Software solutions for premium IOL selection

The MDbackline and Veracity programs can help streamline the process for practice and patient.

Premium intraocular lens (IOL) options are changing the refractive cataract surgery landscape. According to a 2017 Market Scope report, premium IOLs currently account for 12% to 14% of total IOL procedures. However, there is an opportunity for an even more significant impact in the near future, as Market Scope projects premium IOLs to potentially be worth 41% of all IOL market revenues by 2022.

A reason for the lag in adoption of premium IOLs may be that they are time consuming, from both a communication and calculation standpoint. According to the results of an Outpatient Ophthalmic Surgery Society (OOSS) survey published in May 2017 Ophthalmology Management, cost, availability and familiarity drove the use of monofocal lenses over premium IOLs.

Thankfully, several software programs are now available to streamline the IOL selection process, for both patients and ophthalmologists alike.

A screenshot from the MDbackline patient communication system.


Most cataract patients today are looking for the vision they experienced in their youth. Many have had refractive surgery, are tech savvy and are very active. Gone are the days when you could correct astigmatism and presbyopia with a spherical IOL and postoperative glasses. Today’s patients want more, but they don’t know their options. In 2014, Clinical Ophthalmology published a study from Henderson et al that surveyed previous cataract surgery patients; the study found that improved patient education gave the patients a better understanding of their predicted postoperative outcomes, but lens options were only mentioned in 39% of preoperative discussions. Despite minimal knowledge of possible outcomes, a laundry list of questions and an underlying fear of going under the knife, patients are expected to quickly make an IOL choice based on their visual needs, which they have not previously considered.

From a time perspective, physicians — armed with copious data including multiple biometry readings, aberrometry, IOL calculators and an increasing number of IOL brands, designs and options — have to choose the appropriate IOL based on a brief discussion with the patient. Afterward, they need to compile the preoperative data, including patient history and desired outcomes, and formulate a treatment plan while maintaining a full clinical and surgical schedule. It is no wonder that Market Scope data show that premium IOLs are a small portion of the IOL revenue market. But the potential revenue makes them very appealing.


MDbackline is a patented, cloud-based, secure online software solution for automating communications with patients before and after ophthalmological visits. It acquires preconsultation information, delivers patient-tailored learning materials, automates follow-up communications and collects outcomes data, thus enhancing future treatment using analytics from previous surgical data, according to the software’s website.

When confronted with a diagnosis of cataracts, patients usually have many questions. According to John Hovanesian, MD, an ophthalmologist from Laguna Hills, Calif., and founder of MDbackline, a patient must take 43 different steps to complete sequential binocular cataract surgery, including scheduling appointments, filling out insurance information, understanding the risks, signing informed consent forms and using pre- and postoperative drops properly. Patients are often reluctant to ask questions during their brief consultation. They may feel rushed or don’t want to monopolize their doctor’s precious time. Also, their questions may only arise once they have left the office, but better to have them ask the doctor than look for answers on their own.

Enter MDbackline. Staff enroll a new patient in the software’s system at the time of referral prior to first appointment. This enrollment triggers an e-mail or text questionnaire to obtain the patient’s ocular and systemic history and expectations of surgery for distance, intermediate and near. The questions are easy to understand and include useful graphics.

A screenshot of Veracity, a Web-based program for compiling IOL data from EMRs, biometry and diagnostic systems.

“Seventy percent of patients of all ages respond, ” says Dr. Hovanesian. “Even older patients usually have e-mail, and many will solicit the help of a younger relative to complete the modules.

Before the surgeon even enters the exam room for the consultation appointment, he or she has an excellent idea of the patient’s expectations and the type of IOL required. Following the consultation, the patient receives lens recommendations and customized learning materials by e-mail. This increased, accessible communication with patients is also driving the conversion to premium IOLs, as the patient arrives in the office understanding there are added costs associated with those lens options. In October 2016, prior to using MDbackline, Dr. Hovanesian’s practice reported a premium lens conversion rate of 22%. In July 2017, after the practice started using MDbackline, the number of patients adopting premium IOLs rose to 36%.

MDbackline’s patient-specific dashboard is easy to follow and includes a list of important upcoming dates. If the patient has questions regarding the procedure that are not answered by the information database, he or she can easily send a question through the system, alerting the staff and doctor. Also, the system automatically sends e-mail reminders prior to surgery with instructions on removing contact lenses and taking drops.

Following surgery, the patient is reassured via text and e-mail about what to expect in the short and long term. A postoperative questionnaire is sent once follow-up examinations are complete to assess the patient’s satisfaction with the expected outcomes. Responses are relayed to the staff and physician as distilled bare facts — a green light indicates that the patient is happy, or a red light indicates that something further is required to satisfy the patient and a follow-up assessment should be scheduled.

Word of mouth referral is an excellent form of marketing, and MDbackline assists here as well. “When a patient reports top box satisfaction after surgery, the system automatically directs the patient to online review sites like Google, Healthgrades, and Yelp,” Dr. Hovanesian says. This drives the physician’s online reputation, which always helps bring new patient.”


Along with a complicated series of patient communication, premium IOLs also mean more complex treatment planning. That is where Veracity Surgical from Zeiss comes in. Veracity is a web-based software program that streamlines and systemizes IOL review by compiling the information from EMRs, biometry and diagnostic systems into one user-friendly interface. Dr. Hovanesian describes it as “taking disparate information and making it cohesive.”

Kerry Solomon, MD, an ophthalmologist from Mount Pleasant, S.C., lamented that it used to take two of his cataract surgical staff, two days each week, to create the surgical plan binders for the following week’s cases. With Veracity, he can automatically generate documents and communications “with a single click.”

Dr. Solomon describes Veracity as a pre-flight checklist. “Veracity allows you to avoid errors by combing through data and using analytics to optimize outcomes,” he says. “It is able to run compliance checks, such as confirming Medicare or insurance guidelines for glare testing, to make sure that the appropriate tests are completed and patients qualify.” He adds that it checks for variability in diagnostic parameters, offering alerts for poor candidates for monovision or multifocals if comorbidity is present.

In addition to data validation, warnings, documentation and compliance checks, Veracity offers IOL power selection, toric calculators and arcuate incision planning. IOL power is calculated using the Barrett Universal II or Holladay II, while astigmatism correction is planned with the Barrett or Abulafia-Koch toric calculators.

Veracity can be configured by geographic location and physician preferences. As each surgeon’s database grows, it uses analytics, assessing postoperative refractive data to optimize future outcomes and allowing for the refinement of surgically induced astigmatism and A-constant.


Dr. Hovanesian says that MDbackline and Veracity are compatible and synergistic and easy for the physician and staff to use. In terms of return on investment, his practice has experienced an increased annualized productivity of over $150,000 per doctor with MDbackline.

These programs can propel both efficiency and income and allow you to offer patients excellent customer service and enhanced visual outcomes. OM