By P. Dee G. Stephenson, MD, FACS

As a boutique practice owner, premium service has always been central to my approach to patient-centered care. Over time, I’ve learned that consistent premium conversion does not come from a single device or marketing message. Instead, it comes from creating a workflow that allows cataract patients to experience clarity, convenience, confidence, and trust—while also supporting the surgeon in delivering reliable and reproducible refractive outcomes.

Advances in laser cataract surgery—and now robotic laser cataract surgery—have strengthened this workflow. In particular, the ability to integrate image-guided laser treatment directly into the operating room streamlines my surgical days and supports the level of precision I aim to achieve in every case. I also rely on a fully integrated diagnostic ecosystem that includes technologies such as the ORA System (Alcon) for real-time refractive confirmation; Cassini (Cassini Technologies) for corneal analysis; and the Pentacam (Oculus), IOLMaster 700 (Zeiss), and OPD Scan (Nidek) for preoperative diagnostics. Each platform contributes unique, high-value data that inform surgical planning. (For more information, see the sidebar, “Integrating Technology Into a Larger Diagnostic Ecosystem.”)

Triangulating data from multiple modalities—each seamlessly connected to the Ally Robotic Laser System (Lensar)—creates a unified planning environment that reduces the risk of error, maintains consistency, and reinforces confidence in every surgical decision. This ecosystem-based approach becomes especially valuable as premium volumes increase. Equally important, team alignment and consistent patient communication support a premium conversion rate that reliably exceeds 90%.

Building a Foundation for Reproducible Outcomes

Achieving reproducible outcomes while improving workflow depends on 3 key elements: efficiency, precision, and flexibility.

Efficiency. I have used laser-assisted cataract surgery for more than a decade. Because the laser is set up directly in my operating room, patients do not need to be transitioned between rooms, reducing the risk of delays or variability. I also find that robotic cataract surgery saves approximately 1 to 2 minutes per case. Over a full surgery day of 15 or more cataracts, this time savings can translate into adding an extra case, finishing on time, or even finishing early.

Efficiency, however, is not solely about saving time. It is also about minimizing unnecessary friction. Any step, technique, or technology that helps the surgeon and staff remain synchronized and focused contributes to a smoother day and reduces the risk of mental fatigue by day’s end.

Precision. In cataract surgery, precision begins well before the first incision. Reliable imaging and a consistent docking process increase confidence that capsulotomies, incisions, and fragmentation patterns will be accurately placed and reproducible across a wide range of ocular anatomies. The consistency of these steps—and ultimately the effective lens position—depends heavily on how well the eye is captured and aligned before the laser is activated. Improvements in image quality and docking ergonomics, particularly in systems designed to accommodate small palpebral fissures, have made this stage of surgery increasingly predictable.

Customization of lens fragmentation based on cataract density is another area where small refinements can have a meaningful impact.¹˒² Surgeons have reported benefits from AI-driven customization in robotic laser cataract surgery, which automatically tailors energy settings and fragmentation patterns to each eye.³ Reducing phaco energy can positively influence corneal recovery, patient comfort, and postoperative visual satisfaction.

Astigmatism management is another area where precision pays dividends. Patients selecting premium IOLs typically expect reduced dependence on spectacles, and residual cylinder remains the most common reason those expectations are not met. The ability to treat corneal astigmatism, even in cases where pupil size limits lens-based treatment, helps preserve refractive goals in more challenging eyes.

If there is one technology that has had the greatest impact on both precision and postoperative outcomes, it is IntelliAxis. This feature marks the steep axis of astigmatism on both the cornea and the capsule, providing continuous guidance during toric IOL alignment. It reduces guesswork, facilitates intraoperative adjustments, and allows me to detect even subtle postoperative rotation immediately. This level of real-time feedback has made astigmatism management more predictable and has translated directly into higher patient satisfaction.

