Your Premium Cataract Discussion

What is a premium cataract practice?

From my experience, a premium cataract practice consists of a surgeon who offers premium lens options and femtosecond-assisted cataract surgery and truly focuses on an excellent refractive outcome. In our industry, mentioning “premium” usually implies high volume, but I feel it’s more about reducing complications and investing in technology that can help give patients the best possible refractive outcome, all while providing an excellent “customer” experience. Most of these practices also offer intraoperative aberrometry and laser vision correction.

What are conversion rates in a premium practice?

This truly varies from market to market and practice to practice. As an average, my clients that I would consider “premium practices” convert 35%+ of all cataract patients to a multifocal, accommodative or toric lens implant and 50%+ of patients elect to have laser cataract surgery. Some of my clients are as high as 50% premium IOL conversion and 70%+ laser conversion.

The ‘ perfect ’ pitch

It’s really up to the doctor to sell the premium services the practice has to offer. Nothing means more to a patient than a doctor saying, “This is what you need and this is why you should do it.” However, nothing is worse than a doctor saying, “You can choose this multifocal or this accommodative lens or even a toric if you’re OK with reading glasses. Any of these lenses will work.” Undecidedness equals poor conversion rates.

As a doctor, the conversation should go something like this. “Well, Mary, the bad news is you do indeed have a cataract. The good news is cataract surgery today is nothing like your grandmother’s or father’s cataract surgery. Today, we perform cataract surgery in a private ASC setting. We use laser technology that helps make cataract surgery more precise and more predictable than ever before, and it only takes about 10 minutes to perform. Also, looking at the lifestyle questionnaire we sent you prior to your appointment, it indicates that you read a lot, work on a computer and like playing tennis. Mary, it also indicates that if given a chance to reduce or eliminate the need for glasses after cataract surgery, you’d be interested in learning more. Now, I think you would be a good candidate for our multifocal toric lens, which will correct your astigmatism and allow you to have a wide range of vision to see well in the distance, intermediate and even up close with little to no dependence on reading glasses or bifocals. I like to tell my patients that if this is something they can afford to do, it’s something they should do because you’ll be using this every waking moment for the rest of your life. Now, if this was my mother I was performing cataract surgery on, there would be no doubt, this is the lens I would choose for her. Patients who have a multifocal lens can do most things, most of the time without glasses; however, you will still need reading glasses to see small print such as what’s written on a medicine bottle or seeing a menu with small print in a dark restaurant. However, no matter which option you choose, you’ll be very happy because your cataract will be gone and ultimately you should have good vision with or without glasses. Now, do you have any questions for me?”

After this discussion, you should assume the patient wants a premium lens unless they indicated to you that they were not interested. Next, carry over the discussion to the cataract counselor so he or she knows what you discussed with the patient. At this point, it’s up to the counselor to take the doctor’s suggestions and convert the patient to a premium service.

The cataract counselor

As an ophthalmic consultant working in dozens and dozens of practices nationwide, I can tell you a solid cataract counselor can make all of the difference in the world. They will take the doctor’s recommendations and do everything possible to help the patient move forward with those suggestions.

Common objections could be:

  • It’s really expensive.
  • Gosh, for that amount of money, I could buy a lot of reading glasses.
  • I’m not going to live another 30 years, so it just doesn’t seem worth it to me.
  • I’m OK with wearing reading glasses.

Most objections are either “I’m fine with glasses” or “It’s too expensive.” Well, if people are truly fine with glasses and fully understand the benefits of a premium lens, then we shouldn’t be overselling a premium lens to them. But if a premium service is something they want and if cost is the issue, then this is where a good counselor can shine.

A solid cataract counselor helps reinforce the benefits of a premium IOL, femtosecond cataract surgery and intraoperative aberrometry. Most importantly, they show the value of a premium service and help the patient find a way to overcome the financial hurdle so they can get the result they truly deserve. Financing is always a reliable method of overcoming the financial objection.

With a parting note, the best line I have ever heard a counselor use is:

“Mary, you deserve to have this done. You deserve clear vision. You’ve sacrificed your whole life for others. Now you need to give yourself permission to move forward.”


Because a premium service is indeed something a patient will use every waking moment for the rest of their life, it is up to the doctor and counselor to do their absolute best in showing the patient the benefits, while being upfront about the risks and side effects. It is the counselor’s duty to help the patient find the value and help them over the financial hurdle.

Paul Stubenbordt
Paul Stubenbordt