EyeWorld Asia-Pacific December 2013 Issue

24 EWAP CAtArACt/IOL December 2013 by richard tipperman, MD A rose by any other name would smell as sweet: Elective IOLs, premium IOLs, or advanced technology IOLs “What’s in a name? That which we call a rose by any other name would smell as sweet.” – Juliet, William Shakespeare’s “Romeo and Juliet,” Act II, Scene II W hat’s in a name? Shakespeare’s quote above seems to imply that names don’t matter—what matters is only what things are. In terms of presbyopic correcting IOLs (PC-IOLs) and toric IOLs, there are multiple names that have been used including “elective,” “premium,” and “advanced technology.” Why were these names chosen and why have they evolved? What do they mean and, more importantly, what do these names imply to our patients? Nobel prize-winning research in decision making demonstrates that people use heuristics when it comes to decision making. Heuristics can be thought of as a strategy, shortcut, or algorithm. One common heuristic is for people to analyze an unknown situation and develop a strategy or approach to that unfamiliar situation based on previously encountered similar situations. This approach relies heavily on “categorizing”—for instance, if a person encounters a potential new concept and categorizes it as “liberal” then he/she would likely respond and react to this concept in a similar manner that he/she has to other “liberal” concepts in the past. By naming things, it is easy for people to categorize new concepts or situations they encounter and relate to them in a fashion they have with prior experiences in that category. This now leads to the various terms that are used to describe presbyopic correcting IOLs. Initially, when these lenses were released, they were described as “elective IOLs.” Webster’s Dictionary describes “elective” as “permitting a choice” or “beneficial to the patient, but not essential to survival.” An “elective lens” is therefore one which a patient may or may not chose, and while this is certainly true of PC- IOLs, this nomenclature does not confer that there are any potential advantages associated with this lens. Imagine if you were buying a car and there was a base model and then a more expensive “elective” model; would you understand why the “elective” model cost more? Is there any benefit that is intuitively inherent in the description “elective”? For most the answer would be “no” and, in fact, “elective” implies an element of neutrality wherein there is not a major difference between the two items since the choice is “elective.” As such, “elective” was not a great term to describe the PC-IOLs, and its use has gradually faded at least in terms of PC-IOLs. This brings us to the next term in the evolution of category names for PC-IOLs—premium IOLs. Webster’s Dictionary defines “premium” as a “high value or a value in excess of that normally or usually expected.” From this definition, it is not clear whether the premium is in terms of cost of the item or benefits the item delivers. As such, the term denotes both a benefit and an increased cost, which certainly are things that are associated with PC- IOLs. However, there is also an almost pejorative association with premium as it is so closely aligned with the category concept “luxury.” A “luxury” purchase usually connotes an expensive purchase—often for a branded product—where the cost is almost greater in proportion than the value of the item itself. This is typical of luxury branded products where an insignia or trademark is to a large degree what separates the luxury item from a more utilitarian version. Think, for example, of a luxury designer Polo shirt. Although the material and build quality of the luxury version may be somewhat better than the utilitarian version, the practical realities are that in terms of function (wear and fit), there are minimal differences. The branding, trademark, or insignia of the luxury item connotes and defines the expensive nature of the item. Certainly no one would consider calling astigmatic or presbyopic IOLs “luxury” IOLs; however calling them “premium” IOLs is just a short step away from this. Clearly then, premium connotes spending additional money for benefits, but it is not always clear if the “premium” is the additional expense or additional benefits. If you needed to purchase a widget, is a “premium widget” that much better than a “standard widget?” It’s not clear from the nomenclature. Although the term “widget” is purposefully non- continued on page 30