Making the Subjective Objective

So much of premium IOL selection comes down to chair time and questionnaires. But what if it didn’t?

By Mark Hillen

February 2018

At a Glance

  • When selecting or recommending an IOL to a patient, surgeons try to get to know the patient through chair time and questionnaires
  • Subjective assessments are not the best approach because patients can forget or misrepresent their visual requirements
  • Truly and objectively assessing how patients use their vision day-to-day would allow surgeons to select the best IOL for their needs
  • I overview the Visual Behavior Monitor, and how it can make the subjective objective

Woe betide the surgeon with an unhappy patient – especially if that patient has spent a hefty sum of money on elective surgery to get there. Cataract and refractive surgeons describe such patients not as just ruining their day, but ruining their whole month.

One big challenge in refractive surgery is understanding what the patient wants – and then selecting the best course of action to meet that objective. Determining the correct target refraction (see Box 1) is critical, but there’s more to it than that. For example, certain multifocal IOLs perform better in patients with small pupils and mesopic conditions than others; both toric multifocal and small-aperture optic IOLs can correct presbyopia and some amount of astigmatism. The problem is that no simple nomogram exists that can lead a surgeon to the best choice for the patient. It’s why these surgeons spend a considerable amount of time discussing their patients’ lifestyles – hobbies, work, whether they read the news on a newspaper or a phone screen, and even what time of day they drive – all to try to determine which option might be best for their patient. And that’s before they start to make a call on a patient’s personality type…

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