Clinical Scorecard: Why Eligible Patients Still Do Not Choose Eye Surgery

At a Glance

Key Highlights

• The article reports low uptake relative to eligibility: toric lenses account for 6% to 8% of cataract procedures, while an estimated 52% to 70% of cataract patients have qualifying astigmatism.
• A 2015 ASCRS Clinical Survey identified patient cost as the leading barrier to presbyopia-correcting IOL adoption, followed by concern about nighttime quality of vision.
• Market Scope’s David Harmon reported that about 25% of cataract surgeons offered neither presbyopia-correcting nor toric IOLs; he suggested lack of confidence, interest, or selling skill as possible reasons.
• The author argues that patient adoption may be limited by constraints in the patient journey rather than by technology alone.
• The author proposes identifying the largest point of patient loss, improving it with existing resources, aligning other activities to it, adding capacity if needed, and repeating the process.

Guideline-Based Recommendations

Diagnosis

• The author proposes measuring progression through inquiry, consultation, decision, and surgery to identify where eligible patients are most often lost.

Management

• The author proposes addressing the identified constraint before investing in new technology, advertising, or other capacity.
• If consultation is the constraint, improve the consultation process, including the order and clarity of information about value.
• Align other practice activities with the identified constraint; the article cautions against increasing demand when consultation is already at capacity.
• Add people, training, systems, or investment only after making better use of existing resources.

Monitoring & Follow-up

• Reassess the patient journey after addressing a constraint; the article notes that another step, such as awareness or scheduling, may then become the limiting factor.

Risks

• The author argues that investing in a new device or marketing without identifying the binding constraint may not increase patient adoption.
• The article reports patient cost and concern about nighttime visual quality as barriers to presbyopia-correcting IOL adoption.

Patient & Prescribing Data

People eligible for premium or toric IOLs, or laser refractive surgery; the article cites low treatment uptake relative to estimated eligibility.

Market Scope projected premium IOLs at just under 17% of global units in 2025. Toric lenses represented 6% to 8% of cataract procedures despite an estimated 52% to 70% of cataract patients having enough astigmatism to qualify. The article cites estimates that 3.6% of eligible people in the UK and about 13% in the US had undergone laser refractive surgery.

Clinical Best Practices

• The author proposes using practice data to locate the largest loss of eligible patients rather than assuming the cause is price or marketing.
• The author proposes improving the identified step using current resources before adding capacity or making new investments.
• The article recommends explaining treatment value clearly during consultations and attending to patient expectations and trust.
• The author proposes repeating the constraint assessment after each improvement.

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