Article

What Cataract Patients Want

A positive outcome is contingent on meeting patients’ desires

In the films “What Women Want” and “What Men Want,” the protagonists get the power to hear women’s and men’s thoughts, respectively. How many times have we, as doctors, wished we could hear our patients’ thoughts, so we could ensure we’re providing them with excellent care? While reading our patients’ thoughts is, obviously, not possible, we can use our deductive reasoning via our experiences in treating and our communications with them.

With this in mind, here is what cataract patients want, based on our experiences.

THE “RIGHT” IOL

Patients want their optometrists to be knowledgeable of the currently available IOLs that will meet their specific refractive needs and personalities. (See “IOL Options,” p.18.) Their doctor should not assume they don’t have the financial means for a premium IOL, and they should always take the time to educate patients on their options.

Treating cataracts goes beyond its clinical presentation (shown above). It’s about making patients comfortable.
Image courtesy of Dr. Emilio Balius

When assessing patients’ personality types, optometrists should exercise caution in offering premium IOLs for the following patients:

  1. Patients with a history of certain psychological conditions. These include depression and obsessive-compulsive disorder, as these conditions may interfere with the patient’s ability to be satisfied with their vision or cope with possible complications.
  2. Hard-to-please patients. Even if everything comes out 100% perfect, these patients are often still unhappy. Optometrists can identify these patients based on whether they have a history of unreasonable “challenges” with glasses and/or contact lenses or difficulty adapting to minor refractive changes.

WHAT TO EXPECT

Cataract patients want to know what to expect both pre- and post-operatively. This starts with a discussion on the vision they can expect from their chosen IOL. In general, they need to know that, regardless of the IOL type and brand, their vision will not be exactly the same as the vision they had prior to developing cataracts. Additionally, it is important, to the point of mandatory, that patients understand results are not guaranteed, and in some cases — the minority, of course, — we may need to discuss the possibility of a second procedure or prescribe glasses.

Educating patients on possible post-operative complications is also important, so they are not surprised, and, therefore, dissatisfied, should they experience these outcomes.

For example, optometrists should educate patients on the possibility of rebound iritis and its tell-tale signs, such as vision changes, discomfort, sensitivity to light or redness, and to call the practice when experiencing any of these signs, so the doctor can intervene ASAP. Other examples of complications: NSAID-induced keratopathy, allergic or toxic reactions to prolonged antibiotic use, glaucoma, due to steroid response, and cystoid macular edema. (See “Simplify Drop Use,” p.23.)

DEVICE PURPOSE

Patients can feel like just a number and anxious when they’re directed to sit at diagnostic devices without being properly educated on the purpose of the devices. To put patients at ease, optometrists should ensure their techs are trained to explain to patients a device’s purpose. Examples:

  • “This is called a keratometer/topographer. We use this to analyze the shape of your eye to help determine which IOLs would be appropriate, so the doctor can discuss options with you.” (See “Identify Issues Pre-Surgery,” p.18.)
  • “We are going to conduct tests to evaluate the health of your ocular surface and eye lids to ensure you do not have dry eye disease (DED). (See “Make the Ocular Surface Healthy,” p.26.) DED occurs when the eye doesn’t produce enough tears to keep the cornea comfortable. An unhealthy ocular surface can affect your IOL prescription and increase the likelihood of a poor post-operative outcome. If a diagnosis is made, the doctor will start treatment preoperatively to achieve an optimized ocular surface.”

FINAL THOUGHTS

The O.D. may consider a surgical result to be perfect, but if he didn’t address a patient’s specific questions or desires, then he may not have a happy patient. Communication is key. It doesn’t take a mind reader to know that patients place a huge premium on feeling comfortable. OM

PRACTICING MEDICAL OPTOMETRY

See the Oct. 2018 PMO for more on managing cataracts.

→ Dr. Sondra Black reviewed the O.D.’s role in increasing positive surgical outcomes. bit.ly/ODPreOpCare

→ Dr. David Geffen discussed complications to check for and how best to treat them. bit.ly/OMPostOpCataract

→ Dr. Eric Schmidt provided a how-to guide to co-management. bit.ly/HowToCoManage

(An archive of all Practicing Medical Optometry editions, can be found at www.optometricmanagement.com/practicing-medical-optometry .)