Patient-Centered Discussions

Educational discussions and guiding informed decisions

Effective Communication

Importance of Framing

Medical literacy + Language barriers

- Framing influences patients' perception of risks, benefits, and expectations.
- Use of interpreters significantly improve non-English speakers understanding.

Dana Lucia Martinez et al 2024, Cevallos et al 2024, van lent et al 2024, Mudie et al 2023

Co-morbidities and limitations to visual outcomes

Finde et al 2010

Discussion Topics

Benefits of surgery do not currently outweigh risks

- Patients should expect to have a meaningful improvement in vision and ability to perform daily activities after cataract surgery.

Risks cannot be sufficiencly mitigated

- Cannot ensure appropriate post-operative care or follow up.
- Comorbidities are poorly controlled.


Cataract re-evaluation appointment

Timeframe varies depending on several factors.

Strategies

Metaphors

Glaser et al 2020

Teach back method

- Reduces pre and peri-operative anxiety.
- Increases perioperative patient compliance, patients' ocular health literacy, and informed consent.

Shen et al 2023, Seely et al 2022


Medical Management


Patient Populations

Vision changes are unrelated to cataract

Any significant vision changes can be attributed to other pathologies.

History & Social determinants

- Poor adherence to management.
- Poorly controlled co-morbidities.
- Barriers to follow-up care.

Cataract surgery will not provide significant improvement.

Corrective Management

Myopic shift

Treat refractive error, may consider monovision correction.

Glare

Amber tinted glasses.

Poor contrast sensitivity

Increase illumination brightness

- Switch warm colored lightbulbs to 'bright white' at home.


Visual Prognosis and Postoperative Spectacle Requirements

Targeted Power
Intermediate Vision

Arms length or computer distance (~66 cm).

Near Vision

Book or phone distance (~40 cm).

Comorbidities

Patient or caretaker should understand how the comorbidity affects vision.

Lens Selection
IOL Overview
Lens Types

*Communicating IOL pros and cons during approval appointment increases patient awareness and ensures informed consent.