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10 tips to start a winning refractive cataract program


Several points to consider before you make the leap

Careful preparation for a refractive cataract surgery practice can yield better patient outcomes and satisfaction.

Reviewed by Russell J. Swan, MD

Creating a successful refractive cataract practice does not happen overnight. It takes thorough planning and some thoughtful consideration regarding your surgery, patient education, and staff preparation, said Russell J. Swan, MD, Vance Thompson Vision, Bozeman, MT. Here are 10 suggestions from Dr. Swan when considering starting a refractive cataract practice:

Getting started

Do you have a world-class customer experience?

“What we have found is we cannot have a great customer experience without a great work/family experience that then allows our employees to drive a great customer experience,” Swan said. “We are intentional about having fun.”

Special events that allow the staff to get together outside of work help to create a positive work culture, which then translates into a better patient experience.

• How do you educate your patients?

Dr. Swan and his staff have a flow chart they use for patients to easily see if they are ready for cataract surgery and if they are fine using glasses afterward-or if they would rather forego glasses as much as possible. This can help direct patient education about available refractive cataract options.

• How do you educate referring providers?

Let referring providers know that you and your staff are focused on obtaining a great outcome, whether a patient desires standard or refractive cataract surgery. Dr. Swan said he has received questions from referring providers about the different types of IOLs available, so the practice staff put together a “cheat sheet” to help doctors understand the available technology.

They stress the importance of fine-tuning residual refraction, because it is a driver for patient satisfaction after refractive cataract surgery.

• How do you educate staff?

“When we think about our customer service experience cycle, we think about the first interaction when (patients) call, the greeting they have when they arrive at the clinic, and the stories patients get to share during their testing,” Dr. Swan said. “About 90% of a patient’s time is outside of my control.”

For this reason, solid staff education about refractive cataract surgery is invaluable.

  • My patients cannot afford it

This is probably something that many ophthalmologists think about, as does Dr. Swan. “It’s not our job to decide how patients will use their money,” he said. “It’s our job to let them know about their options, their costs, and to empower them to make the best decision for them.” People pay for experiences all the time and what better experience can we provide than renewed vision for the rest of the patient’s life, he added.

  • What will my mentors think?

As a younger ophthalmologist, this was a consideration for Dr. Swan, who said that many mentors within academic programs may have concerns about refractive cataract surgery. However, it is possible to educate patients without overselling to them, he said.

  • What’s the financial consideration?

“All of the equipment comes with a price tag, whether you are in solo practice or in a group,” he said. You’ll have to decide regarding which technology is worth integrating into your practice. Dr. Swan noted that if you are selective in your use of technology and grow a practice committed to it, you can see long-term benefits.

  • What’s your enhancement plan?

Develop a plan to handle enhancements, whether it is finetuning with glasses in conventional cataract surgery patients or laser touch-ups in refractive cataract patients.

  • Have intraoperative acumen.

To strengthen his own surgeries, Dr. Swan enjoys using the Zepto capsulotomy device for automated capsulotomies. “You have the ability to obtain 360° capsular overlap, which can be really nice,” he said. He also likes to use intraoperative aberrometry, especially in patients who had previous LASIK and in those with astigmatism.

  • Prep for adequate preoperative analysis.

“For me, this is trying to identify patients proactively who would be a poor candidate” for refractive cataract surgery, he said. This can include patients with irregular astigmatism, higher-order aberrations, anterior basement membrane dystrophy, and looking at the angle kappas that can affect patients’ ability to tolerate a multifocal lens.


Russell J. Swan, MD
E: Russell.swan@vancethompsonvision.com
This article was adapted from Dr. Swan’s presentation at the 2018 meeting of the American Academy of Ophthalmology. Dr. Swan has no related disclosures.

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