Prevent Blindness has designated June as Cataract Awareness Month, making it a good time for optometrists to review how they educate patients on cataracts, IOL options, and surgical referrals.

“One of the most important things optometrists can do is prepare our [cataract] patients for the inevitable,” says Marc Bloomenstein, OD, FAAO, of Schwartz Laser Eye Center clinics, in the Phoenix area. “But, more importantly, we can also prepare them for exciting new opportunities.”

DISCUSSING LENSES

“I like to speak about cataracts when patients reach the age of 55,” says David Geffen, OD, of San Diego’s Gordon & Weiss Vision Institute. “I tell them about lenticular changes and what to expect. I also emphasize that in today’s world, cataract surgery is something to look forward to,” as patients will have excellent vision after the operation.

Sondra Black, OD, FAAO, an optometrist and independent consultant in Toronto, says she starts the conversation by explaining that cataracts are a clouding of the eye’s lens, and surgeons “are going to replace the cloudy lens with a new one, and we are essentially starting from scratch, so we can decide what kind of vision they want after surgery.” Dr. Black says she typically gives patients a lifestyle questionnaire to fill out, to determine what activities they enjoy and what lenses would best suit their needs and hobbies.

“What’s great about our profession is we know what’s important to our patients,” says Dr. Bloomenstein. “If someone is an avid reader, they will want near vision without the need of glasses or contact lenses,” and that’s a need IOLs can fulfill. “Talking to patients about multifocal IOLs, trifocal IOLs, and extended depth of focus (EDOF) lenses, is really a way for us to get patients thinking about what the next phase or stage of their vision journey will look like.”

In Dr. Bloomenstein’s experience, he says the “vast majority” of patients usually want an option that provides good middle distance.

OTHER ITEMS

The education optometrists provide should help set their patients’ expectations for the results of the surgery. For example, patients should understand that a standard IOL will not correct astigmatism, says Dr. Geffen. In addition, patients need to know that with the standard monofocal IOL, patients will require reading correction and near correction for any tasks they perform within 40 inches. Premium options, such as toric and multifocal IOLs, can address these issues.

“Optometry needs to discuss this with their patients before referring the patient to a surgeon,” says Dr. Geffen. “This will make sure the patient knows that it is not a simple sales pitch when the surgeon discusses premium IOLs.”

Likewise, “we cannot prejudge the patient’s willingness to pay for these lenses,” he continues. “Often, the patient thinks Medicare pays for the lenses, so there is no need to pay for the upgrade.”

One last caution from Dr. Geffen is that it’s “critical that, as the patient’s primary eye care physician, we explain the co-management process;” this should include a clear explanation of which medical provider is responsible for what follow-up care.

Dr. Black adds to check for ocular surface disease (OSD). Some patients may not even be aware that they have OSD, and instead of saying they have dry eye, may, instead, say their eyes “water all the time.”

“[Meibomian gland dysfunction] is very prevalent, so it’s important to check the glands’ function and structure ideally,” Dr. Black says. Optometrists “need to do a thorough check and ideally treat appropriately prior to the referral.” OM