This perception gap affects both sides. Clinicians can be reluctant to offer premium lenses to avoid coming across as pushy salespeople and face the risk of patient dissatisfaction. On the other hand, patients arrive primed by negative online stories, as well as, quite surprisingly, the IOL marketing itself, where bright futures promised by advertising collide with the more cautious, realistic consultation discussion of limitations, trade-offs, and potential complications.
The situation may seem chronic and unbreakable, yet experience shows that we can change this perception through a shift in how we communicate. A surprisingly large number of patients are, in fact, ready to accept premium IOLs if we just broaden our view of the informational landscape, and adjust what, when, where, and how we communicate.
For years, I have helped clinics and brands sell high-quality and expensive premium solutions. At some point, I realized a simple truth: all bills in the industry are paid for by the patient, either directly (private) or indirectly (public). Once you accept this, one thing becomes clear: we must focus on how we communicate, ethically, while supporting the economics required for technological progress. With this understanding, there is only one win-win scenario: the patient receives the best possible vision for their lifestyle, and the industry receives margin, satisfaction, and long-term trust.
To support this goal, I designed an approach called Patient Decision Design Architecture (PDDA™) – a structured behavioral model that defines how patient decisions are formed under uncertainty, and how clinicians can intentionally design that environment. PDDA is valuable not only for patients but also for surgeons, for whom uncertainty and pressure can be equally destructive when offering complex premium technologies.
The approach is built on three layers:
The Value Layer – understanding how vision supports a patient’s life values, and what value the chosen technology can realistically bring to an individual.
The Communication Layer – a structured, personalized consultation that aligns needs, expectations, and clinical reality.
The Decision Environment Layer – the invisible foundation: removing fear, cognitive overload ,and decision paralysis so that the patient can make a confident, pressure-free decision.
Let’s explore how the value layer appears in real life, starting with what I call "the digital trust gap" – the gap between what patients have learned online and what they actually encounter at the clinic.
Patient education no longer works the same way it did 20 years ago – patients are no longer passive listeners; they actively research online and compare what they find and what they choose to believe with your messages. Whether you are a manufacturer or a surgical clinic, you are competing for attention, and you cannot control online narratives. But you can adjust how you de-bias those narratives and realign the conversation around evidence, patient needs, and patient values.
I observe two common problems in digital presence: under-promising and over-promising. Both of these can damage premium conversion. Under-promising filters out the most motivated patients, the ones actively looking for the best solution. Over-promising does the opposite: it creates cognitive dissonance in the consultation room. When a patient who is primed for unrealistic visual outcomes finally meets the realistic environment of the consultation process (a process which generally involves explanations of compromise, occasional spectacle use, and neuroadaptation), they will naturally feel cheated. Even the most empathic consultation loses power when a patient is forced to rebuild their internal reality from what marketing campaigns have led them to expect.
When we work through the full PDDA cycle, we begin by redesigning the online presence using the Smart Promise Framework™ to better educate the patient before their consultation, aligning what they expect in the clinic with what they may actually hear and perceive.
Many small- to mid-size clinic owners have never clearly defined their core business value – their “Why,” as the American business leadership author, Simon Sinek, describes it. This is why it's important, initially, to begin the process by uncovering your unique values, ones which might differentiate you from other clinics.
Then comes a detailed audit of the current claims you make. Try it yourself: read your website and printed materials and identify where you tend to overpromise, where you speak only in clinical metrics, and whether your informational output clearly communicates how vision improvements connect to a patient's quality of life. This is the true starting point and may give you powerful insights into how to reframe your marketing practices.
When core messages are aligned across your website, social media, and front-desk communication, you pre-frame the consultation and, more importantly, you pre-qualify leads. For example, a premium-lens candidate who is fixated on “the cheapest option in the area” is not your patient, unless you are indeed the cheapest option. Personally speaking, I never work with clinics that compete on price, discounts, or overselling. Those models may work, but they are simply not my segment. I work with high-value clinics, where value, rather than price, drives decisions.
The Smart Promise Framework naturally reduces workload while empowering conversion, as incoming leads are better aligned with the clinic’s positioning prior to the consultation. Once the core messages are aligned and integrated online, offline, and in your front-desk communication, the first-mile contact reduces or eliminates possible friction, and makes the Smart Sight consultation smoother, more natural, and more effective.
The Patient Decision Design Architecture works only when the owner and top management are aligned in a patient-centric approach - accepting the reality of online influence and seeing a human being in every patient, not just another customer who is unwilling to pay premium prices for brilliant technologies.
It’s time to rethink the way you communicate with your patients. They are the ones who pay all of us, and they deserve respect. Likewise, as specialist clinicians, you make life-changing procedures possible, and you also deserve a respectful income that reflects your unique skill set. When both sides are truly seen and valued, the win-win synergy becomes real. Our responsibility is to design that synergy intentionally – because now we finally know how it works.
