The Winning Difference: Modern Day Cataract Care Dr Paul Ajamian OD FAAO 33789‐AS exp. 2/21/2015/ CET C‐18687 ‐ Event ID ‐EV‐37759 Description 
This course will provide optometrists with the fundamentals of how to co‐manage cataract surgery patients. Objectives 
Discuss patient selection for cataract surgery 
Discuss premium lenses 
Optometrist’s role in educating, treating and co‐managing patients 
Successful cataract practice requires a team approach 
Cataract Surgery is now perceived as a refractive surgery procedure 
Patient expectations 
Patient satisfaction 
Medico‐legal considerations 
OD’s Role IS Crucial 
Incorporate OD’s in decision making 
OD’s know their patients better 
Establish co‐management fees Patient Selection 

Pre‐operative Considerations o
Patients who no longer desire to wear glasses o
Functional and occupational requirements o
Pre‐existing ocular pathology o
Patients visual demands‐hobbies Patient Selection 
Pre‐operative considerations o
OCT o
Beware diabetics o
Astigmatism management o
Dry eye treatment 
Patient Selection: 
Subjective Exclusion Criteria o
Hypercritical patients o
Patients with unrealistic expectations o
Those who want to wear glasses o
Occupational night drivers Setting Expectations What to Say ‐ Setting Proper Expectations 
“You can expect your vision to continually improve” 
“Your vision is already good enough to pass a drivers test” 
“Be patient and allow your eyes to work together” 
“You will need to bring near objects closer to you then you did before the surgery” 
“Resist the urge of habit to grab your reading glasses, let yourself adapt to your new vision” 
“If you see some halos and glare, remember that it is a normal part of healing that will get better over time” What to Stay Away From 
Your vision is 20/XX. Ask how they are, few people understand Snellen 
You are doing okay‐ sound upbeat! 
No one else has that problem‐be reassuring and let them know that different people heal differently 
OBJECTIVES FOR CONSULTATION DAY 
Premium lens: Premium Experience 
Create inviting spa‐like atmosphere 
Adjust schedule (cat patients only) 
Do not overbook 
High tech educational media 
Commit to extra chair time 
Take home materials 
Educating Your Staff 
It takes a team to have a successful premium lens oriented practice The Importance of Team Work 
Everyone should be educated on all patient materials 
Know the talking points and quick facts handout 
There are six opportunities to capitalize on before the surgeon sees the patient The Consultation Process 
Front Office 
1 Tech for workup 
Surgeon 
Scheduling What is Your Role on the Team? 
Remember everyone is involved in the process and the 6 steps 
Front desk‐ is info out in lobby? Are you able to answer basic questions? 
Techs‐ are you putting a bug in their ear? Able to answer basic questions? Finding out lifestyle activities and expectations? 
Surgeon‐ asking the right questions? Making a strong recommendation? 
Scheduler‐ are you closing the patient? Able to answer final questions? Answer insurance 
You Have 6 Opportunities to Educate Before the Consultation 
Web site 
Phone operators/Hold Service 
Welcome packet or mail packet 
Lobby Materials 
DVD Patient Education 
Your Lanes 
Tools are already available to you On the Phone 
Can your staff answer basic questions? 
Can your staff generate excitement? 
“We now have options for our cataract patients that give you the greatest chance of reducing your dependence on spectacles. Make sure to ask our doctor about which option might be best for you.” On the Phone/At the Front: What they really need to know ‐ Cheat Sheet What are premium lenses? 
A cataract lens replacement that will give you a full range vision. How is it done? 
The cloudy, hardened lens in your eye is removed, and a new multifocal lens is implanted. Does it work? 
Very well. More than 80% of patients don’t need glasses after the procedure. This compares to 100% needing glasses for near vision with the old type of lens surgery. What does it cost? 
$X,XXX/eye plus any deductible or co‐pay. 
Telephone On Hold Messaging 
Capitalize on opportunities to educate your patients while they are on hold 
Scripts are available 
Mailing Beforehand 
It is really important to do this beforehand 
Why? It eases the patient’s burden 
Too overwhelming to have the conversation that you have a cataract and need an upgrade in the same conversation Getting Information to the Patient ASAP 
This will save everyone time in the long run 
What can we give the patient right away? o
Patient questionnaire ? o
Mailer beforehand? o
Letter from the surgeon? o
Brochure? o
Welcome folder? o
Web site address? Are you Talking about Financing Proactively? 
Show patients that it is affordable 
Emphasize benefits of various payment methods 
1 year interest free, extended payments, low monthly payments 
“Most of our patients finance the procedure” 
Use the term “monthly payments as low as…” Pre‐Op Reading Vision Evaluation Your Lobby Should Be a Showcase 
Your Lobby is your 1st impression. You get one chance to make a 1st impression 
Use this opportunity to showcase your practice‐ educational materials, DVD education, and testimonials 
Try limiting magazines 
Brochure Holder 
Can be set up in lobby, lane, trade shows, OD office. 
