November 2013




The art of advanced technology IOLs

Should have, would have, could have: Understanding post-purchase dissonance

by Richard Tipperman, MD

Richard Tipperman, MD


Picture this: You're lying in bed in the middle of the night. Earlier that week you purchased an expensive car (readers, please note, I drive a minivan). You begin to think, "Should I have bought that car?" "Was it the right car?" "Did I pay a fair price for the car?" These are normal aspects of what is termed post-purchase dissonance; however, most people are more familiar with the term "buyer's remorse."

Buyer's remorse is a normal human emotion that occurs with many purchases. The term was originally used to refer to the anxiety and stress a person might have when purchasing a new house—one of the largest single purchases 99% of people make in their lifetime. Now "buyer's remorse" is commonly used to refer to the anxiety some people experience with the purchase of many goods and services. Ophthalmologists, however, are not used to dealing with this phenomenon (1) because of the incredibly high quality results we deliver to patients (which tends to limit post-purchase dissonance), and (2) until recently, in most cases reimbursement came from an insurance company rather than direct out-of- pocket payment from the patient. When there is limited economic investment in a purchase, the potential for buyer's remorse is limited.

It's important to understand post-purchase dissonance because this alone can lead to patient dissatisfaction, even when technically and surgically the patient has a good result. In some cases, when a patient seems dissatisfied or unhappy following implantation of an advanced technology IOL, even unbeknown to himself or herself, the patient is merely externalizing buyer's remorse. To paraphrase "I think therefore I am" in terms of post-purchase dissonance, "If you feel unhappy, you will be unhappy." So if patients are experiencing stress or anxiety regarding the expenditure associated with an advanced technology IOL, this stress may manifest in them being dissatisfied despite a good clinical result. Realtors, car dealers, and big box appliance salespeople all understand that dealing with or preferably eliminating post-purchase dissonance is important to achieving happy, satisfied customers.

In order to eliminate or reduce post-purchase dissonance, we need to better understand what causes it. Behavioral scientists have identified certain factors that are more prone to lead to buyer's remorse. These include higher cost, less pre-purchase research, and a purchase decision not reinforced or supported by a peer group.

When talking about cost, it's important to realize the relative value of an item is much more important than its absolute cost. The cost of advanced technology IOLs may seem high, but the real question is high in relation to what? In relation to inexpensive earbuds for a portable music player or a cup of coffee—yes. In relation to designer frames and progressive lenses that can easily run more than $1,000—no. This is why educating patients so they understand the value in the benefits they achieve with an advanced technology IOL helps ameliorate buyer's remorse. The same patient who would not think twice about purchasing bottled water or Starbuck's coffee daily (yearly cost: $4 x 365 = $1,460) might assume $1,000+ for an IOL is too expensive until they realize the relative value.


The more thoroughly people research a purchase, the less likely they are to suffer buyer's remorse. This is one of the many reasons why educating patients prior to their decision making about IOL selection is so important. Educating patients so they can assess their needs, understand benefits and potential drawbacks and cost not only allows the patients to make an informed decision but also helps banish post-purchase dissonance subsequently.

Lastly we will address one of the final factors impacting post-purchase dissonance: reinforcement or support of a decision by the purchaser's peer group. Companies expend extraordinary resources to establish and maintain their brand recognition. Not only does the branding of a "luxury" product allow the company to promote its image, but it also lets the end user demonstrate to friends and peer groups the use of the product.

For example, in the case of designer shirts, the presence or absence of a horse-riding polo player insignia on a shirt should not materially affect the wear or function of the shirt, but it does allow others to recognize and acknowledge the luxury purchase of the buyer.

In another example with automobiles, an advertisement describing a recently purchased vehicle as "the most luxurious in its class" may make the buyer more comfortable with the overall purchase. With advanced technology IOLs there is no outwardly obvious branding that allows observers to reinforce the value of the purchase. Additionally, even educated patients may not realize the true benefits they are achieving from their advanced technology IOLs when compared to basic lenses and therefore not appreciate the real world clinical advantages. This is why it is important for the ophthalmologist and staff to continue to be supportive and educate patients even in the postoperative period. By using low minus power trial lenses, staff can effectively negate the add power of presbyopic IOLs and demonstrate what vision would have been like if a basic lens was implanted. This, along with support and reinforcement of the patient's near visual function, can help provide validation of the patient's initial decision to proceed with a presbyopic IOL.

Editors' note: Dr. Tipperman is affiliated with the Wills Eye Hospital, Philadelphia.

Contact information


Should have, would have, could have: Understanding post-purchase dissonance Should have, would have, could have: Understanding post-purchase dissonance
Ophthalmology News - EyeWorld Magazine
283 110
216 144
True, 11