Michele Gamache, the clinical manager of Pepose Vision Institute in Chesterton, Mo., is a certified ophthalmic assistant.
Q: I understand that a lot of cataract surgeons still prefer to personally discuss choice of intraocular lenses with patients. Is that a good idea?
Michele Gamache: It's a good idea, but it means the surgeon has to spend a good deal of time on lens selection. Is that an efficient use of his time? And does it make the patient happy? If it's the surgeon doing this, patients may not feel they were getting enough time. Deciding on an IOL is a big decision for a cataract patient, so it's important to let them ask all the questions they need to ask and understand all their options. They value their vision and want the best outcomes.
Q: How do you handle this at Pepose Vision Institute?
MG: Six years ago, we decided to make IOL selection part of the work-up, which is usually done by a certified ophthalmic assistant or other staff before the patient sees the surgeon to prepare for cataract surgery. Typically, the COA gathers data on the patients and dilates them for the surgeon. We have extended this visit by adding IOL selection.
I personally do this work because, in addition to serving as clinical manager of Pepose Vision, I am a COA. In the extended visit, I see the patient for 45 minutes to an hour. If family members are there, I talk to them as well. I spend a lot more time with the patient than the surgeon could. We are in a special room that has models of the eye and models of different types of implants so that they can see what is going to happen.
Q: How much more efficient can the cataract surgeon be under this arrangement?
MG: Having me discuss IOL choice takes 10-20 minutes off the surgeon's time with cataract patients before surgery. I'm working with each patient for up to an hour, and the cataract surgeon is then seeing them for about 10 minutes, instead of 20 or 30 minutes. That means he can see another patient while I'm working up his next cataract patient.
Q: How do you help patients choose an IOL?
MG: One tool I use is the IOL Counselor, a proprietary computer program that helps the patient experience what it would be like to have the various types of IOLs that are implanted in cataract surgery. To help patients understand how well they will see, IOL Counselor presents three scenarios on the computer screen: grocery shopping, attending a ball game and driving.
In the grocery store scenario, patients see an image of a shopping list, portrayed as 12 inches from their eyes to demonstrate reading vision with each kind of IOL. The screen then portrays items in the cart, giving the patient an idea of midrange vision, and then looks across the store, showing far vision. With the less expensive standard IOL, the far vision would be clear but the shopping list and the items in the cart would appear slightly blurred. The IOL Counselor portrays this.
The ball game scenario portrays the same three types of vision –– near, midrange and far –– but the driving scenario portrays something different: night vision. With a multifocal IOL, there can be halos around lights at night. Patients can get a good idea of what that looks like with a multifocal IOL and decide whether they want to put up with it.
Q: The IOL Counselor website says it can "dramatically increase the number of patients converting from standard monofocal IOLs to premium IOLs." Have you found that to be the case?
MG: Not really. We do not view the session as a sales opportunity. Our conversion rate to premium IOLs ranges from 56-73 percent, which is about what it was before we started using the IOL Counselor. But I do think IOL Counselor is a useful tool to help give patients an idea of what it will be like with each type of lens. Anything that can help show the patient what it would be like with each choice of IOL is useful. We don't want patients to be surprised about their vision after the lenses have been put in.
Learn more about Pepose Vision Institute.
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