4/6/2017 0 Comments Maximizing refractive outcomesWe have all had that patient... Prior to surgery, they are complaining about poor vision, difficulty driving at night and difficulty reading. Their best corrected vision is 20/80. After surgery, you look at the chart and know that this will be a quick one-week post op visit. The patient is doing well with UCVA of 20/30 which improves to 20/20 with +0.50-1.25x175. As you enter the exam room, the first thing the patient asks, "Did they put in the wrong lens? Why am I not seeing better?" You immediately think (but don't dare say), "Are you serious?" It's obvious that patient's expectations in regard to cataract surgery outcomes have skyrocketed. Regardless of the cause, we have to respond and do everything possible to maximize our refractive outcomes following surgery.
In light of this, we wanted to share a few things to consider as it relates to co-managing patients and maximizing outcomes and patient satisfaction. 1. Know and help set patient expectations. It all starts with patient expectations. No one knows your patients better than you, but it's still important to discuss expectations. As with many things, it's always wise to underpromise and overdeliver. Is he or she the type of patient that wouldn't be recognized or wouldn't feel right without glasses or do they expect to not wear glasses for any activity after surgery? If they are not expecting to wear glasses for any event, I still try to dampen their expectations. I never promise that life will be completely free of glasses, but always talk in terms of reducing dependency on glasses. The bottom line in terms of expectations is to know your patient.
I firmly believe that the best patient care occurs when we, VisionAmerica, act as an extension of your practice. One of the best ways for that to occur as it relates to cataract surgery is when you initiate the discussion regarding IOL options prior to your referral and we simply verify and confirm. Here's a quick rundown of current IOL options (although we'll go into more detail in the future)
One of the main factors affecting unplanned refractive outcomes following cataract surgery is inaccurate corneal power. The most common cause of inaccurate corneal power measurements is an irregular ocular surface secondary to dry eye syndrome or basement membrane dystrophy. A thorough evaluation of the ocular surface prior to referral is critical for a successful refractive outcome. Be sure to carefully treat any surface issues that may be present. 4. Communicate This seems obvious, but it is a simple, yet often overlooked, part of meeting patient expectations. Communicating your patient's expectations to the surgical team is the first step in establishing a surgical plan. Whether it's simply a desire to wear glasses after surgery to monovision or presbyopic correction, sharing this information is critical. If monovision, communicating the planned refractive outcome is critical. For example, should the target at near be -1.25 or -2.50? Which eye should be targeted for distance or near? In addition, the patients hobbies or visual needs are important to share. All of these details are critical to meeting and exceeding patient expectations. If you ever have questions or concerns, please don't hesitate to give us a call.
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