Astigmatism Basics | May/June '17

Keys to Communication

P. Dee Stephenson, MD, FACS

My approach to astigmatism reflects that it is an integral part of surgical outcomes and patient satisfaction. I have also been explaining intraoperative aberrometry to patients for the past 9 years. This helps them to understand this is a real-time reading of their eye at the time of surgery and measures the true total astigmatism. Further explanation of how this information allows me to correct their astigmatism and place the toric IOL in the appropriate position puts it all into perspective for the patient. As we all know, uncorrected astigmatism results in blurred vision, glare, spectacle dependency, and unhappy patients.

As a refractive cataract surgeon, I strive to achieve LASIK-like results for my cataract patients. To attain this goal, it is imperative to understand how to diagnose and treat astigmatism. Approximately 52% of the population has at least 0.75 D of astigmatism; therefore, patient education is essential. This is especially true when patients are paying out of pocket for astigmatic correction, whether it be manual limbal relaxing incisions, femto arcuate incisions, or a toric IOLs. This concept can be a very tough topic to explain to patients without overwhelming th

Many patients are well educated even before they set foot in our practices. My office will suggest patients visit my website, where patient education and videos are easily accessible. Doctors and surgery consultants can talk about the different kinds of astigmatism—with the rule and against the rule, anterior and posterior—but, most of the time, this just confuses the patient. I prefer to talk to patients and ask them, “How do you want to see after surgery?” I simply explain that their eye is not perfectly round and they have astigmatism that will not be corrected with standard surgery, but that at the time of their cataract surgery we have the “opportunity” to correct this. I also explain that if we do not correct the astigmatism, they will need to wear glasses for everything they do.

After hearing patients’ responses and answering their questions, I will briefly talk about the different lens options that we offer. I let them know what I think is their best choice. After their preoperative testing is completed and reviewed, patients will then see my surgical counselor. I believe this person is invaluable, not only as a practice representative but also as a knowledgeable educator who explains the educational videos that simulate vision with or without astigmatic correction. The surgical counselor will also answer any further questions from patients and give them the needed information to factor into their decision. All of these steps combined will result in greater patient satisfaction.

VIDEO. P. Dee Stephenson, MD, FACS, shares pearls for starting to build astigmatism management into one’s practice.

Blake Williamson, MD

When talking with patients during their cataract consultation, the first thing I always do is tell them what else is wrong with their eye “besides” the cataract. Invariably, they have dry eye, macular degeneration, or some other common ocular comorbidity. I position these comorbidities as the primary issue, as they will remain after the cataract is removed and because they are chronic diseases that can be treated but not cured like a cataract can.

However, when a patient has astigmatism, that is the last thing I mention in the list of comorbidities; I say, “Last but not least is your astigmatism, and you’re so fortunate because this is something we can fix. It is important to know that, in order to fix your vision and not just the cataract, the astigmatism needs to be corrected. So, you’re going to have to fix it one way or another: I can either give you a new pair of bifocals after cataract surgery, or if you prefer I can correct your astigmatism surgically and likely prevent you from needing bifocals.” I find that when I position astigmatism as a separate disease process that can be easily treated and reinforce the idea that I cannot fully correct the patient’s vision without addressing it, this leads to better patient understanding.

In terms of how to broach the subject of cost, I like to educate my patients that cataract surgery is a one-time thing and that the lens they choose is likely the most important decision they will make for their vision for the rest of their lives. I tell them it is like choosing a heart valve in the sense that it will never come out, we will not be repeating this surgery, and they cannot have buyer’s remorse and come back in 2 years to swap it out for an advanced lens. Clearly expressing the finality of this process is key, as is highlighting that this is something they will benefit from every waking minute for as long as they live.

I do give patients a general idea about total cost and average per-month rates from our financing plans before they see our counselor. I do this to prevent sticker shock and to control the messaging if I sense they are sensitive to cost. If they are, I again reiterate what I mentioned above, and I compare the cost of advanced cataract surgery to weekend beach trips or to bringing the grandkids to Disney; however, the benefits of this purchase (crisp vision and freedom from glasses) will be enjoyed for a much longer duration of time. For the patients wanting to finance, I compare those monthly fees to mundane things they are already paying for, such as cable bills. I say, “It’s kind of like having an extra cable bill next year, except that, at the end of the term, you get to keep the benefits forever!”

author
P. Dee Stephenson, MD, FACS
author
Blake Williamson, MD

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