Choose Your Words Carefully

When we ourselves as doctors seek medical care, we have the unique privilege of having some innate understanding of the terminology presented to us in the general field of medicine. Outside of our respective fields however, we are still at the mercy of the expertise of the physician whose help we have come to seek. We can therefore only imagine how challenging this must be for our patients – especially those who may come with little to no health background. Like them, there are two virtues we value most during consultations: firstly, that the doctor is clear at explaining our conditions, and secondly, that the doctor is concise when explaining our treatment options. In the end, no matter our knowledge level, we all want enough information to make informed decisions about what might be best for our health.

The plethora of acronyms springing up in every subspecialty of medicine has increasingly obscured the clarity sought after by patients, making the decision-making process confusing and complex to the layperson –even to those surgeons at the beginning of their subspecialty learning journey. If this is a source of confusion to the average resident or fellow embarking upon the field, how can we possibly expect our patients to partake in their own health decision-making?

The need for standardization of terminology is crucial in ensuring accuracy and consistency in communication between healthcare providers and patients. Surgeons play a vital role in leading this change, as we are at the forefront of healthcare and have the ability to influence and shape medical practice.  By adopting standardized terminology and promoting its use among our colleagues and during our industry interactions, we can reduce confusion and misperception among patients and professionals alike.

Standardized terminology also allows for proper classification and discernment between procedures. It sets the foundations for more stringent comparisons between various procedures of the same type, and, at the same time, allows for improved and nuanced understanding of procedures that differ in principle but treat the same issue. The adoption of such standard terms should filter into the realms of the medical literature and set solid foundations for meaningful comparison.

It is also imperative that the standardized terminology adopted is industry independent.

Industry manipulation of language promotes profound confusion at the level of the patient, particularly where direct-to-consumer marketing is concerned. Patients may be particularly swayed by companies with more effective or larger advertising budgets and, as a result, become fixated on a particularly named procedure, setting up the surgeon for the difficult task of realigning the patient’s understanding and expectations, with time, mental energy, and resources being wasted in the process. Industry manipulation of terminology also monopolizes the playing field and detracts from the speed of adoption and exploration of new technologies aiming to address the same issue. Using brand names for procedures is neither appropriate nor professional, especially where longevity in a particular field may create an unfair advantage for a single manufacturer compared with a newer player on the market that may have developed superior technology, but has had less time “on the playing field”.

We, as surgeons, must lead the conversation in the consultation room, as well as in our industry interactions. We have a unique opportunity to define the terminology and set the appropriate standards accordingly.

To this end, the Refractive Surgical Terminology Committee (a subcommittee of the Refractive Surgical Alliance) was formed in 2022 to define standardized terminology for the following procedures. The committee consisted of experienced refractive and cornea surgeons from Europe, the Americas and Asia-Pacific region ensure that the terminology was not only accurate and reflective, but sensitive to language translation in various geographical regions. The terminology was then presented to the RSA membership at large for input and commentary before formal endorsement.

Lens replacement
 

In considering standardized terminology for lens replacement procedures, the term “lens replacement” stood out as the most appropriate choice. This term is simple, yet elegantly encompasses the essence of the procedure - the replacement of a dysfunctional lens with a custom-fit replacement. The term “lens replacement” allows for improved flexibility in the language used by clinicians in different contexts, and factors in various language considerations and subtle differences in counseling techniques. In addition, using the term “dysfunctional lens” in consultation with patients effectively communicates the need for the procedure, while “customized lens replacement” accurately describes the solution.

Furthermore, the term lens replacement is already widely adopted by patients, indicating a level of stickiness and ease of understanding. The use of “replacement” as opposed to “exchange” also aligns with the terminology used in other medical specialties and better conveys the idea of switching an old lens with a new one. Alternative terms were considered (see sidebar: “Rejected!”) but ultimately discarded as they did not convey the same level of simplicity and understanding for patients.

Overall, the use of the term lens replacement in the refractive surgery industry promotes clarity and understanding for both patients and colleagues in the fields of ophthalmology and optometry, and supports the goal of standardization in terminology.

LALEX
 

The term LALEX– which stands for “laser assisted lenticule extraction” – elegantly encompasses all lenticule extraction procedures, including SMILE, ReLEX, CLEAR, SmartSight and SILK. In particular, the use of this term does not demonize one laser vision correction procedure over another. Another key advantage of using LALEX is that it minimizes the use of technical jargon that may not be easily understood by patients; for example, “femtosecond” or “intrastromal.”

It should also be noted that the term LALEX has already been adopted by our German colleagues, and we recognise their contribution in arriving at this term.

Other terms were considered but ultimately rejected (see sidebar) as they did not effectively encompass all lenticule extraction procedures nor did they have the desired level of simplicity and ease of understanding for patients.

STODS
 

STODS  – which stands for “surgical temporary ocular discomfort syndrome” – is now the endorsed term to describe the temporary discomfort experienced by patients after vision correction procedures. The priority in the naming of this syndrome is to convey the understanding that the discomfort is temporary and will heal over time. This is important to validate the experiences of patients and to avoid any unintended manipulation by the media. The term STODS encompasses the neurological deviation that can occur after all types of vision correction procedures. It is important to note that this is not solely a “dry eye condition” but a distinct clinical entity as evidenced by research evaluating the differences in inflammatory markers between dry eye disease and STODS.

It is important to note that STODS is not a unique complication, but rather a normal and temporary part of the healing process after vision correction procedures. Alternative terms were considered (see sidebar: Rejected!), but they did not convey the temporary and healing nature of the discomfort experienced.

Words Matter
 

Technical jargon used carelessly when communicating with patients can create barriers to understanding and lead to needless confusion and stress. It is important for doctors to present information in a clear and concise manner, using terms and language that are easy for the patient to understand. Avoiding brand names and eliminating industry manipulation of terms is not only the ethical and transparent thing to do, but it also keeps things simple and engenders trust. Clarity and consistency also ensures that patients fully comprehend their health status, treatment options, and any potential risks and benefits. For the surgeon and for the advancement of refractive surgery, the adoption of standardized terminology and classification also clears the path for newer technologies to find their rightful place and allows for clearer and more robust comparison between different technologies.

Ultimately, the terminology we use should empower patients, enabling them to make clear and informed decisions about their health and treatment. The adoption of the RSA endorsed terms – “lens replacement”, “LALEX”, and “STODS” will improve patient engagement and understanding, leading to improved patient experience and, in the end, better health outcomes.

The authors wish to thank the other members of the RSA Terminology Committee:  Drs. Dagny Zhu, Lance Kugler, Luke Rebenitsch, Guy Kezirian, Arthur Cummings, and Brett Mueller, as well as the RSA membership.