Reminds staff to put out more brochures 
New plastic brochures are available now 
Inform Your Patients With Posters 
Patient Education DVD 
Patient Education Video on DVD‐ 
To be played during the consultation process 
Saves chair time 
The baby sitter‐ self educates 
Increases conversion 
Small DVD players are dirt cheap these days 
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Sample custom CD/VIDEO of Patient Ed Video‐ PEC only 
Can be customized with practice information 
Great for referrals Testimonial Forms 
How are they useful? 
Collect and put in a notebook to be viewed in the lobby or in the lane 
Testimonials help build new ReStor patients 
Encourage every patient to fill out Education in the Lanes 
Useful in consultation to explain the procedure‐ it can be customized on the back 
Posters‐hang in lobby, lanes, co‐managed OD office 
Laminates are small easy tools for tech or MD to walk through the procedure IOL Models 
Monofocal IOL View 
Multifocal IOL View Cataract Medicare Payment Plan Page For Further StudyMarketing Wizard 
Module Topics 
Building your bottom line 
Create a positive patient experience 
Getting patients in the door 
Visual Simulator 
How to establish and defend o
your price point 
How to manage your business efficiently 
Identifying and knowing your competition 
Advertising Materials 
High‐resolution product images and logos, as well as ad templates and tools for optometrist outreach. 
FDA Labeling 
Documents related to the FDA labeling of the brand name IOLs. 
Marketing Planning Tools 
Tools that will help you market your practice, including templates to help you develop strategies and budgets. 
Reimbursement Information 
Materials related to reimbursement and payment issues. 
Website Materials 
Web‐resolution assets for use online, including images and animations 
WEB SITE www.omnieyeatlanta.com 
Treatment Options for Astigmatism Glasses or Contacts o
Patient dependent o
Cosmetic / Lifestyle issues o
Lack precision o
Unpredictable outcomes o
Increased risk Incisions 
o
Regression o
Limited treatment range Treatment Options for Astigmatism Lasers o
Additional procedures o
Risk of complications o
Glare / halos / dry eye Ideal Treatment 
o
Precise and accurate o
Predictable outcomes o
Permanent o
Safe and convenient Treatment Options for Astigmatism How many patients are Candidates? 
Cylinder Powers SN60T3‐T5 
Clinical Study Design 
Randomized, Prospective, Multi‐Center Clinical Investigation 
494 Subjects enrolled by 11 investigators 
Follow‐up to extend 1 year following first eye implantation 
No other surgical correction of astigmatism was permitted Clinical Results Summary 
How Do We Work Toric Into our Practice? How Does Toric fit into the Premium IOL World? 
Patient needs to be informed that they have options for surgery now 
Which lens are they a candidate for? Surgeon needs to set criteria 
Presenting all options at once can overwhelm the patient 
Patient Selection 
Patients with a clinically significant cataract 
Patients with regular corneal astigmatism 
Patients with realistic expectations 
Intact capsule 
In the bag lens placement 
Do Not Over Correct Cylinder Power! Toric IOL Procedural Considerations 
Surgeon performs standard cataract procedure from capsulorhexis through phacoemulsification 
Toric IOL implantation requires only minor variation from standard procedure: 
IOL calculation 
Marking of the eye 
IOL alignment (on‐axis) 1. IOL Calculation 
Step I: 
Determine required spherical power using preferred method 
Step II: 
Utilize AToric IOL Calculator to determine o
The correct IOL model, and o
Optimal axis location of the IOL in the capsular bag 2. Marking of the Eye 

Reference Marks (pre‐op) o
Placed at limbus in two locations 180 degrees apart (3 o’clock and 9 o’clock) o
Patient in sitting position (cyclotorsion) Axis Marks (intra‐op) o
Axis marks identify the optimal axis of IOL placement as determined by the Toric Calculator o
Axis marks are placed on the eye using pre‐op reference marks for alignment of instrument 3. IOL Alignment 
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
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3 Step Procedure: Gross alignment Removal of OVD Final alignment 
IOL Alignment 
Gross Alignment o
Rotate IOL clockwise to approximately 20 to 30 degrees short of desired position o
Completed while the IOL is unfolding in the capsular bag 
IOL Alignment 
Stabilize IOL During OVD Removal o
Take care to prevent IOL from rotating past intended axis during OVD removal 
2nd instrument 
Silicone I/A tip 
IOL Alignment 
Final Alignment o
Carefully rotate IOL clockwise precisely onto the intended axis of alignment o
Tap IOL down into capsular bag to seat lens in place Precision Calculations: o
Uses vector analysis to determine correct axis o
Compensates for surgically induced astigmatism Data Input: o
Preoperative keratometry o
IOL power o
Incision location o
Estimated surgically induced astigmatism Output Screen 
Patient Add’tl Info 
Anticipated Residual Astigmatism is calculated 
“Nasal” and “Temporal” added for clarity 
OS (Left) / OD (Right) added for clarity 
Spherical Powers are limited to those available (Now 6.0 – 30 D SN60TT) 
What Tools are Available? 
Toric Integration Kit 
Brochure 
Poster Thank you 
Any Questions?