JAN 2012

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

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Page 55 of 71

56 EWInternational The correction continued from page 55 Dr. Suárez: They do not have any additional cost. If they had it and the patient had to pay for it, I think it would play a role and if that was the case for private insurance companies. Dr. Carreño: In my country, ad- vanced technology IOLs for presby- opic correction have an additional cost for the patient. I think that this economical factor plays a significant role in the amount of implantations. Different Health Systems cover one basic, foldable, hydrophobic IOL with a UV filter, and if the patient chooses an advanced technology IOL, he or she should pay for the difference. From a personal point of view I think that my rate of multifo- cal IOL implantations (over 60%) could be even higher if the patient did not have to pay an additional cost for the IOL. Dr. Centurion: In São Paulo, Brazil, advanced technology IOLs are not covered by the Health Service or by private insurances. If the surgeon recommends these IOLs and the patients want them, they should pay for the differ- ence between the standard IOL and the advanced technology IOL. Ap- proximately 20% of my patients do not have advanced technology IOLs implanted because of the price, thus limiting the expansion of this mar- ket. In order to achieve conversion our most important objective is the education of the patients and their family as well as all the staff engaged in treating these patients (reception- ist, nurses, telephone operators, technicians, surgery organizers) by means of explanatory leaflets. How- ever, most of the indications for conversion rely on the word of the surgeon and the outcomes. The focus should be the surgeon's experi- ence, knowledge, and results, and not the IOL. Dr. De La Peña: Do you think that motivation for IOL implanta- tion is similar to that of other coun- tries such as the U.S. or Europe? Dr. Suárez: It is definitely differ- ent. As with corneal refractive sur- gery (RK, LASIK, etc.), the amount of surgery is proportionally much higher in some Latin American countries where aesthetics plays a more important role, as occurs with cosmetic surgery. Dr. Carreño: I do not think that there is a great motivational differ- ence among the different countries, but in my opinion the amount of implantations might be favored in more developed countries because of the greater amount of information available among the general popula- tion regarding new technology and its advantages, as well as the higher economical capability to reach high cost products. Dr. Centurion: In my clinic, we give a questionnaire to all the pa- tients who are candidates for lens surgery, be it for cataract or refrac- tive surgery, and they are asked the questions [in Figure 1]. Along with the answers, we in- clude the index of conversion of conventional IOLs (spherical mono- focal) to advanced technology IOLs (multifocal, toric, aspherical). Our results show that the num- ber of patients who do not care for elimination of optical correction does not prevent a high index of conversion, provided that the strat- egy for advanced technology IOLs is adequate. One important limiting factor is the cost of IOLs [Figures 2-4]. January 2012

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