Educating Patients About Refractive Cataract Surgery

Chapter 8

John A. Hovanesian, MD, FACS

Presbyopia-correcting lens implants and femtosecond laser cataract surgery are becoming the standard of care among practices that have learned to conquer the technical and psychological aspects of setting up expectations and then delivering them. Delivering spectacle freedom to patients has a snowball effect in which happy patients refer their friends and family specifically for these premium lenses. It is not unusual for 60% to 70% of cataract patients to choose elective refractive options in practices that are experienced in delivering these results.

In my own private practice, Harvard Eye Associates in southern California, we have seen similar enthusiastic acceptance of these technologies by patients, yet we don’t believe this is just the result of the greater awareness of lifestyle in California. Like colleagues from more rural states who have had similar success, we believe that the value of spectacle freedom is universally appealing. However his or her lifestyle is compromised by age or illness, every patient can benefit from spectacle freedom and deserves to fully understand the options before undergoing cataract surgery. Furthermore, observing 10 simple principles will lead every practice to success in educating patients about the best technologies.


It takes a certain leap of faith for the surgeon who is new to refractive cataract surgery to educate patients enthusiastically about it. As surgeons, we should always have our patients’ best interests in mind. We understand that our ethics and our reputation depend on delivering the same treatment to our patients that we would to family members. We also understand that refractive surgical options entail significant added cost for patients and a much higher expectation of what will be delivered. Gaining confidence that this greater expectation can be met takes both knowledge and experience. It is the hope of the authors of this book that readers will gain the knowledge necessary to deliver results. Confidence takes some time to develop. With experience and many happy patients, this excitement develops naturally, not just in the surgeon but also in staff members. Meanwhile, remind your staff members that we always remember a patient who is unhappy, but we easily forget the vast majority who love their results and refer their friends.


What takes a few minutes for us or our staff to discuss has a lifelong impact on a patient. For most of our patients, the costs involved in refractive cataract surgery can be daunting. Be sure to take adequate time for this discussion. Rushing the process will leave questions unanswered and create angst for the patient. If asked, many will say, “I don’t mind wearing glasses. I’ve done it all my life.” That automatic response usually comes out because the patient has never seriously considered the alternative. Yet once these same patients understand that no (or minimal) additional surgery will be needed to greatly reduce spectacle dependence, their latent need for refractive cataract surgery may become manifest.1 For this reason, we do not begin our discussion by asking whether the patient is interested in refractive options. Instead, we take the time to explain the benefits of these options in understandable terms to every single patient. We schedule extra time for this discussion for patients who we expect may be ready for cataract surgery. We also recommend that a family member be present for this cataract consent process. This truly enhances our older patients’ retention, and having a loved one present allows the patient to make a decision (and remember it) with confidence.


Before meeting the doctor, we ask each patient to fill out a questionnaire that rates his or her visual disability and determines his or her needs for distance, intermediate, and near vision. Derived from the survey developed by Steven Dell, MD,2 this questionnaire (Figure 8-1), which can be downloaded at, helps us understand the patient’s needs. But it doesn’t substitute for asking directly what activities the patient enjoys. We then describe the implant’s benefits in the context of these activities. Retailers tell us that most big-ticket purchases are driven more by emotional motivation than exhaustive analysis. Showing the individualized lifestyle benefit of each surgical choice helps patients understand its advantages on a very personal and emotional level.

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Apr 7, 2019 | Posted by in OPHTHALMOLOGY | Comments Off on Educating Patients About Refractive Cataract Surgery

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