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Progressive Practice | May/June 2024

Engage Patients in Lens Choices

Arthur B. Cummings, MBChB, FCS(SA), MMed(Ophth), FRCS(Edin), discusses the rise of participatory medicine and customized IOL selection.

In a detailed discussion about the growing sector of posterior chamber IOLs and participatory medicine, Arthur B. Cummings, MBChB, FCS(SA), MMed(Ophth), FRCS(Edin), shared with us his insights into how patients’ involvement in treatment decisions can enhance their outcomes and increase their satisfaction.

The posterior chamber IOL sector is experiencing significant growth with further expansion possible. This surge is in alignment with the evolving concept of participatory medicine. The term refers to how patients’ active engagement in their treatment choices reshapes both the delivery and their experience of care. A patient-centered approach generally improves their eye health outcomes and satisfaction.


Dr. Cummings is a proponent of participatory medicine and elaborated on its appeal. “Participatory medicine invites patients into the heart of decision-making,” he explained. “They become familiar with different lens options, understand their mechanisms, and appreciate the freedom to select the preferred lens.”

LiveseySolar Practice Builders documented a specific technique called custom match to involve patients in the decision-making process. Dr. Cummings commented, “Anything that helps patients choose well is important. It’s a technique that simplified our processes when we began implementing it. We have performed many of these procedures and have yet to encounter a patient who regrets their choice. Thus, it’s highly accepted. You’re addressing the issues that matter most to patients and mitigating risks while maximizing benefits. Patients who prefer blended vision, which rates well, only need coverage for part of the range. Blended vision with monofocal IOLs adequately covers two of the three ranges—distance, intermediate, and near. Patients with prior laser vision correction may be accustomed to blended vision, and I am not inclined to offer them full range focus lenses if they have already neuroadapted to blended vision.”

That said, most patients prefer lenses that provide a full range of focus (FROF). Dr. Cummings described the process: “They receive a FROF lens in their nondominant eye. They can then assess how things feel for an entire week. This trial period helps them make an informed decision about which IOL to select for the dominant eye.”

He said that initial reactions include concerns about glare but that patients’ perceptions tend to improve significantly over time. By the end of the week, most of his patients opt to have the same lens implanted in the contralateral eye.

“For the 10% who do not want the FROF IOL in the dominant eye, they know they are making a decision based on their experience,” Dr. Cummings said. “They opt out of having this in both eyes if they are sensitive to glare and halos, but, for many, full vision is a significant benefit.”

He emphasized the practical benefits of custom match. “When you drive, you do so with both eyes open,” he explained. “Having one eye with a FROF lens and the other with an increased range of focus lens provides the best range of vision while safeguarding the [patient’s] ability to drive at night. In these custom match cases, glare and halos are not noted if the dominant eye has no FROF IOL. This approach maximizes vision. It empowers patients, leading to greater satisfaction and better outcomes in eye care.”

According to Dr. Cummings, participatory medicine makes the decision-making process collaborative, informed, and highly personalized. This shift in power gives patients more control over and confidence in their eye care choices.


In collaboration with Dr. Cummings, we have created a public playbook on participatory medicine for those who wish to learn how to engage patients in their lens choices (click here to access this tool). He reviewed this comprehensive resource, which provides valuable tips on how to help patients make informed choices about their eye care.

Arthur B. Cummings, MB ChB, FCS(SA),MMed(Ophth), FRCS(Edin)
  • Consultant Ophthalmologist and Medical Director, Wellington Eye Clinic, Dublin
  • Chief Medical Editor, CRST Global | Europe Edition
  • Member, CRST International Board
  • abc@wellingtoneyeclinic.com
  • Financial disclosure: None acknowledged
Laura Livesey
Rod Solar