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    Managing unhappy presbyopia patients

    Listen, counsel before taking action; identify cause

    With careful selection of candidates based on thorough preoperative evaluation and counseling combined with meticulous intraoperative technique, cataract surgeons have a high likelihood of achieving satisfaction among patients who choose a presbyopia-correcting IOL. However, the rare unhappy patient can ruin the day.

    Understanding the patient’s complaints and knowing the potential reasons for patient dissatisfaction with a presbyopia-correcting IOL provides a basis for appropriate evaluation and successful management, said John P. Berdahl, MD.

    “We really can get these patients to a place where they will be happy,” said Dr. Berdahl, assistant clinical professor of ophthalmology, University of South Dakota, and private practice, Vance Thompson Vision, Sioux Falls, SD. “To use a football analogy, we should not give up on them at the 3-yard line when we know that with some extra effort we can get them into the end zone.

    “The first thing surgeons need to do is listen to the patient,” he said. “Not only will you get information that helps to determine the cause of the problem and therefore an effective solution, but it will make patients feel that you are on their team. To quote the wisdom of my grandmother: People don’t care what you know until they know you care.”

    Refractive error is the most common cause of patient dissatisfaction with vision after presbyopia-correcting IOL implantation, but before addressing residual astigmatism or spherical error, cataract surgeons should look for and manage dry eye.

    “This is a situation where listening to the patient’s complaints is very helpful for directing your care,” Dr. Berdahl explained. “If the patient reports having visual fluctuations, then dryness of the ocular surface is a problem, and treatment of residual ametropia will address the refractive error as it is measured at one point in time.”

    Treating dry eye

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