Premium IOLs are an important addition to any cataract practice. Lens technology has improved significantly in recent years, and patients’ levels of expectations for their postoperative vision are at an all-time high. Premium lenses offer the “wow factor” that patients are looking for and, when used properly, can help build a referral base to the practice.
The first step to success with premium lenses is proper patient selection. Patients who are not good candidates clinically are those with macular and optic nerve pathology. It is important to be realistic about the expectations of IOLs with patients and to demonstrate their advantages and disadvantages to the families as well.
The second step is to go beyond the thorough examination with biometry and testing. I suggest performing manifest refraction and an OCT of the macula. This is important because, in the past few years, I have noticed some patients who have macular issues that may not show up on standard exams. I perform preoperative OCTs on almost all of my premium IOL patients because it is important to identify any macular puckers or retinopathy, preoperatively. Additionally, ophthalmologists need to look for pre-existing dry eye disease and ensure proper treatment prior to the surgery. This enables the best chance of success, which is vital to growing the IOL practice.
Often, the biggest obstacle to incorporating these technologies is the notion that surgeons shouldn’t “sell” to their patients. But if you have an optical shop or carry products, you are already selling to them. Although we don’t often like to discuss financials, we are running a business. Every year, staff members are requiring more money, office space rent is on the rise, and insurance premiums are increasing. Combine this with declining reimbursement rates, and it becomes clear why adding premium services to your practice is essential.
PRESSURE TO INCREASE PATIENT VOLUME
In the current climate, ophthalmologists feel pressure that often translates into seeing more patients for less pay. The American Academy of Ophthalmology recently published a study estimating that the average practice will need to increase its volume by 47% in order to maintain the same revenue by the year 2020. This model is doomed because, as the practice sees more patients, the quality of care naturally drops off. Ironically, Centers for Medicare & Medicaid Services will be correlating future payments to the patient satisfaction score of the practice. What will happen to the patient satisfaction scores of a practice if its volume increases 47%? Thus, from a financial perspective, it makes sense to diversify and offer these services to your patients.
In my practice, I have all types of IOLs. The key to lens choice is focusing on the patient’s needs. With the Tecnis IOLs (Abbott Medical Optics Inc.), for example, I have found that there is a large “sweet spot” for visual acuity, especially for reading and driving. I am currently conducting a study looking at cylinder, and uncorrected cylinder tends to be quite favorable with the Tecnis Multifocal. There is a definite “wow” factor, and patients have been thrilled with their outcomes.
I recently evaluated 32 patients in whom I had implanted these lenses, specifically looking at reading versus distance visual acuity immediately after surgery. Patients’ visual acuity results at 15 minutes postoperatively are shown in Figures 1 and 2.
Adding premium lenses to your practice can benefit both you and your patients. Patients expect practices to offer the newest technology. Premium lenses also benefit your bottom line, which is continually declining. The costs of running a practice are increasing, and reimbursements are decreasing. If ophthalmologists just implant standard IOLs, they are going to have to see a lot more patients and make less money. It’s a vicious cycle. Patients want this technology, and they are willing to pay for it as long as they understand its value. They are going to get these IOLs one way or another. They are either going to get them at your practice, or they are going to go somewhere else. It is important that you are on board. This is the same procedure as implanting standard IOLs, so there is no reason not to offer premium lenses to your patients.