Educating Patients on IOL Options

Because we know the characteristics of each IOL category and our patients’ visual histories and personalities, we must educate them on their options to aid in their decision making and manage their postoperative expectations. Regarding the latter, I have had great success in starting the IOL choice conversation by framing it around compromise: “Cataract surgery gives you the chance to choose how you want to see after surgery. No IOL perfectly mimics the vision your natural lens provided, so the goal is to choose the option that best fits your lifestyle and involves compromises you are comfortable making.”

Here are the scripts I use to educate patients on their IOL options, organized by IOL category. Additionally, I provide descriptions of the ideal patient for each IOL (see “Practical Pearls”).

STANDARD MONOFOCAL IOL

• Patient-Facing Script. “These IOLs aim to give you the clearest quality of vision at the distance you choose. You will have to wear glasses to see at your nonchosen distance, and you may need to wear them full time.”

• Ideal Patient. This patient wants the sharpest, not the widest, range of vision, and is willing to wear glasses to maintain that sharpness. As a result, this patient tends to be a night driver, highly detail-oriented, or have ocular comorbidities that make them a poor candidate for other IOL options. These comorbidities are glaucoma or AMD, as they affect contrast and visual clarity and, thus, limit the perceived benefit and utility of multidepth lenses.

TORIC IOL

• Patient-Facing Script. “Toric IOLs will correct your astigmatism and give you the clearest quality of vision at the distance you choose, with the aim of reducing your dependence on glasses at your chosen distance. Plan to wear glasses full time at the distances you do not correct for.”

• Ideal Patient. This patient is similar to patients who want standard monofocal IOLs, but they desire increased independence from glasses at their chosen distance and would otherwise experience residual astigmatism.

EXTENDED DEPTH-OF-FOCUS IOL

• Patient-Facing Script. “Extended depth-of-focus IOLs are designed to give you a wide range of vision. They can allow for vision at distance and in the intermediate range. Expect to use reading glasses for small print or prolonged near work.”

• Ideal Patient. This patient wants the visual flexibility to drive, work on the computer, cook, play golf, play pickleball, and see the dashboard without constantly reaching for their glasses.

SMALL-APERATURE IOL

• Patient-Facing Script. “These IOLs work like the pinhole test we use to check vision. By allowing the most focused light through and reducing some of the unfocused light, they can improve the range and quality of your vision. The compromise is that some patients may notice dimmer vision, especially in lower-light settings.”

• Ideal Patient. This patient wants a more functional range of vision but may not be an ideal candidate for multifocal optics due to optical imperfections from, for example, mild corneal irregularities.

MULTIFOCAL IOL

• Patient-Facing Script. “Multifocal IOLs are designed to reduce your dependence on glasses at all distances. They will give you a range of vision that is close to what your natural lens provided. You may notice halos around lights, especially at night, and your vision may not feel as sharp in every situation.”

• Ideal Patient. This patient is highly motivated to reduce glasses dependence, and they understand and accept the compromises.

POSTOPERATIVE ADJUSTABLE IOL

• Patient-Facing Script. “Postoperative adjustable IOLs allow your prescription to be fine-tuned after you undergo cataract surgery, your eye has a chance to heal, and the IOL stabilizes in the capsular bag, providing control over the final visual target. For an optimal outcome, you must follow strict postoperative protocols, such as wearing ultraviolet -blocking glasses during waking hours.”

• Ideal Patient. This patient desires control over their final refractive target and is willing to follow the strict postoperative protocols to achieve it.

CONFIDENCE IS KEY

We, as optometrists, are uniquely positioned to lead the conversation with patients on IOL selection. This is because we know our patients’ eyes, lifestyles, and expectations. What’s more, when we use that knowledge, we help these patients feel more confident in one of the most important decisions they will make regarding their eye care. The bottom line is that clear patient communication before surgery leads to happier patients.