The principles of asphericity are important to understand when applying either corneal laser treatments or IOL implantations in order to give patients the best vision possible with minimal visual symptoms.

Positive spherical aberration occurs when marginal rays come into focus in front of paraxial rays. Pseudophakic eyes implanted with spherical IOLs have significantly higher spherical aberration compared to age matched phakic eyes.

Both laser refractive surgery and lenticular surgery attempt to change the peripheral shape of either the cornea or lens, respectively, so that those marginal rays come into direct focus and do not intersect the periaxial rays, causing blurred images. In short, improving the focus of the marginal rays improves vision by counteracting spherical aberrations. Spherical aberration is the source of visual symptoms at nighttime, because the enlarged pupil lets more paraxial light into the eye and thus more marginal rays into focus. Adding an aspheric surface at the source of the aberrations, either on the cornea by way of an aspheric laser ablation or on the lens by the implantation of an aspheric IOL such as the AcrySof ReSTOR IQ lens (Alcon Laboratories, Inc., Fort Worth, TX), counteracts the aberrations and puts marginal rays into sharper focus, thereby improving overall quality of vision.

In the case of corneal laser ablation, unless the ablation to correct the refractive error takes into account the peripheral portion of the cornea, the cornea will lack the aspheric optics necessary to correct spherical aberration, and the patient will experience visual symptoms. The ALLEGRETTO WAVE Eye-Q excimer laser (Alcon Laboratories, Inc.) is able to reshape the peripheral cornea within its ablation zone. It imparts an aspheric correction that maintains the eye’s optimal prolate shape and gives the eye all of the benefits of an aspheric corneal surface.

Stephen S. Lane, MD, is Adjunct Clinical Professor at the University of Minnesota in Stillwater. He is a paid consultant for Alcon Laboratories, Inc. Dr. Lane may be reached at (651) 275-3000; sslane@associatedeyecare.com.

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Five common mistakes that ensure failure.

No. 1. Gear your approach toward what you want, rather than what optometrists need.
What you want are more LASIK patients. What optometrists (ODs) need is a single-surgeon or single-practice resource that will handle not only their LASIK surgeries, but also patients with cataract and pathology.

No. 2. Ask for their support without committing your time.
Optometrists are very attuned to whether an ophthalmologist supports optometry. They find it disingenuous that you want their patients, but will not take the time to make a phone call, meet with them personally, or discuss how you can best assist their practice. The biggest misconception surgeons have is that an OD liaison will grow a referral network. When direct patient acquisition turns soft, many ophthalmologists decide that they need more OD referrals. The common solution is to hire an individual—usually an outgoing, friendly woman from within the practice—to call on ODs, bring bagels, and drop off brochures. What most ophthalmic practices fail to realize, however, is that every LASIK surgeon is doing the same thing! The optometric office staff dreads this constant stream of (mostly) women dropping by. The OD liaison is ineffective if the OD does not personally know or respect you as a surgeon. It is an undifferentiated strategy. It says you, personally, only value the relationship enough to send your employee to sell your skills. Do you think the OD wants to share his surgical needs or problems with this person? It harkens back to the very issue of whether your approach is directed toward what you want or what they need.

No. 3. Question their professional expertise.
Do you refuse to accept dilated exam results that are submitted by the OD? Do you repeat every test on their patients? Do you not think the patient resents a second dilation and complains to the OD upon return after surgery? Does your staff inadvertently say to the OD’s receptionist who tries to fax exam notes, “Oh, don’t worry about it. Dr. Doubter doesn’t trust any refraction unless it’s done by SuperTech Becky, so we’ll just redo it.” Aside from the issue that comanagement payment must be predicated upon work performed, such undermining confirms a lack of confidence in an OD’s skill. Might they take offense if you overrule their recommended target refraction for a surgical plan, when they have been fitting this patient with glasses and contacts for years and understand potential nuances of his refraction that you simply cannot uncover in your brief preoperative exam?

No. 4. Do not update them on patients’ progress.
Do you keep referring ODs posted at every stage of the patient’s progress? Do you fax or e-mail them notes after the consultation to advise them of the patient’s decision to move forward and to communicate the scheduled surgery date? Do you fax ODs an update after a patient’s surgery to advise them on how it went and confirm who will see the patient for the 1-day postoperative visit? Do you fax a reminder 2 weeks and 2 months after a patient’s surgery to make sure the ODs return refractions and acuities for outcomes tracking updates?

No. 5. Steal their patients.
Do more than 10% of your referred patients stay with you, and never make it back to the OD? Is it possible you or your staff plant seeds of doubt in the patient’s mind that they would fare better staying with you postoperatively?

Virtually every practice that has trouble building or expanding an OD referral network makes one or more of these mistakes. However, there are ways to effectively build a comanagement network. Next month, I will share several techniques that will help you create vibrant, sustainable OD referrals.

Kay Coulson is the President of Elective Medical Marketing, a consulting group based in Boulder, Colorado, that helps surgeons grow their elective vision service lines. She may be reached at kay@electivemed.com.

This article reflects the views of the author. It does not necessarily reflect the opinions of Alcon Laboratories, Inc.

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