Market research indicates that one in nine patients presenting for cataract surgery is implanted with a premium IOL, whether toric or presbyopia correcting. With the demonstrated patient satisfaction with these premium IOLs^1,2,3 this number is likely to increase over time. It is now a surgical standard of care to let cataract patients know about these lens options at the time they present for cataract surgery. However, it is far more effective if they become familiar with them well in advance of their visit with the surgeon.

Patients may often express concern when you first mention that beginning cataract in one of their eyes, though it may be their symptoms that brought them to your office. They may remember their parents having cataract surgery, with a long hospital stay and thick spectacles afterwards. Or, hopefully, they’ve had a friend who has had surgery recently and can let them know that it is safe, effective and can be completed from start to finish in a few hours. Either way, you can reassure them that, given today’s lens options, this is a great time to be having a cataract!

Discussing lens options with a patient is only the first step, however. Setting realistic expectations regarding their suitability for these options is important. For instance, a patient with high levels of pre-existing corneal astigmatism, greater than 1.0 D, may not be a candidate for a presybopia-correcting IOL since there are no astigmatism correcting multifocals on the market in the US at this time. Such a patient may also be counseled regarding the potentially higher relative benefit of a toric IOL, more likely to provide spectacle independence at distance though necessitating reading glasses for near work. A patient with irregular corneal astigmatism may be advised that achieving an ideal correction with any lens may be a challenge.

Optimizing ocular health before surgery is also important in the preoperative period, particularly with regard to ocular surface disease. A clear and intact tear film will provide more accurate measurements of ocular dimensions and reduce potential fluctuation in autorefraction or autokeratometry readings. Extremely small pupils may be problematic for a zonal refractive IOL, and retinal or endothelial pathology that interferes with potential visual acuity may be relative contraindications. You may advise the patient that the surgeon will consider these findings in their final evaluations.

Some practitioners suggest that the best approach is to underpromise and overdeliver with regard to premium IOLs. It is more professionally satisfying, perhaps, to set appropriate expectations in your patients and then have these expectations met. One can’t promise a given outcome will be achieved, but an appropriate preoperative assessment can help provide an indication of the likelihood of success for a patient with a given premium IOL. This will help you and (later) the surgeon ensure that the patient gets the lens that best suits their needs after due consideration of their ocular health.