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The Art of Patient Education in Cataract Surgery

Surgeons can learn to build trust, communicate value, and guide patients toward the IOL option that best fits their needs.

By: Brian Szabo, DO
Ophthalmology Management October 19, 2026

At our practice, Newsom Eye, about 60% of our cataract patients choose a premium (toric, adjustable, or presbyopia-correcting) intraocular lens (IOL). That’s much higher than the industry average of 21%.1 I believe this reflects the attitudes my partners and I have about the benefits of premium lens technology, which informs the way we advise patients as they make crucial decisions about their vision. 

Ophthalmology is one of only a few specialties with the ability to offer patients premium options beyond the basic Medicare-covered service to better suit their lifestyle needs. That is what allows us to offer IOLs that provide patients with reduced dependence on spectacles, but it also puts the onus on us to be able to educate patients about these options. A lot of doctors tell me they are uncomfortable talking to patients about premium IOL packages that carry additional, out-of-pocket costs for the patient. In my opinion, there are 2 reasons to get more comfortable with this aspect of contemporary practice—and quickly.

First, it is better for patients to have medically appropriate options to suit their lifestyle. There is a meaningful difference between the outcomes we can offer with a standard IOL and the benefits patients gain with a premium IOL. Premium IOLs transform lives on a daily basis, enabling patients to do any number of activities from reading a menu to seeing the ball accurately on a golf swing. If cost were not a barrier, I truly believe that most, if not all, of my patients would prefer to have at least fully corrected distance vision without glasses and, ideally, not have to wear reading glasses for near or intermediate tasks, either. That’s what I would want for myself and for my own family members, so I want patients to have that option—as long as their ocular health and anatomy permit. 

Secondly, having a healthy ratio of premium IOLs also aligns with our goal of maintaining a healthy, independent practice. Inflation-adjusted Medicare physician reimbursement for ophthalmic procedures has declined substantially over the past 2 decades.2 With the professional fee projected to drop another 4% next year to just $444, purely Medicare-dependent practices may not be able to survive.3 When they fit patients’ needs, premium IOLs can help balance out an otherwise unfavorable reimbursement landscape.   

Crossover Skills

Business-oriented books or podcasts have been great tools for me to further my goals of improving patient care and practice health. I listen to business authors as I’m driving between offices and have enjoyed learning more about consumer psychology. Here are 4 techniques I’ve adapted to the medical setting that have helped me to more effectively educate patients:

  • Build trust. In the book “Sell It Like Serhant,” Ryan Serhant talks about how important connection is for trust-building. Many doctors do this instinctively: We need to earn the patient’s trust to get informed consent and to ensure adherence to a treatment plan. As a cataract surgeon whose patients are typically referred by and comanaged with outside doctors, I have a very limited time frame (the preoperative consultation) in which to build trust, so the first thing I do when I walk in the room is greet the patient by name and try to make a connection. That connection might be based on where the patient grew up, a sports team or hobby, or some other point of commonality. Making a connection serves not only as idle chit-chat but also as a way to lower the patient’s defenses and increase their comfort in what we know is an uncomfortable surgical setting. It serves as a foundation to allow me to then talk about an IOL recommendation and the science and performance behind that IOL.

  • Demonstrate value. Whether one is advising or selling, demonstrating the value of the product is essential, as Jordan Belfort discusses in “The Way of the Wolf.” Part of the preoperative conversation we have with patients is educating them about the value of undergoing surgery at all and the value of choosing one procedure or lens over another. This is true whether the procedure will be covered by insurance, paid out of pocket, or some combination of both. After I evaluate the patient’s biometry and ocular history, I listen to what they tell me about how they want to use their eyes. Then I bring it all together by recommending a specific lens and explaining why it’s a good match for them: I describe what it will mean for their lifestyle and long-term health, as well as how cataract surgery with this particular lens can make it easier to engage in the activities they enjoy. 

  • Limit the options responsibly. I have never been a fan of presenting the patient with a whole menu of options, some of which aren’t appropriate for them, and telling them to choose. The patient deserves an expert recommendation: It is the surgeon’s responsibility to match the patient with the best choice for their anatomy, refraction, lifestyle, and visual needs. Another lesson I’ve taken from Serhant is the value of saying “no” to something. He talks about this in the context of building trust by steering real estate clients away from bad choices, and it’s a good approach in cataract surgery education, too. I explain to patients that while some patients get X, I don’t think it’s the best option for them because they have macular degeneration, or because they want to be able to golf without wearing glasses, so I recommend Y instead. This underscores my expertise and tells the patient that I listened to their priorities and that I want what is in their best interest.

  • Make good on your promises. Ultimately, you also have to be a good surgeon to succeed with premium IOLs. A premium IOL surgeon should be able to offer the full range of refractive services, from phakic IOLs to IOL exchanges and laser enhancements. All the sales tactics in the world won’t help if your patients (and the primary eyecare doctors who refer them) don’t see the results that were promised. Here, I believe that careful biometry, surgical skill, and effective expectation setting are all equally important. If you tell patients they’ll never need glasses or contact lenses again, you are going to have disappointed patients, because that’s just not how the technology works. I am always clear that no matter how good the outcome, the patient might need readers for fine-print tasks. I pick up the bottle of hand sanitizer in the exam room and show them that they should be able to read everything on the front of the bottle, but may need reading glasses to see the ingredient list on the back.

