Biography: Younger is an ophthalmologist in Fountain Valley, Calif., and is affiliated with multiple hospitals in the area, including Fountain Valley Regional Hospital and Medical Center and MemorialCare Orange Coast Memorial Medical Center.
July 15, 2019
3 min read

BLOG: Communicating laser cataract surgery’s value to patients

Biography: Younger is an ophthalmologist in Fountain Valley, Calif., and is affiliated with multiple hospitals in the area, including Fountain Valley Regional Hospital and Medical Center and MemorialCare Orange Coast Memorial Medical Center.
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One of the most important aspects of how we talk about laser cataract surgery and premium IOL options with patients in our practice is framing the conversation. For example, I say, “Normally, I use the laser for surgery.” If he or she is a candidate for a multifocal lens or an extended depth of focus implant, such as the Tecnis Symfony from Johnson & Johnson Vision, I start the discussion with that as the first lens option. I say, “We need to use a clear lens implant for surgery. That lens is prescription, and it is going to reset your vision.” I explain that one type of lens option will “give you a range of vision so you can see far and you can see your phone.”

What they want

Remember, at this point in the consultation, I know the patient’s hobbies, by glancing at their vision questionnaire to see if there are any specific visual demands (eg, does the patient do really close work or high-definition distance tasks). Plus, patients report if they prefer reading glasses or not, giving me an idea of their targets. I have found that most patients’ answers are pretty spot on.

My conversations about astigmatism are easier now than before having the laser. As mentioned in my last blog, patients in my practice watch a video of the laser and they have a sense of what it does during the procedure. It follows that I tell them that their astigmatism will be corrected by the laser. If the patient has a higher amount of astigmatism, I am going to recommend a toric lens, so I change my wording.

For example, I might say: “The laser does multiple steps in cataract surgery. The laser makes a very precise opening in the cataract in one second, creates the incisions and breaks up the cataract, so we don't need to use as much energy and heat. Also, the vision step of correcting astigmatism, which improves vision without glasses.” The concept makes sense to most patients, and it fits with what they assume we do with the laser.

Technology is the answer

I focus on the precision of what the laser does rather than specifically explaining how the laser works. This makes the conversation about the outcome that the patient has indicated he or she desires. This is in contrast to the approach of having a list of technologies to offer the patient and starting at the bottom of the pyramid. Beginning a technology discussion with basic options and working up results in emphasizing price in the patient’s mind rather than their vision.


When you gain experience and become comfortable with advanced IOL technology, you can match it to what patients want for their visual outcomes. With technology you believe in, you can be confident in recommending the best implant for your patients. For some, at the end of the consultation, after all the education and conversation, their best option may be manual cataract surgery with a monofocal lens.

But, starting with a refractive plan, as your go-to, first option, makes the conversion to laser cataract surgery and also premium IOLs, naturally increases.

Consistency and the refractive package

It is important to have a consistent message with patients. Most consultations are going to take about the same amount of time in terms of your education, patient questions and testings. Even if patients have multiple questions, answer what you can, and tell them they can write down additional questions for the surgery counselor for you to answer at the preoperative visit. You can feel comfortable sharing much the same message with all of your patients, and consults become smoother and a strong recommendation is easier to make.

Importantly, focus on offering laser cataract surgery, astigmatic correction and the range of premium implants as a refractive management package or charge a refractive management fee. Because you cannot charge patients a 'laser fee', as per most insurance guidelines, it is crucial you stay consistent and compliant with regulations. Use proper terminology for your paperwork and in your explanation to patients of what they are paying for, indicating that the additional costs — the laser, etc — relate to refractive fees and ensure patients understand that.

Tie it up in a bow

Even if you feel that the patient understands your recommendation, pause and summarize the information at the end of the discussion, quickly restating it. Phrase it candidly: “OK, to summarize, what I recommend is ... .” Here I review my vision plan and which technology I am going to use to get them to their desired outcome quickly. With that, patients are generally satisfied with the information, and feel good about going to schedule with the surgery counselor.  

Stay tuned to this space for a deeper dive into tips for further patient education, pearls for success with laser cataract surgery and surgical case examples showing specific tricks I have learned.


Disclosure: Younger reports he is a consultant to Johnson & Johnson Vision.