Multifocal io ls tips for increasing patient satisfaction

Multifocal IOLs-Tips for Multifocal IOLs-Tips for increasing patient increasing patient

satisfactionsatisfaction

Dr.Anand SudhalkarDr.Anand Sudhalkar

BOS 7-6-2015BOS 7-6-2015

7-6-2015 1Sudhalkar Eye Hospital

Premium IOL, High Cost Premium IOL, High Cost

Advantages ClaimedAdvantages Claimed UNAIDED Distant, UNAIDED Distant,

intermediate and near intermediate and near visionvision

Freedom from glassesFreedom from glasses Old age, Physically Old age, Physically

handicapped handicapped Indoor life style, day Indoor life style, day

time outdoor activitytime outdoor activity

DownsideDownside Compromised quality, Compromised quality,

contrast sensitivity at all contrast sensitivity at all rangesranges

Glare, at time Glare, at time unbearable in night unbearable in night drivingdriving

Some need glasses for Some need glasses for near, extra lightnear, extra light

Not suitable for skilled Not suitable for skilled fine work e.g. surgeonsfine work e.g. surgeons

Co-Morbidities Co-Morbidities

7-6-2015 Sudhalkar Eye Hospital 2

Satisfaction Satisfaction

Inversely proportionate to Inversely proportionate to ExpectationsExpectations

Lesser the expectations, better Lesser the expectations, better satisfactionsatisfaction

Pre-OP visionPre-OP vision ““Other Eye” visionOther Eye” vision


Importance of of Preop Vision Importance of of Preop Vision

Accurate uncorrected / corrected Accurate uncorrected / corrected preop vision:preop vision:

Good preop vision is a Good preop vision is a contraindicationcontraindication..

Advanced cataract in old age group Advanced cataract in old age group appreciate betterappreciate better


Visual Potential of the eyeVisual Potential of the eye

Clinical JudgmentClinical Judgment History, AmblyopiaHistory, Amblyopia

Pin hole visionPin hole vision Colour visionColour vision

Co morbidities, AMD, Co morbidities, AMD, GlaucomaGlaucoma

Special investigationsSpecial investigations PAMPAM

OCTOCT


Unhappy Multifocal PatientUnhappy Multifocal Patient


Basic InfrastructureBasic Infrastructure

DiagnosticDiagnostic Slit Lamp with Slit Lamp with

Applanation, 90DApplanation, 90D BIOBIO Ultrasound & Optical Ultrasound & Optical

BiometeryBiometery OCTOCT Retinal Photography FFA Retinal Photography FFA

SurgicalSurgical Operating microscope, Operating microscope,

zoom, XY foot controlzoom, XY foot control Phaco Machine with Phaco Machine with

anterior vitrectomy, anterior vitrectomy, 2.2 tip2.2 tip


UPS Backup, Generator

Fine tuningFine tuning


Choice of IOLChoice of IOL

Personal experience, Ease of Personal experience, Ease of ImplantationImplantation

Regression analysis, results of all Regression analysis, results of all previous casesprevious cases

Good track record, Good track record, ““No Proprietary/Financial Interest” No Proprietary/Financial Interest”

Literature reviews Literature reviews Independent of “Phaco-Independent of “Phaco-machine machine

bundling”bundling”7-6-2015 Sudhalkar Eye Hospital 9

Multifocal SelectedMultifocal Selected

Distance, Intermediate and near Distance, Intermediate and near Distant + intermediate or Distant + intermediate or

Near + IntermediateNear + Intermediate


Monofocal AdvantagesMonofocal Advantages

Clarity, sharpness, Contrast Clarity, sharpness, Contrast Depth of FocusDepth of Focus

Myopic astigmatism advantageMyopic astigmatism advantage



Surgical SkillsSurgical Skills Are you confident of putting Multifocal in Are you confident of putting Multifocal in

your :your :

Parents, Parents, In-laws, In-laws,

Near relatives, Near relatives, Friends, Doctor Colleagues Friends, Doctor Colleagues

If yes, we proceedIf yes, we proceed


30 EYES, 17 PATIENTS30 EYES, 17 PATIENTS

13 Bilateral, 4 mono-ocular13 Bilateral, 4 mono-ocular M=4M=4 F=11F=11 AGE 37 TO 76AGE 37 TO 76


AGE GROUP AGE GROUP


OCCUPATIONOCCUPATION


POST OP-VISIONPOST OP-VISION



Pre OP CounselingPre OP Counseling

Discourage High expectations due to high costDiscourage High expectations due to high cost Mention glare and reduced contrast sensitivityMention glare and reduced contrast sensitivity

Show advantage of good range of Spectacle Show advantage of good range of Spectacle free “Intermediate” visionfree “Intermediate” vision

Highlight need for glasses for too far or too Highlight need for glasses for too far or too near visionnear vision

Extra light for readingExtra light for reading Consider “Other” eye conditionConsider “Other” eye condition

Keep option of monofocal open in Technical Keep option of monofocal open in Technical difficulties during surgerydifficulties during surgery


Best way to learn SwimmingBest way to learn Swimming

Jump in the PoolJump in the Pool

Mistakes are the best teachers if you Mistakes are the best teachers if you respect themrespect them

All spoon feeding teachers are BIG All spoon feeding teachers are BIG MistakesMistakes


Thank youThank you



Health & Medicine

Multifocal io ls tips for increasing patient satisfaction