Surgeons’ ability to bring technologically advanced lens implants to cataract patients grew significantly when the Centers for Medicare & Medicaid Services decided to allow physicians to offer IOLs that improve vision beyond monofocal distance correction. Surgeons may now correct and charge for two conditions that the Centers for Medicare & Medicaid Services previously did not cover— presbyopia and astigmatism. I believe that ophthalmologists promptly shot themselves in the foot, however, by marketing these lenses as “premium IOLs.”
When used as an adjective, premium can mean high quality, but the word is just as likely to be understood as high priced. Consumers purchase premium gasoline, they prefer premium olive oil, and they pay for premium seating. Premium in the United States has become less about quality and more about price. In fact, I believe most consumers would say that, if the only adjective you apply to your extra-special product is premium, you may suffer from a lack of imagination and a penchant for trickery.
Where is the word vision in the description of these lenses? Isn’t the real promise of presbyopia- and astigmatism-correcting lenses found in the increased range of vision they provide? Isn’t the choice of lenses that surgeons are offering to their patients more about the vision patients would like to enjoy every day for the rest of their lives? Isn’t this option primarily about patients’ living without dependence on spectacles?
When we counsel a 20-, 25-, or 30-year old about LASIK, we don’t have to discuss their lifestyle too much, because what they want and need is distance vision. But when we counsel a 65- or 70-year old, the vision that suits their lifestyle is distinctly different. Do they still drive? Work? Are they a golfer? Quilter? Hunter? Do they spend time on the computer? Read a great deal? Do they have certain night-vision needs? Each person will have a slightly different requirement for the vision that best suits them for the remainder of their lives.
Until 2005, we never even had this conversation in cataract surgery! The lens decision was made in the OR by the surgeon. Beginning in 2005 the question, “What vision do you want?”, moved into the clinic. Our cataract patients had never been asked (except for a brief monovision discussion) and didn’t know how to answer. Clinic staff didn’t know how to phrase questions, and didn’t know how to use the responses. This is a wholesale shift in how we collaborate with the aging population about their vision. We can’t underestimate the training and fine-tuning that is required to perfect this conversation. The words we use are important, and still very new to most ophthalmology staff and surgeons.
Ophthalmologists will see explosive growth in the adoption of lifestyle IOLs when they stop presenting these lens implants as a choice between high price and no price and instead make the selection about a fuller range of vision versus single-range vision. Practitioners who have spent time in examination rooms with patients know that, if they are not motivated to be free of glasses during a majority of their day, they are not going to choose a presbyopia- correcting IOL. If a patient has not felt as though he or she has suffered for years and paid extra for glasses and contact lenses due to astigmatism, he or she is not going to choose a toric IOL. Practitioners should focus the conversation with patients on the real benefit of these IOLs—the vision. When patients believe in the value of the vision that lifestyle lenses can provide, their cost will cease to be an issue.
Surgeons should eliminate premium, upgraded, new, and noncovered from their vocabulary. These adjectives describe only price and invite comparisons regarding insurance reimbursement. The way forward in ophthalmology is to focus on technological advances that provide a choice of vision that is independent of insurance reimbursement. Far better terms for educating and counseling patients are lifestyle IOLs, patient-preferred vision, full-range vision, zoom vision, natural-focus vision, multifocal vision, accommodating vision, adjusting vision, and progressive vision.
Surgeons should consider abandoning their premium IOL business before its too late and adopting lifestyle IOLs in order to revolutionize ophthalmic practice.