Flexibility. Image-guided laser surgery also provides the flexibility to adjust treatment parameters intraoperatively. If cataract density is greater than anticipated or incisional architecture requires modification, I can make real-time decisions that better match the eye in front of me.

Using Clear Communication to Drive Conversions

I am often asked how I maintain a premium conversion rate of approximately 92%. The answer has less to do with selling and more to do with education. Patients arrive well informed. Our website includes patient-friendly explanations and testimonials, so by the time they meet me, most already understand what premium cataract surgery entails and why precision matters.

At the consultation, every patient undergoes a comprehensive ocular evaluation, including a thorough dry eye assessment, macular OCT, and glaucoma testing when appropriate. This allows me to present a complete picture of ocular health. When pathology is present, I explain candidly why certain lenses may not be appropriate. Patients value honesty, especially when they sense that a surgeon is protecting them from a mismatch between expectations and reality.

My discussions focus on tailoring surgery to each patient’s eye and visual goals. Patients respond strongly when they understand that recommendations are being made specifically for their eyes—not from a menu of generic options. Consistency also matters: My technicians, patient counselors, and I use the same language when explaining astigmatism, dry eye, and lens choices, and educational videos help ensure uniform messaging.

The Quiet Force Behind Predictable Outcomes and High Conversion Rates

Behind every successful premium surgery day is a well-trained, well-aligned team. My lead technician performs all preoperative measurements and knows exactly when repeat testing is necessary. My surgical counselor reinforces my recommendations and addresses patient questions. After years of working together, our workflow is cohesive and calm—and patients sense that synergy the moment they walk through the door. I believe this dynamic plays a significant role in our consistently high premium conversion rate.

Other contributing factors include data-driven surgical planning, reproducible surgical steps, streamlined workflow, and precise astigmatism management. Ultimately, patients value their postoperative outcomes more than the technologies used to achieve them. They notice how they are treated and how smoothly the entire experience unfolds. In my practice, this approach has sustained a high conversion rate—not because I aim to provide luxury, but because I consistently deliver efficiency, precision, and excellent vision. OM

P. Dee G. Stephenson, MD, FACS, is the founder of Stephenson Eye Associates in Venice, Florida. She is a consultant to Lensar. Reach her at eyedrdee@aol.com.

References

1. Morley D, Evans M. Scheimpflug image segmentation using deep learning. Presented at: Association for Research in Vision and Ophthalmology 2024 Annual Meeting; May 5-9, 2024; Seattle, WA.

2. Morley D, Evans M. Multi-device pupil, limbus, and eyelid segmentation using deep learning. Presented at: Association for Research in Vision and Ophthalmology 2024 Annual Meeting; May 5-9, 2024; Seattle, WA.

Integrating Technology Into a Larger Diagnostic Ecosystem

Part of maintaining a high conversion rate is how well the Ally Robotic Laser System (Lensar) fits into the rest of my diagnostic workflow.

ORA for real-time refractive confirmation. I use the ORA System (Alcon) for wavefront intraoperative aberrometry on every case and have for nearly 15 years. Aphakic refraction, posterior corneal astigmatism, and real-time refractive data help confirm my surgical plan (and occasionally correct it). When ORA suggests a power change, I follow it because it has proven reliable over thousands of procedures I’ve personally performed.

Cassini for corneal analysis. The digital guidance provided by Cassini (Cassini Technologies) is my go-to for stable, repeatable corneal measurements. Its data integrate seamlessly into my planning process.

A comprehensive approach to diagnostics. In addition to ORA and Cassini, the Pentacam (Oculus), IOLMaster 700 (Zeiss), and OPD Scan (Nidek) also feed into my workflow. My goal is simple:Use the best diagnostic modality for each required measurement and let the data triangulate the truth.

Bluetooth connectivity. Lastly, connectivity between the Ally laser and preoperative diagnostic systems eliminates transcription errors and supports consistent planning, something that becomes more important as premium volumes grow.