Focusing on the Match

In our practice, we offer 3 categories, each with its own pricing: a standard IOL, typically covered by insurance or Medicare; custom vision with a fixed lens; and custom vision with an adjustable lens. All the patient really has to decide is whether they want to invest in a lens that will reduce their dependence on glasses. Beyond that, it is the surgeon’s job to match the patient with the lens that best meets their needs. We aren’t incentivized to choose one lens over another, because almost all IOLs with a refractive goal are priced similarly in our practice.

I typically base my IOL choice on ocular health and anatomy first. That rules out some or all lens choices. After that, the patient’s hobbies or how they spend their day are the primary deciding factors for me. For patients with healthy eyes who spend significant time on very near work, like reading or sewing, I’m likely to choose the TECNIS Odyssey lens (Johnson & Johnson) for its full visual range, low rates of bothersome dysphotopsia, and good tolerance to residual error.4-6 For patients who read less and are more focused on playing golf or pickleball without glasses, I lean toward TECNIS PureSee (Johnson & Johnson) because of its very high quality of vision, ability to extend depth of focus, and monofocal-like contrast.7,8 I don’t implant multifocal IOLs in imperfect eyes, so if the patient has macular degeneration or an epiretinal membrane, I’m going to opt for a purely refractive, extended-depth-of-focus lens like PureSee. Or, if the patient wants to participate more in their visual outcome, I recommend the Light Adjustable Lens (LAL or LAL+, RxSight). For postrefractive patients, anyone with a complex cornea, and patients who prefer monovision, we offer the LAL.

My mentor and practice partner T. Hunter Newsom, MD, always says that we have 3 barriers to overcome in order for a patient to choose a premium IOL: fear of surgery, lack of knowledge of the technology we can offer, and cost. Using the skills I described above, I aim to overcome any fear or uncertainty a patient may have while helping them feel confident in me and in the choices we’re making about their surgery. Cost may still be a barrier—but it should be the only one left if we have effectively educated the patient.

As an avid consumer of business podcasts and books, I have embraced the commonalities between running a business and running a practice, and I’m comfortable with the language of sales. Of course, there are lots of things we don’t have in common with someone selling stocks or real estate or consumer products. High-pressure tactics have no place in medicine, and I would only ever want to sell a patient something that benefits them. So although we may not want to emulate every tactic in the sales playbook, there is a lot that we as surgeons can learn about how to establish trust, convey value, and help patients identify the cataract surgery choices that will lead to long-term satisfaction. 

References

  1. Market Scope. 2026 cataract surgical equipment market report: global analysis for 2025 to 2031. Market Scope; June 2026. Accessed August 19, 2026. https://www.market-scope.com/pages/reports/579/2026-cataract-surgical-equipment-market-report-global-analysis-for-2025-to-2031-june-2026

  2. Bhatt AN, Brower D, Pan E, et al. A blurry bottom line: the economics of declining medicare payment trends in ophthalmology subspecialties, 2003 to 2024. Inquiry. 2025;62:469580251399357. doi:10.1177/00469580251399357

  3. Centers for Medicare & Medicaid Services. Calendar year (CY) 2027 Medicare Physician Fee Schedule proposed rule. Published July 14, 2026. Accessed August 19, 2026. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule

  4. Hacopian AG, Brunson PB, Hall B. Patient reported outcomes and visual acuity after bilateral implantation of a next generation presbyopia correcting intraocular lens. Clin Ophthalmol. 2026;20:572703. doi:10.2147/OPTH.S572703

  5. Johnson & Johnson Surgical Vision, Inc. Evaluation of real-world data on the performance of the TECNIS Odyssey IOL. ClinicalTrials.gov. NCT05991960. Updated February 2, 2024. https://clinicaltrials.gov/study/NCT05991960

  6. Johnson & Johnson Vision. Optical bench data on file. 2024DOF4003 and 2024DOF4017. 2024.

  7. Corbett D, Black D, Roberts TV, et al. Quality of vision clinical outcomes for a new fully-refractive extended depth of focus intraocular lens. Eye (Lond). 2024;38(Suppl1):9-14. doi:10.1038/s41433-024-03421-6

  8. Koh K, Tuuminen R, Na DG, Jeon S. Patient-reported outcome measures after non-diffractive extended range of field implantation: PureSee versus Vivity. Acta Ophthalmol. Acta Ophthalmol. 2026;104(6):649-655. doi:10.1111/aos.70076

Brian Szabo, DO

Brian Szabo, DO, is in private practice at Newsom Eye, with 5 offices in central Florida. He is a consultant for Johnson & Johnson and RxSight. Contact him at b.szabo@newsomeye.net.