This document discusses tips for increasing patient satisfaction with multifocal IOLs. It notes that satisfaction is inversely related to expectations, and pre-operative vision and the vision in the other eye impact expectations. A accurate assessment of the patient's pre-operative vision is important, as is considering any comorbidities. The choice of IOL depends on experience and evidence, and monofocals have advantages in clarity and contrast sensitivity. Thorough pre-operative counseling is emphasized to set appropriate expectations about potential issues like glare and reduced contrast sensitivity.

1. Multifocal IOLs-Tips forMultifocal IOLs-Tips for
increasing patientincreasing patient
satisfactionsatisfaction
Dr.Anand SudhalkarDr.Anand Sudhalkar
BOS 7-6-2015BOS 7-6-2015
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2. Premium IOL, High CostPremium IOL, High Cost
Advantages ClaimedAdvantages Claimed
 UNAIDED Distant,UNAIDED Distant,
intermediate and nearintermediate and near
visionvision
 Freedom from glassesFreedom from glasses
 Old age, PhysicallyOld age, Physically
handicappedhandicapped
 Indoor life style, day timeIndoor life style, day time
outdoor activityoutdoor activity
DownsideDownside
 Compromised quality,Compromised quality,
contrast sensitivity at allcontrast sensitivity at all
rangesranges
 Glare, at time unbearableGlare, at time unbearable
in night drivingin night driving
 Some need glasses forSome need glasses for
near, extra lightnear, extra light
 Not suitable for skilledNot suitable for skilled
fine work e.g. surgeonsfine work e.g. surgeons
 Co-MorbiditiesCo-Morbidities
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3. SatisfactionSatisfaction
 Inversely proportionate to ExpectationsInversely proportionate to Expectations
 Lesser the expectations, betterLesser the expectations, better
satisfactionsatisfaction
 Pre-OP visionPre-OP vision
 ““Other Eye” visionOther Eye” vision
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4. Importance of of Preop VisionImportance of of Preop Vision
 Accurate uncorrected / corrected preopAccurate uncorrected / corrected preop
vision:vision:
 Good preop vision is aGood preop vision is a
contraindicationcontraindication ..
 Advanced cataract in old age groupAdvanced cataract in old age group
appreciate betterappreciate better
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5. 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
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6. Unhappy Multifocal PatientUnhappy Multifocal Patient
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7. Basic InfrastructureBasic Infrastructure
DiagnosticDiagnostic
 Slit Lamp withSlit Lamp with
Applanation, 90DApplanation, 90D
 BIOBIO
 Ultrasound & OpticalUltrasound & Optical
BiometeryBiometery
 OCTOCT
 Retinal PhotographyRetinal Photography
FFAFFA
SurgicalSurgical
 Operating microscope,Operating microscope,
zoom, XY foot controlzoom, XY foot control
 Phaco Machine withPhaco Machine with
anterior vitrectomy, 2.2 tipanterior vitrectomy, 2.2 tip
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UPS Backup, Generator

8. Fine tuningFine tuning
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9. Choice of IOLChoice of IOL
 Personal experience, Ease of ImplantationPersonal experience, Ease of Implantation
 Regression analysis, results of all previousRegression analysis, results of all previous
casescases
 Good track record,Good track record,
 ““No Proprietary/Financial Interest”No Proprietary/Financial Interest”
Literature reviewsLiterature reviews
 Independent of “Phaco-Independent of “Phaco-machine bundling”machine bundling”
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10. Multifocal SelectedMultifocal Selected
 Distance, Intermediate and nearDistance, Intermediate and near
 Distant + intermediate orDistant + intermediate or
 Near + IntermediateNear + Intermediate
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11. Monofocal AdvantagesMonofocal Advantages
 Clarity, sharpness, ContrastClarity, sharpness, Contrast
 Depth of FocusDepth of Focus
 Myopic astigmatism advantageMyopic astigmatism advantage
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13. Surgical SkillsSurgical Skills
 Are you confident of putting Multifocal in your :Are you confident of putting Multifocal in your :
 Parents,Parents,
 In-laws,In-laws,
 Near relatives,Near relatives,
 Friends, Doctor ColleaguesFriends, Doctor Colleagues
 If yes, we proceedIf yes, we proceed
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14. 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
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15. AGE GROUPAGE GROUP
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16. OCCUPATIONOCCUPATION
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17. POST OP-VISIONPOST OP-VISION
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19. 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 SpectacleShow advantage of good range of Spectacle
free “Intermediate” visionfree “Intermediate” vision
 Highlight need for glasses for too far or too nearHighlight need for glasses for too far or too near
visionvision
 Extra light for readingExtra light for reading
 Consider “Other” eye conditionConsider “Other” eye condition
 Keep option of monofocal open in TechnicalKeep option of monofocal open in Technical
difficulties during surgerydifficulties during surgery
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20. Best way to learn SwimmingBest way to learn Swimming
 Jump in the PoolJump in the Pool
 Mistakes are the best teachers if youMistakes are the best teachers if you
respect themrespect them
 All spoon feeding teachers are BIGAll spoon feeding teachers are BIG
MistakesMistakes
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21.  Thank youThank you
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