How to Manage Patients Unhappy with Cataract, Refractive Surgery Outcomes

How to Manage Patients Unhappy with Cataract, Refractive Surgery Outcomes


It starts with setting expectations and educating patients before the procedure

Patient satisfaction with cataract surgery is high. But there is always the chance of those rare patients who are not happy with their results. Blurred vision and glare are common complaints in patients with certain IOLs. Getting the best outcomes starts with asking the right questions, setting expectations, and educating patients about their options. And in 2018, that means showing patients what they can expect, not just telling them. Is your patient education the best it can be?

Start by asking the right questions

Ensuring that patients will be satisfied with their cataract surgery starts long before the procedure. With many IOL options, it is the doctor’s job to help patients carefully consider the choice that best suits them and their lifestyle.

Patients’ daily activities and willingness to wear glasses for certain tasks will determine the right procedure for them.

Explain to patients that their occupation and favorite activities should drive their decision. Use specific examples and ask questions like, do you play golf and need to see from long distances? Are they avid readers? Do they frequently drive at night? Patients who want good uncorrected vision to do close-up detailed tasks, such as needlework, are good candidates for a higher add multifocal IOL, said ophthalmologist John P. Berdahl, M.D., in an article in Ophthalmology Times, whereas an extended depth of focus or accommodating IOL would be better for patients who need to see farther distances. Remember that patients may not understand terms like “intermediate vision,” which is why it’s important to use examples of daily activities.

Also, find out whether they are hoping the surgery will allow them to reduce dependence on glasses, or if they are willing to wear them for certain tasks. Their answers will inform your treatment recommendation, and help you assess the patient’s personality. Dr. Berdahl tries to identify “visually demanding” patients who may be unsatisfied with premium IOLs by asking whether they would require multiple adjustments on a new pair of glasses. “If they say ‘yes,’ I explain that I am not sure they will be happy with a presbyopia-correcting IOL because I cannot make adjustments for them the way it was done with their glasses.”

Our short video, Considerations for your IOL Choice, can walk patients through the decision:

Show patients what typical outcomes look like

Asking questions is not the only way to set expectations before surgery—showing patients what they can expect is an even more powerful method. Our Outcome Simulator is a new, customizable tool that lets you help patients make more informed treatment decisions and get better visual outcomes.

Our Outcome Simulator shows patients the “before” and “after” of their uncorrected vision next to what they would see after various treatments.

Outcome Simulator works like this: you can choose from several realistic custom-photographed scenes—such as nighttime driving or reading fine print. You can simulate patients’ current, uncorrected vision next to a treatment option to show how the image will change with the selected treatment. You can show patients the “before” and “after” next to each other and even compare treatment options side by side to show differences at a glance. This illustrates clearly to patients how a particular treatment will affect glare or blur, for instance.

Some doctors even find it helpful to show patients the Outcome Simulator again after surgery to demonstrate the improvement, since many patients forget how poor their vision was pre-operatively.

Dealing with the most common complaints

No matter how much you prepare them, of course, there is always the chance of that rare, unhappy patient. If you do encounter a patient who is dissatisfied with their vision following surgery, it’s important to listen to them rather than getting defensive or jumping in with a solution immediately. Your patients trust you and rely on your expertise, so reassure a frustrated patient that their results are normal and can likely be improved.

“We really can get these patients to a place where they will be happy,” said Dr. Berdahl. “The first thing surgeons need to do is listen to the patient. Not only will you get information that helps to determine the cause of the problem and therefore an effective solution, but it will make patients feel that you are on their team.”

Dry eye is a common cause of refractive error in post-op IOL patients.

Refractive error is the most frequent cause of patient dissatisfaction with vision after presbyopia-correcting IOL implantation, according to the article. A common culprit? Dry eye. For instance, patients may report having visual fluctuations, which may be caused by dryness of the ocular surface. The treatment for dry eye will vary by patient.

For more on this topic, see How Dry Eye Centers of Excellence Benefit Patients, Doctors, and Practices Alike

In some cases, a “refractive touchup” may be necessary, noted Dr. Berdahl. He said in his practice, all pre-op patients are notified of the possibility of having an additional excimer laser enhancement procedure, the cost of which is included in his premium package.

Why patient education is the best defense against dissatisfaction

Another Ophthalmology Times article stated that glare, blurred vision, and optical aberrations are the most common reasons for patient dissatisfaction with multifocal IOLs, according to surveys, as well as “excessive preoperative patient expectations.”

“These data again underscore the need to counsel patients carefully about the outcomes and to beware of those who seem to want magic and are hoping for complete spectacle independence,” said Nick Mamalis, M.D.

“I tell my patients that by choosing these lenses, they are trading some visual quality for an increase in flexibility through decreased dependence on glasses,” said Dr. Berdahl. “I say they will likely have some glare and some halos and that the brain usually learns to adapt to these issues, just as it learns to filter out the shadow created by the edge of their frames or their nose when they look through their glasses.”

The right kind of patient education can make all the difference in setting patient expectations and getting positive outcomes.

In some cases, however, both doctors noted that some patients still might not be happy with their vision, in which case you may need to pursue other treatment options.

The right patient education makes all the difference. If you’re still using verbal explanations and pamphlets, it’s time to see what the latest innovations in digital patient education can do for your practice. For more information and a free trial of Rendia, get in touch with us today!

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