At the preop level, minimize premium IOL choices as patient confusion may deter surgery altogether. No US FDA- approved presbyopia IOL addresses astigmatism yet and dependent on your patient counseling a toric IOL upgrade might be a better option.
Find out the wants and needs of your patient, such as job-related tasks (truck driver with lots of night vision needs), or hobbies (golf annually or weekly). Avoid IOL selection based on an annual hobby such as the October 3-day hunting trip, but rather select a premium IOL for the needs of the patient the other 362 days of the year.
Take Preop Action
Patients also need to be counseled preoperatively about the need for possible Yag Capsulotomy and/or residual refractive error correction postoperatively. Topographic analysis preoperatively is critical: a patient with Keratoconus or Forme Fruste Keratoconus (FFKC) may not be a candidate for refractive enhancement postoperatively for residual myopia and/or astigmatism.
Telling the patients more information preoperatively will reduce chair time and patient dissatisfaction postoperatively.
Avoid Postop Dissatisfaction
Lastly and unfortunately, the most chair time consuming problem is when the patient declines the premium upgrade preoperatively, has uncomplicated surgery, then complains postoperatively about the need for glasses still.
Though not out of malpractice necessity, we have our patients sign a consent waiver actually stating their decision not to upgrade so they have no place to complain postoperatively! Good riddance and hope they enjoy the big screen TV they chose to spend their precious dollars on instead!
Look out for the next blog: Managing the Preoperative Evaluation.