This issue features an excellent array of articles that deal with refractive implants—both phakic and added value pseudophakic IOLs. There are many common themes as well as some unique topics presented in this grouping of articles; however, each author is careful to emphasize his personal areas of experience.
The first step to increasing refractive IOL volume is for the surgeon to make the decision to introduce change into his practice. This endeavor is all-inclusive and encompasses the surgeon and his supporting team. Many surgeons remain in their comfort zone of laser eye surgery and regular cataracts, both of which are somewhat flat in terms of revenue—laser surgery as a result of a plateau in numbers and cataracts because of decreased reimbursement.
So if the advantages of refractive IOLs are not enough to pull you toward performing the procedure, perhaps the potential of reduced income will help push you to consider!
Refractive IOLs are a phenomenal addition to the armamentarium of the anterior segment and refractive surgeon; however, many areas need to be addressed to ensure success. The introduction of these procedures requires a strategic approach—in the parlance of administrators, change management.
Education is vital, and the surgeon must be prepared to spend time not just learning how to perform the procedures but also acquiring as many pearls as possible to address the variety of scenarios that he might encounter. Precision and attention to detail are fundamental, and this includes everything from educating the supporting administrative and technical team to obsessive objective evaluation, such as biometry for refractive lensectomy or anterior segment dimensions and configuration for phakic implants.
Managing patient expectations is a huge component of success, for which all members of the practice team must contribute. Tools that aid patient education, including Eyemaginations software (Towson, Maryland) and the IOL Counselor (Patient Education Concepts, Inc., Houston; and Eyeland Design Network, Germany), are also very useful and provide a means to convey information in comfortable surroundings (away from the potentially oppressive presence of the doctor).
Other issues, like treating astigmatism and residual refractive error, are part and parcel of this type of surgery and also need to be embraced. Often, surgeons experience one or two disappointing cases and lose confidence, completely abandoning the procedure in spite of numerous previous successes. This is quite understandable, and I have encountered this among a number of colleagues. My suggestion to them has always been the following: First, identify why the issue has occurred (so as to avoid it in the future) and then do whatever it takes to rectify the problem, making sure to audit outcomes and put the less-than-ideal but usually rectifiable experience into context.
As usual, CRST Europe provides phenomenal pearls to the reader, and I do feel that this issue is especially informative. Enjoy, and please do contact us if you would like to make any comments or contribute in terms of your own experience.