Dr. Goldman discusses pearls for practice building with Dr. Jeremy Kieval, an ophthalmologist in suburban Boston who has experienced tremendous practice growth in a short period of time. Tips for choosing the proper presbyopic lens for each patient are discussed, as well as things to look out for during preoperative examination.
Video Interview: Pearls for Ophthalmic Practice Building
Dr. David Goldman Interview with Dr. Jeremy Kieval
Dr. David Goldman: Hi, I'm Dr. David Goldman, Refractive Editor for OphthamologyWeb.com, speaking now with Dr. Jeremy Kieval, a practicing cornea/cataract/refractive specialist at the Lexington Eye Associates. Thank you so much for joining us today.
Dr. Jeremy Kieval: Thank you for having me.
Dr. David Goldman: Absolutely.
Now, Jeremy, in a very short period of time since joining the group, you've become one of the highest volume producers, and it's quite an impressive feat at a younger age. You know, what do you think are some of the pearls for your quick success?
Dr. Jeremy Kieval: Well, I think that being a refractive specialist has really allowed me to capitalize on some of the out-of-pocket procedures and, in such, LASIK and refractive surgeries, but specifically in my market, with an older population, some of the lifestyle, intraocular lenses, multifocal lenses, accommodative lenses. And this all, I think, has contributed to my success in a short period of time.
Dr. David Goldman: And regarding the multifocal lenses, is there a lens that you prefer to use for your patients?
Dr. Jeremy Kieval: You know, really, I think it depends on the patient. I think, really, with any lifestyle lens or presbyopic correcting lens, you really need to think about what's going to be best for the patient and whether they're even a candidate.
And specifically, between the different platforms that we have, you really need to take into consideration what the patient wants to achieve, what sorts of activities they're going to be doing and needing excellent vision for, and what sort of things, if they had any limitations, would they not be bothered by.
Dr. David Goldman: And so, which lenses do you think are better for different populations of patients?
Dr. Jeremy Kieval: Well, really, one of my really choice--my choice lens would be the Alcon ReSTOR with the 3-plus add. I've had great, great results with this lens, and especially since having changed the platform to a 3 add.
But, the limitations of it are, certainly, difficulty with vision in poor-lit situations and a--and somewhat of a compromise with intermediate vision. So, patients who don't mind that particular situation who don't have problems if they were going to be going out to restaurants at night and having difficulty seeing the menu or whatnot, then it's a great lens choice. For patients that I have who are working in situations that are poorly lit and situations where they need a closer reading add, I often will turn to a TECNIS multifocal.
Dr. David Goldman: And what do you think are the limitations with the TECNIS multifocal?
Dr. Jeremy Kieval: With the TECNIS multifocal, I find that the reading add is a little bit stronger and that patients don't have as much of an intermediate focal point. And so, patients who are often on computers for extended periods of time, it may not be the best lens choice for them.
Dr. David Goldman: And so, obviously, preoperative management, as well as postoperative management, are important with these multifocal lens patients. What are some of the things that you look out for or that you talk about with a patient?
Dr. Jeremy Kieval: Yeah, really, I'm looking at a full ophthalmic exam, almost to the same degree that I would do a LASIK or laser vision correction examination, really looking for ocular surface disease, looking for any posterior segment disease. So, I'm often doing a battery of tests with these patients, from topographies to optical coherence tomographies, and those tests really are critical to see whether or not patients are going to have a good quality of vision because, certainly, if there's ocular surface irregularities then they're really not going to achieve the outcome that they may hope for.
Dr. David Goldman: And so, selecting that group of patients, what would you say your success rate is using multifocal lenses?
Dr. Jeremy Kieval: Yeah, I would put my success rate over 95 percent with patients. I have very few patients that are bothered with any symptoms with multifocals. I have very few patients that are unhappy with the results. I certainly have some patients that don't feel that it was the outcome they may have expected or may need a pair of over-the-counter reading glasses for certain tasks, but for the most part they all find it to be a much better alternative to what they could have had otherwise.
Dr. David Goldman: Well, thank you so much for sharing all of those pearls with us.
Dr. Jeremy Kieval: It was my pleasure.
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