Uncovering Patient Preferences in Eye Surgery


Vision simulators bridge the gap between what patients say and what they want 

 When a patient schedules a consultation for LASIK or cataract surgery, an eye doctor is faced with a daunting task. The doctor must: 

  • gather clinical data
  • gain an understanding of the patient’s personality and visual preferences 
  • make recommendations, and 
  • explain several complex concepts in a way patients can understand

Yet even after an in-depth—and time-consuming—consultation, patients may not fully understand the benefits of the premium options. They may choose the cheaper option, only to regret missing their chance to eliminate or reduce their dependence on glasses. What’s a doctor to do? Questionnaires are a good start, but technology provides an even better solution. Read on to find out how Rendia’s Outcome Simulator takes standard patient counseling one step further.

 The real value of the Dell questionnaire

One way to address this problem was created by Steven J. Dell, M.D., who developed a cataract and refractive lens exchange questionnaire in 2004. “I needed a way to quickly establish a common vocabulary with patients, assess how they wanted to see postoperatively, and determine if they were flexible enough to handle the optical compromises needed for success with early presbyopia-correcting IOLs,” he wrote in MillennialEYE. The Dell questionnaire has been very successful for many eye surgeons, and was updated in 2016.

The Dell questionnaire subtly alters patients’ expectations about outcomes, and can be a predictor of post-op satisfaction—except that patients don’t always answer accurately.

Dr. Dell noted that “the real value of the tool is that it subtly alters patients’ expectations regarding spectacle independence and dysphotopsias.” Patients may want and expect to not need glasses after surgery, but this outcome may not always be possible. Or if it is, patients may need to make some compromises, such as dysphotopsias or loss of stereopsis, he noted.

The questionnaire also can be a predictor of patient satisfaction: “Patients who rated their personality as exactly midway between ‘easygoing’ and ‘perfectionist’ tended to be the least happy postoperatively,” according to Dr. Dell.

How vision simulations bridge the patient education gap

Unfortunately, patients don’t always accurately portray their personalities, or understand how much their vision can be improved by various procedures. Take, for instance, presbyopia patients. This condition affects millions in the U.S., with symptoms that range from difficulty reading to near-vision loss. Patient responses to presbyopia range from annoyance to feeling helpless, according to the Ophthalmology Times.

“Although choices for near-vision correction include glasses, contact lenses, monovision corneal laser refractive surgery, corneal inlays, and IOLs, 90 percent of patients aged 40-55 years remain frustrated or irritated with presbyopia.”

The article continues, “In part, this is due to the fact that even though nearly two-thirds of patients with presbyopia seek help from their eye care provider, barely one-half report obtaining the information they needed.”

Only half of presbyopia patients say they were provided sufficient education. That’s why doctors must use tools like Outcome Simulator to assess patients’ visual preferences and help them understand treatment options.

Besides questionnaires, doctors must employ other tools for assessing patients’ visual pain points, preferences, and understanding of treatment options. That’s why Rendia’s Outcome Simulator was created—to show patients what they can expect from certain options in a more impactful way than simply telling them.

Outcome Simulator is the most advanced vision simulator on the market, and can be customized to each individual patient. Let’s say you have a patient in his 60s who presents with presbyopia and early cataract. He’s an architect, so he cares about style and quality, which you also know from the hip eyeglasses he wears.

Using Outcome Simulator, you can show this patient a realistic-looking office scene, and what it looks like with his current vision. As you explain that his near vision has naturally become blurrier with age, and that his eye’s lens is starting to get cloudy, too, you can show him that on the screen. Next, you can show him what his vision could look like with a standard IOL, explaining that he would still need reading glasses for many tasks.

Next, you can show that if he wants to be less dependent on glasses, a trifocal lens will allow him to work comfortably at the computer without glasses. 




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A more effective way to manage expectations

To use another example, let’s say you have a patient in her early 80s who likes to play bridge and drives herself home at night afterwards. She tells you she wants the lens her neighbor has that gave her “perfect vision.”

This is an opportunity to set realistic expectations—explain that while attaining the “perfect” vision of a 20-year-old may not be possible, you can certainly offer her a solution that will clear up her cloudy vision. Using Outcome Simulator’s nighttime driving scene, you can also show her possible dysphotopsias, such as halos and glare around lights. 

Outcome Simulator can help manage patients’ expectations so that they don’t make erroneous (and preventable) assumptions, while including caregivers in treatment decision-making.

Doctors can use Outcome Simulator to give patients the confidence to make informed treatment decisions while managing their expectations so that they don’t make erroneous (and preventable) assumptions. Plus, you can use the visual simulations to loop in caregivers. You can either show a spouse or family member during the appointment, or email a video that the patient can watch with their family at home later.

As Dr. Dell wrote, “nothing is a substitute for a thorough conversation with a patient,” but tools like his questionnaire and Outcome Simulator can help bridge the gap between what patients say they want and their true preferences, and show them realistic outcomes for their vision.

 Read more: Patients Don’t Understand Presbyopia, or Correction Options

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