An expert weighs in on considerations involved in the choice between multifocal and light adjustable lenses.
Sharon Richens, MD, FACS: Part of the conversation was how do you integrate both multifocals and light adjustable [lenses] into the practice. What is the role for the different people in the practice? And after you begin to introduce the idea to the patient, how do you follow through on that? And several of the practices do use the video simulations that are available from some of the manufacturers and also from the patient education software systems, and those seem to be helpful. A well-trained surgical counselor is invaluable, and several of us have optometrists who are fully employed and embedded within the practice. I thought it was interesting: We asked the question, “How well integrated are light adjustable lenses with your optometric referral network and would you consider having optometrists either in the practice or who are referring doctors participate in the light adjustment process with the new light adjustable lenses?” And the consensus seemed to be that getting the referring doctors on board so that they fully understand the potential of the technology was really important and that those who were already referring to multifocal lenses had a pretty good understanding of what the advantages and disadvantages of the light adjustable lens might be. But there was a real reluctance to trust optometrists who were not fully employed and embedded in the practice with the actual final refractions and light adjustments. The time in clinic, of course, is an issue both with the multifocals––because it takes a certain amount of time, maybe on average 3 months for neuroadaptation––and also with the light adjustable [lens], where you’re looking at a greater number of postop[erative] visits. And the report back from several of the physicians who participated was that the average number of treatments for light adjustable lenses was 2, not 3, and then of course you’ve got the 2 lockdowns, and in discussion very few doctors had any reports of anything having gone wrong, as it were, or diminishing the patient’s vision in the process of light adjustments. Overall [there was] a lot of enthusiasm for premium lenses, for the preoperative precision and surgical technique and postoperative management that goes into getting them right, and really a great amount of joy and satisfaction in achieving the best possible results for these patients, provided that they have a clear understanding of what to expect, not just in the short term but over the course of their lives.
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