DEC 2016

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/753216

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Page 128 of 130

Methods for making laser-assisted cataract surgery fit in your practice 6 by Elizabeth Yeu, MD Discussing LACS: Physician experience with proper patient conversation, expectation management, and acceptance Consistent messaging and language are key in successful patient communication I n our practice, we have found that patients welcome our commitment to femtosecond laser-assisted surgery (LACS) for cataracts. They like the idea of standardized procedures and surgery that provides the precision of the laser and is as "blade-free" as possible. Patients with cataracts are interested in learning how we can improve their quality of vision by using LACS—and this is partic- ularly true if they want to gain postoperative spectacle indepen- dence. Cataract counseling Ultimately, every patient will not choose to have LACS, but during cataract counseling we discuss our three packages with all patients. Because the cataract eval- uation is keenly important, we follow a standardized protocol. This does not require a large ancillary staff, but all staff are trained and educated thorough- ly and we ensure that everyone who interacts with patients uses similar language. In our practice, we have "Cat Chats" with staff approximately three times per year in order to familiarize all the clinicians and the cataract team of counselors, surgical schedulers, and techni- cians with the evolving technolo- gy and techniques. About 75% of our cataract surgery patients are directly referred from outside clinicians. Thus, they are new patients, and it is important to create a positive experience for them. The actual patient experience begins with a pre-appointment introduction phone call from our practice that introduces Virginia Eye Consul- tants to the patients and pre- pares them to expect a thorough appointment during their cataract evaluation, one that lasts approx- imately 3 hours to perform all di- agnostics and provide the proper education surrounding cataract surgery. We make every effort to provide a personalized experience for them. We escort patients from one phase of the examination to the next. The technician who meets them for their workup takes them to cataract counseling and picks them up to take them to diagnostics. Then the techni- cian dilates the patient's pupils and introduces the patient to the surgeon. As we talk with patients, we stress visual outcome goals, such as achieving near and distance vision vs. distance vision only. To simplify the details, we do not discuss IOL brands or use terms such as "multifocal IOL." We follow a uniform format, with uniform language, because cat- aract surgery can be a confusing process for patients. Our cataract counselor jots down specific information about the patient, such as the patient's hobbies, visual goals, and profes- sion. This sets up a more directed conversation with the ophthal- mologist (Figure 1). When I meet the patient, I provide a brief overview of cata- ract surgery, including the length of surgery, what to expect, and risks and benefits. I also explain that there is no safety difference between manual cataract surgery and LACS, but it provides a Practice pearls: The enthusi- asm for advanced technology IOLs and LACS is contagious. Patients and staff will be ex- cited about this technology if surgeons are passionate about it. Having almost 4 years of experience with LACS and seeing the reliable, reproduc- ible outcomes and high pa- tient satisfaction continue to feed into the entire process. In addition, from the prac- tice's perspective, being well informed, up-to-date, and educated on our own results helps maintain the integrity of what we offer patients. –Elizabeth Yeu, MD Figure 1. Checklist for developing a refractive recommendation for patient having cataract surgery Refractive cataract surgery evaluation checklist Diagnostic evaluation of astigmatism: minimum 2 devices Topography, optical biometry, manual keratometry Patient characteristics Height Age Hobbies Profession Time spent reading versus distance activities How patient reads (e-reader, books, newspaper, computer, etc.) Existing co-morbidities (systemic, ocular) Patient refractive goals

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