best result after your cataract surgery. You have a visually significant cataract in only one eye, and that eye must have surgery if you ever hope to see well with it. The other eye sees well with glasses or contacts and therefore does not currently require surgery for best vision. If I take advantage of the side effect of cataract surgery by choos- ing an implant to make that eye see well without glasses, it will no longer get along with your unoper- ated eye. "Assuming we achieve this goal with your new implant, the image you see from that eye will be a normal size. Due to the laws of optics, the other eye, which needs thick glasses to see clearly, will have a smaller image through the glasses prescription. The brain cannot use both eyes together when the images are different enough in size, and this will cause you to see double. We call this anisometropia. I have written this word down for you so you can Google it if you choose. When we wear a contact lens the power need- ed to focus light is closer to the eye than in glasses. The laws of optics make the image less minified or in other words, it is not changed as much." I show with my hands the distance from the eye and the image sizes. "This then will allow the two eyes to work together. Because of these facts, if we aim to see distance with the operated eye without glass- es (called emmetropia), there will be One of the many non-scientific skills that I wished I had learned but was never taught in medical school is effec- tive patient communication. In addition to protracted chair time and patient dissatisfaction, we all understand how much unnecessary harm can be done by poorly worded communication. Lisa Arbisser, MD, EyeWorld Cataract Ed- itorial Board member, has volunteered to lead a new EyeWorld column that explores how we can better communi- cate with our patients. For every install- ment, Lisa will pick a clinical topic on which we must regularly communicate with our patients. In addition to dis- cussing how she words the explanation, she will invite colleagues to add their communication pearls. Lisa has also enlisted psychologist and author Craig Piso, PhD, to collab- orate with this ongoing column. Craig is president of Piso and Associates, a nationally recognized consulting firm specializing in professional development in the healthcare arena. His insights as a non-physician specialist will be important. Lisa was one of the busiest and best cataract surgeons in the coun- try before retiring last year from the multi-subspecialty group practice that she founded in Iowa approximately 30 years ago. She is a popular lecturer and author and past president of the Amer- ican College of Eye Surgeons. However, a lesser known distinction is that she is the daughter of celebrity psychologist Joyce Brothers, PhD. Known for being an eloquent speaker and gifted surgical teacher, I am delighted that Lisa will be bringing her experience and sea- soned communication skills to this new column. –David F. Chang, MD, chief medical editor In this column, 3 physicians share how they discuss this scenario with patients: "You need to use a soft contact lens for the first time for the bilateral high myope having an IOL in just one eye." Anisometropia decoded I nformation is power when it is clear, accurate, relevant, and helpful. There- fore, physician communications are vital to relationship and rapport building. The most successful ophthalmologists are those who generate both outstanding medical/ surgical outcomes and tremendous patient satisfaction and loyalty. When you commu- nicate face-to-face, ideally with complete presence and good eye contact, about two-thirds of the messages patients receive are nonverbal (e.g., facial expressions, bodily posture, tone of voice). So in addition to communicating good information, which is intellectual, make full, effective use of your nonverbal signals, which express your feelings—the combination having the positive effect of more fully empowering your patients. The second facet of an empowering communication style is affirming your patient's right to select the treatment option of his or her choice. The most influential approach typically takes place in 3 steps: 1) educating the patient regarding all possible treatment options, including probable risks versus rewards, objectively and without apparent prejudice; 2) deliberating the cost/ benefit of each option; and ideally at the patient's request, 3) weighing in with your treatment recommendation. First listen to the patient's wants, needs, hopes, and fears, and then share your medical/surgical recommendation. Your ability to gain patient confidence and commitment regarding your treatment suggestions is enhanced simply by adopting one of Stephen Covey's The 7 Habits of Highly Effective People: "Seek first to understand, then to be understood." The following language samples shared by 3 expert ophthalmologists clearly reflect these principles of patient empow- erment and, therefore, effective rapport building. Craig N. Piso, PhD, What's my line? editor

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