Thursday, March 21, 2013

Tools for Patients’ Education


Educate cataract patients before they even arrive at your office for the examination.

Cataract surgery is one of the most successful surgeries in all of medicine. It also enjoys a very low
complication rate. With the aging population in this country, most patients know someone who has undergone the procedure. In addition, the newest IOL technology offers patients the possibility of excellent
vision at all distances without glasses. Efficiently and effectively educating patients on cataracts and the options for IOLs, however, can still be a challenge. In my practice, we have found that an effective patient education plan starts as soon as the individual contacts our office. The plan provides patients with ample opportunity to familiarize themselves with their pathology and the treatment
options before they have any decisions to make.


When a patient makes an appointment with our office, whether he or she was referred by an optometrist,
a patient who is a friend or family member, or is following up from a previous experience in our office, the front office staff member always asks for certain demographic information including age and e-mail address. For the 50% to 60% of patients from whom we are able to obtain an e-mail address, we send them an introductory message before they come in for their appointment. For patients in the cataract demographic, the e-mail message they receive includes information about our office and links to interactive educational software (ECHO, Eyemaginations, Inc.) about the pathophysiology of cataracts as well as an introduction to premium lens options for the patient to view.

When the patient arrives at the office, the file is “flagged” to identify him or her as a cataract patient. A technician escorts the individual into the examination area, takes the history, and begins a diagnostic evaluation.  If it is clear that the patient has a cataract, his or her visual function is measured in several different ways including tests to determine the level of astigmatism. While the patient is waiting for the dilating drops to take effect, the staff has him or her watch a simple video of me explaining the cataract process, what the experience is like, and informing him or her about lens options. I emphasize that all of the implants are good options and he or she will see well with each of them. Then, I outline the differences between what we call the basic high-tech implant, the advanced distance high-tech implant (a toric IOL), and the advanced distance and near implant (a presbyopia correcting IOL). During the dilation, the staff will also play educational videos on the Eyemaginations LUMA platform in the examination rooms to reinforce the information that the patient has already received.


Once the patient is dilated, an optometrist performs the pre-examination to determine whether or not the patient can be corrected with spectacles and also evaluates the cataract’s size and severity. The optometrist expands on the information provided in the educational video, reintroduces the concept of choice, and alerts the patient to whether or not all three options are available. For example, we know that if the patient has macular degeneration, a presbyopia-correcting IOL is likely not an option. The optometrist also encourages patients to fill out a lifestyle survey and dives a little deeper into their visual life: how do they use their eyes, what activities do they participate in, and what is most important to them. The goal is to find out what will make patients the happiest.


This is the point at which I come in, confirm the diagnosis, determine whether the patient is a surgical candidate, and answer any questions. After I review the IOL options, I ask the patient to make a choice regarding which implant he or she would like to receive.

Nationwide, approximately 9% of cataract patients choose a premium IOL, according to Market Scope. Our conversion rate was consistently 22% until about 3 years ago when we made two distinct changes. First, I created the video that we have all cataract patients watch while their eyes are dilating. Second, we started e-mailing all possible cataract candidates the ECHO educational software about cataracts and the premium lens options. Since we have implemented those two strategies, the percentage of patients that choose premium IOLs has increased to 35% and has remained at this figure for the last 2 to 3 years. 

Our patients’ experience has always been centered on trying to access their learning strategies in as many different ways as we can. We interact with them verbally, we provide printed material, and because we know many people are visual learners, we offer interactive media as well.


In addition to the specific materials, timing is a very important element of patients’ education. The first time
patients hear that they have a cataract, they are not really able to pay attention to anything else. Although they may have friends or family members who have undergone successful procedures, they are still trying to mentally digest the diagnosis. By our office sending an email and starting their educational process at home before they ever come into the office, we have moved that emotional reaction upstream from the decision point.  When I meet with cataract patients in the examination room, they have accepted their diagnosis, they have been educated on the disease’s pathology and the surgical procedure, and I am able to answer any remaining questions.  I can then help them decide which IOL is right for them. I spend less time explaining what a cataract is and more time discussing what constitutes their visual life, what things are important to them, and how they use their eyes. I believe that my patients now are more comfortable with the decisions they make.

It is very frustrating for physicians and patients when a  patient chooses a standard IOL and then has “non-buyer’s remorse”—they wish they did not have to wear reading glasses, for instance. Today, that does not happen as often as it did previously because patients have been presented with the information on the IOL options several times before they are required to make a final decision.


After discounting the first 2 years of explosive growth in the practice, we have consistently grown 8% to 11% each year with no external marketing and a very small, dedicated base of referring optometrists. Although it is difficult to measure exactly, our best guess is that our growth has come from referrals from satisfied patients: we simply encourage our patients to send their friends, family, and colleagues to our practice. I believe a large part of our success is that we very openly make every effort we can to educate our patients about their disease process. Our patient-education plan is a central part of what our version of a patient-centered medical experience should be. 

Darrell E. White, MD, is the founder of Skyvision Centers of Westlake, Ohio. He is a consultant to Eyemaginations, Inc. Dr. White may be reached at

Advanced Ocular Care Magazine March 2013

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