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    Managing unhappy presbyopia patients

    Listen, counsel before taking action; identify cause


    Dr. Berdahl said the cost of an exchange procedure also is included in the surgical package.

    “It is hard to predict when an exchange will be needed, and we do not want to make these patients unhappier by charging them more for another procedure,” he said.

    Some patients who choose a presbyopia-correcting IOL may be unhappy with the result if their best near point is not consistent with their visual needs. The best management for this problem is prevention, and that involves listening to the patient before the surgery.

    Patients who want good uncorrected vision to do detailed near tasks, such as needlework, are good candidates for a higher add multifocal IOL, whereas someone whose needs are more for intermediate and far distances would be happier with an extended depth of focus or accommodating IOL, Dr. Berdahl said.

    “Knowing the best near points for the different presbyopia-correcting IOLs is useful for recommending a lens that will match each patient’s visual goals,” he said. “In some cases, different lenses can be implanted in fellow eyes to give a patient a range of vision that will make them independent of glasses all of the time.

    “However, I don’t ever promise freedom from glasses,” Dr. Berdahl said. “That may be my internal goal, but I always make sure patients accept the possibility that they may need to wear glasses some of the time.”

    The “visually demanding” individual represents another scenario for patient dissatisfaction after presbyopia-correcting IOL surgery. Dr. Berdahl described this group as people who want ultra-crisp distance vision.

    To screen for them preoperatively, he asks: “Are you visually picky?”

    “Usually patients say they don’t know what I mean, and then I ask if when they got new glasses, they would return multiple times for adjustments,” he said. “If they say ‘yes,’ I explain that I am not sure they will be happy with a presbyopia-correcting IOL because I cannot make adjustments for them the way it was done with their glasses.

    “I remind them that they have to decide if they are interested in increasing their visual freedom and flexibility in exchange for some decrease in visual quality,” Dr. Berdahl added. “Then, a presbyopia-correcting IOL might be a good fit for them.”

    Patients who are still unhappy

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