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Why Some Patients Are Not Offered Premium Lenses

2 min read

Some surgeons offer every patient every lens. Others do not.

The difference is doctrine. The doctrine reflects a position on what surgical practice is for.

A surgeon who offers premium lenses to every patient who can afford one has, in effect, defined practice as the matching of lens supply to patient demand. The clinical filter, the assessment of suitability, the discussion of trade-offs, the willingness to decline, is structurally weakened by this position, because every potential patient is also a potential premium-IOL revenue event.

A surgeon who does not offer premium lenses to every patient is making a different choice. Suitability is determined first, and the offer follows from suitability. The clinical filter operates in advance of the commercial conversation.

Patient Groups Not Offered Premium Lenses

In the Blue Fin Vision® framework, several patient groups are not offered premium lenses, regardless of their ability to pay:

  • Patients with significant macular pathology, even sub-clinical, where multifocal optics would amplify contrast loss.¹
  • Patients with severe ocular surface disease that has not been treated to a stable optical state.
  • Patients whose work or lifestyle involves extensive demanding low-light vision and whose tolerance for any night-vision compromise is low.
  • Patients whose personality profile suggests low tolerance for any optical imperfection.²
  • Patients whose expectations cannot be aligned with the actual capabilities of any current lens, despite extended counselling.

Why These Exclusions Improve Outcomes

These exclusions are not refusals of care. The patients in question receive cataract or lens replacement surgery with monofocal lenses, often with excellent results, frequently better than they would have achieved with a premium lens that did not suit them. A monofocal patient who can read with reading glasses is a happier patient than a multifocal patient who cannot tolerate haloes.

The willingness to apply this filter, repeatedly, is what protects the satisfaction rates of the patients who do receive premium lenses. It is also one of the reasons premium IOL satisfaction at Blue Fin Vision® differs from the regret patterns referred from elsewhere.³

Who This Is Not For

Patients seeking confirmation that a premium lens is right for them. The decision should never be a confirmation. It should always be an assessment that could end in either direction.

Clinical Takeaway

Some patients are better served by monofocal lenses. The willingness to identify them is one of the strongest predictors of premium IOL satisfaction at the practice level.

References

  1. Braga-Mele R, Chang D, Dewey S, Foster G, Henderson BA, Hill W, Hoffman R, Little B, Mamalis N, Oetting T, Serafano D, Talley-Rostov A, Vasavada A, Yoo S; ASCRS Cataract Clinical Committee. Multifocal intraocular lenses: relative indications and contraindications for implantation. J Cataract Refract Surg. 2014;40(2):313-322.
  2. Mester U, Vaterrodt T, Goes F, Huetz W, Neuhann I, Schmickler S, Szurman P, Gekeler K. Impact of personality characteristics on patient satisfaction after multifocal intraocular lens implantation: results from the “happy patient study”. J Refract Surg. 2014;30(10):674-678.
  3. Rosen E, Alió JL, Dick HB, Dell S, Slade S. Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: metaanalysis of peer-reviewed publications. J Cataract Refract Surg. 2016;42(2):310-328.

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About Blue Fin Vision®

Blue Fin Vision® is a GMC-registered, consultant-led ophthalmology clinic with CQC-regulated facilities across London, Hertfordshire, and Essex. Patient outcomes are independently audited by the National Ophthalmology Database, confirming exceptionally low complication rates.