EyeWorld Asia-Pacific September 2014 Issue

September 2014 17 EWAP FEATURE Lomb, Bridgewater, NY, U.S.), Tecnis multifocal (Abbott Medical Optics, Santa Ana, Calif., U.S.), or TRULIGN (Bausch + Lomb), this cost is included with the procedure. For monofocal patients, Dr. Tipperman has these patients cover at least the facility fee costs. For advanced technology IOL patients, it is included in the service. Dr. Waltz’s strategy is to amortize the cost over a large number of patients, so the extra cost would be very low. He said that he does not even present this to his patients as an extra expense, as it is inherent in the price. That way, if a patient needs the enhancement later on, it is already paid for. Patients realize that there is some cost associated with refractive enhancement because a physician would not be doing it for free, he said, adding that he gives patients his enhancement rate. If you plan to refer to a colleague, how is the cost determined? “I think you should emphasize the surgeon doesn’t have to do these enhancements,” Dr. Waltz said. “You can arrange for a refractive surgeon to help you.” In Indianapolis, he does enhancement procedures for other doctors in the area. The advantage is that surgeons can prearrange the relationship, whether they are receiving others’ patients or referring to another doctor. “You cannot do multifocal lenses or toric lenses correctly without a backup plan,” he said. Working on patients with two or more doctors can prove challenging when the cost issue is brought in, but Dr. Waltz’s practice has an internal system in place for when he performs enhancements on patients from his partner so that his partner will pay for the cost and Dr. Waltz would get some benefit as well. Externally, Dr. Waltz has a couple of options. Sometimes, other doctors will send patients for him to charge what he deems fair, and other times, the referring doctors will prearrange a particular patient and pay a certain fee. The bottom line, Dr. Waltz emphasized, is to treat the patients in the best way possible. Dr. Trattler said that if a patient is referred to him from another physician within his practice, then there is no charge for refractive enhancement. However, if a patient gets referred from outside the practice, that patient would pay the usual customary rate for laser vision correction. What if a patient complains about the extra cost? Dr. Tipperman said that a preoperative discussion is helpful for patients who are dissatisfied or worried about the extra cost. Having that discussion ahead of time will help address concerns prior to surgery. The reason that Dr. Trattler’s practice includes the cost of enhancement in the price is to cover patients who have cataract surgery and pay extra for a premium technology and then end up with vision that is unsatisfactory where they have to have more surgery, he said. “It’s hard at that point to ask them to pay more money since they are already disappointed and frustrated. It’s much better to have it all included so if a patient is unhappy, the next step is already covered to make him happy,” he said. EWAP Editors’ note: Dr. Tipperman has financial interests with Alcon (Fort Worth, Texas, U.S.). Dr. Waltz has financial interests with Abbott Medical Optics and WaveTec (Aliso Viejo, Calif., U.S.).Dr. Trattler has financial interests with Abbott Medical Optics, Bausch + Lomb, and LENSAR (Orlando, Fla., U.S.). Contact information Tipperman: rtipperman@mindspring.com Trattler: wtrattler@gmail.com Waltz: klwaltz@aol.com OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 • Fax +852 2987 1090 www.oculus.de • info@oculus.hk OCULUS Pentacam ® HR The new Belin / Ambrosio Display III: Unique for keratoconus and ectasia detection based on corneal tomography Combination of 5 corneal elevation and pachy- metry parameters into one final overall index • for quick visual inspection • for quick decision making • comprehensive but intuitive ONLY available for Pentacam! • database for hyperopic patients • novel pachymetric parameter ARTmax