You may not be comfortable implanting premium IOL’s, but I think we have reached a point where it would unfair not to discuss them with patients- and we can’t make any assumption about their level of income. Even patients who strike us as odd, cheap or just plain dumb,  they may surprise us with their desire for these IOL’s and their readiness to pay out-of-pocket. If a patient learns that her friend is so happy with her toric or presbyopic IOL, he will demand an explanation from you why he was not offered the same, and if you don’t have a good answer, the patient, rightly so, will view you poorly.

So, be sure to explain to your patient all the IOL options, and why you think he is not a good candidate; and if the patient is a good candidate, but you don’t feel comfortable implanting the IOL, I think you have an obligation to refer the patient elsewhere.