At Discover Vision Centers in Kansas City, Missouri, we balance bill for the cost of the premium IOL and also for all of our services associated with implanting any lens technology beyond the standard monofocal IOL. I could not comprehend ever placing anything beyond a standard monofocal IOL (which has no refractive expectation on patients’ or my part) and not charging significantly above the cost of the premium IOL.

With presbyopia-correcting and toric IOLs, there is a refractive outcome expectation that takes a tremendous amount of work to achieve. A certain and significant percentage of these patients require additional treatment, which in our center is in the form of laser vision correction. Additionally, there is a massive amount of counseling required before and after surgery to achieve what the patient deems success. 

About one-third of the IOLs I implant are presbyopia-correcting lenses. If I could not collect an extra fee (US$2,650 for cataract upgrade or US$4,650 for refractive lens replacement), I would place zero of these lenses. It is simply way too much time and hassle to not be compensated for the work involved. 

John F. Doane, MD
• Private practice, Discover Vision Centers, Kansas City, Missouri
• Clinical Assistant Professor, Department of Ophthalmology, Kansas University Medical Center, Kansas City, Kansas
• Member, CRST Europe Global Advisory
• jdoane@discovervision.com