Years ago, a patient in her 40s presented with a posterior subcapsular cataract. Her surgical outcome was “good,” but in looking back on that patient, I feel it could have been better. Why? She went with a standard IOL that required instant dependance on near correction because I didn’t go far enough in educating her on all her IOL options.

This patient encounter reinforced to me that as the co-managing OD who often diagnosis and refers patients for cataract surgery, I must provide clear, understandable, and comprehensive information that enables these patients to make informed decisions. (See “Talking Price and Preparing Financially,” p.15.)

Here, I provide the patient scripts I use for both the foundational IOL discussion and the individual talks on each IOL category, to facilitate this crucial pre-operative counseling.

Foundational script
“Intraocular lenses, also referred to as ‘IOLs,’ are artificial lenses implanted in the eye to replace the eye’s natural lens that has a cataract, and that lens is removed during cataract surgery. IOL implantation has the same safety profile we discussed with cataract surgery. 
There are several categories of IOLs available, each designed to meet different vision needs, and each comprised of several brands that offer individual characteristics.
Each type of IOL offers advantages and compromises. It’s important you understand this, so you are not surprised and, therefore, dissatisfied post-operatively. We will work together to determine the most suitable IOL for you, taking into consideration your daily activities, visual requirements, and any other eye conditions you may have.
Do you have any questions, or would you like to know more about what I’ve discussed? I urge you to continue asking questions during the IOL selection process, so we can ensure we are on the same page.” 

IOL categories
Below are the patient scripts I use to educate my pre-cataract surgery patients on the advantages and compromises of each of the IOL categories.
• Monofocal IOLs. “These IOLs contain a single-focus strength for distance or near vision. As a result, patients who choose monofocal IOLs may still need to use glasses for uncorrected astigmatism and often need reading glasses.”        
• Toric IOLs. “These IOLs take care of the cataract and astigmatism at the same time, providing clearer vision without the need for corrective lenses at distance post operatively. Because the surgeon must align this IOL at a certain angle, postoperative misalignment of the IOL can occur, requiring a post-operative IOL rotation.”
• Extended depth of focus (EDOF) IOLs. “These IOLs provide a continuous range of vision from near to far distances, with a focus on improving intermediate vision, while still providing functional near and distance vision. The side effects of these IOLs can be halos and glare, especially at night.”
• Multifocal IOLs. “These IOLs provide clear vision at multiple distances, reducing or eliminating the need for glasses or contact lenses for most activities. They work by having different zones set at different powers for near, intermediate, and distance vision. Some patients report difficulty seeing at close or intermediate distances, which may be corrected with glasses or good lighting conditions. Additionally, some patients develop glare, halos, and a decrease in nighttime vision, with this subsiding over time in most patients.”
• Light Adjustable Lens (LAL). “These IOLs allow for non-invasive post-surgical adjustments using UV light to fine-tune vision. LALs are part monofocal, part toric, and part EDOF lens. Adverse effects associated with the LAL include erythropsia and changes in color vision, which tend to resolve after UV light adjustments are completed.”
• Accommodating IOLs. “These IOLs allow the eyes to see objects at varying and clear distances. The exact position of the accommodative lens must be where the natural lens was, which can’t be predicted accurately prior to surgery. This IOL is also available in a toric version. Some designs are in the pipeline.”

Preparation
I have found that preparing patients for the inevitability of cataracts long before a “cataract evaluation” softens the blow, making patients more amenable to this IOL education. As a result, I highly recommend mentioning cataracts the first time you note a significant lens change on slit lamp or (more often) when a patient returns to the practice, saying their new glasses or antiglare coat “don’t work.” OM 

KRISTOPHER A. MAY, OD, FAAO is owner of Coldwater Vision Center, with offices in Coldwater, Ashland, and Tishomingo, Miss., and serves as adjunct and consulting faculty for the Southern College of Optometry. He has served as a consultant and/or speaker for Sight Sciences, IDOC, Bausch + Lomb, Alcon, RadiusXR, Glaukos, and Visionix.