Bonus Playbook: Helping Patients Choose their IOL

• Send the patient a detailed lifestyle and vision needs questionnaire before the appointment.
• Provide educational materials on lens options, including videos or brochures, to familiarize patients with their choices.

• 
  
  • Review the completed lifestyle and vision needs questionnaire with the patient.
  • Identify the patient's primary vision zones: 
    • Distance (e.g. looking out a window), 
    • Intermediate (e.g. looking at a computer screen), and 
    • Near (e.g. looking at your phone or a book).
  • Communicate the compromises
    • Standard Vision (0): For distance vision without glasses. Key point:
        

      "Glasses are required for intermediate and near zones."

       
    • Blended Vision (-1): One eye for distance, one for intermediate. Key point:
        

      "You will require glasses for reading."

       
    • Blended vision (-2): One eye for distance, one eye for reading. Key point:
       

      "You may need to move closer to the screen for intermediate tasks in order to use the -2 eye."

• Explain monofocal IOLs corrected for distance vision (with reading glasses for near) and blended vision.
  
  
• Discuss when and where glasses may still be required with the above options. 

• Describe FROF and IROF lenses, highlighting peaks, troughs, and the absence/presence of halos.
• Use third-party stories to illustrate patient experiences with these lenses.

• FROF Lenses key points:

  • "Recognize they have peaks for Distance, Intermediate, and Near vision."

  • "Be aware of potential halos around lights."

  • "Ideal for those valuing reading vision over night driving."

•  IROF Lenses:
  • Option 1: Lenses set for Distance in both eyes. Key point:

    "You will need glasses for up-close activities."

  • Option 2: Set one eye for distance and intermediate vision (target emmetropia) and the other for intermediate and near vision (-0.50 or -0.75D). Key point: 

    "You will experience minimal glare and halos while greatly improving your range of vision. However, you will still need glasses to read very small print or in low-light conditions."

• Discuss the patient's night driving and reading habits to personalize lens recommendations.
• Present visual simulations or demonstrations to show potential vision outcomes with different lenses.

If you're a night driver (e.g., taxi driver), consider your need to see road signs, dashboard, and phone clearly. IROF lenses may be preferable for minimal glare and halos.

If night driving isn't a priority and you desire a complete range of vision - FROF lenses could be the best fit.

• Assist the patient to reflect on their daily experience and vision priorities.
• Simulate the blended vision experience for the patient using one or more of three steps:
  1. Full refractive correction using the phoropter to emmetropia for both eyes. This is full correction and becomes the reference for the patient of "100% vision." Defocus the non-dominant eye to -1.50 and ask the patient to rate the vision compared to the reference 100%. If the patient rates the vision as 80% or more of the 100% reference, the odds are close to 100% that they will accept blended vision. (99% for myopes and 98% for hyperopes in our experience over 25 years of using this method). Demonstrate the reverse to the patient, i.e. the non-dominant eye corrected to distance and the dominant eye corrected to -1.50D. Sometimes, this is preferred to the first demonstration. Select the option that the patient prefers. This is based on sensory dominance.
  2. Trial frames -Trial frame: If the phoropter test outlined above does not yield a conclusive result, conduct a trial frame test for at least ten minutes in the clinic with the patient using the trial frame to view all distances. Compare 0/-1.50 to -1.50/0. Most often, this trial frame test will provide a conclusive answer.
  3. If step 2 remains inconclusive, proceed to a contact lens trial for a few days so that the patient can experience blended vision at home and at work in their real-world environment. 
• Why blended vision?
  • It costs less than the alternative (AT-IOLs)
  • Glasses can correct any glare symptoms or range issues if required.
    
    
• Summarize the pros and cons of each lens type based on the patient's lifestyle and vision needs.
• Assist the patient in making an informed decision by answering any remaining questions.

• Schedule a final consent meeting to confirm the patient's lens choice.
• Set realistic expectations about the surgery, recovery, and potential need for glasses in certain activities.

• Conduct a follow-up consultation to assess satisfaction and address any vision concerns.
• Collect feedback on the lens performance in various vision zones and daily activities.

• Organize regular training sessions on the latest lens technologies and patient communication strategies.
• Ensure all team members have up-to-date knowledge to support patient education effectively.