Medical Model

Educate Patients on Preventative Eyecare

By JeanMarie Davis, OD


Differentiate your practice by offering a preventative approach to medical eyecare. Let patients know that you test for eye conditions and diseases well before problems arise.

Most ODs today practice medical eyecare addressing conditions ranging from eyecare emergencies to managing diseases like macular degeneration and glaucoma and monitoring patients with diseases like diabetes for potential eye health complications. Perhaps the most essential component to a successful medical eyecare practice is what you do not when the condition or disease is acute or in its last stages, but what you did to prevent or offset the issue in the first place. Here is how doctors can put even more of a focus on preventing serious threats to their patients’ vision and eye health.

Catching eye diseases at an early stage will enhance your practice in several ways. First of all, proper patient education and explaining increased risk factors, when appropriate, will generate a larger volume of routine examinations. Many patients who are at higher risk for eye diseases are unaware. They will be appreciative of the education you provide, and will increase their loyalty, as well as create referrals to other family members or friends who also are at risk.

Let Patients Know You Practice Preventative Eyecare

Invest Time for Patient Education

To be most successful in preventive eyecare, some additional time must be spent on patient education. This time pays off. Some of the education should come from the OD. This will create greater credibility and have a bigger impact than just having staff do the education. Usually, not much additional time with the OD is needed to educate patients. An additional three to four minutes should be more than enough educational time for most of patients. Having your staff then provide patients with written materials or web sites they could use as references is a great way to provide additional or more detailed information without adding to chair-time. This practice resulted in patients having a greater understanding and coming back more frequently. Editor’s Note: Click HERE for patient resources from the National Eye Institute.
Educate Patients that Annual Comprehensive Exam is Key to Prevention

Preventative eyecare is as easy as getting a routine eye examination at least every 12 months if you are in good general health and possibly more frequently if you have any systemic illnesses. The earlier changes are found, the better the prognosis. We get a full physical every year even when we are healthy to make sure everything is normal. The same type of preventive care should be followed for the eyes. Often, early changes are asymptomatic. If undiagnosed, this can potentially lead to some very serious damage and possibly even loss of vision.

Doctors should talk with patients in the exam room about the importance of returning every year for a comprehensive examination–even if the patient has just been given a clean bill of eye health. Patients who have already been diagnosed with conditions are usually aware of what is at stake if they neglect to return for their next exam, but it is easy for patients with healthy vision to become complacent. Be sure to educate patients about why that is not a good idea: “Mrs. Jones, I’m happy to say your eyes are healthy! But I do want you to return in a year for another comprehensive eye exam. Monitoring your eyes annually is the only way we can continue to monitor your ocular health.”

Educate What High-Risk Means

Determine Which Patients Require Additional Testing

Deciding on which tests to conduct on patients depends on the risk factors associated with that patient. If a patient has a family history, or is of a certain high-risk demographic, certain medical plans will provide guidelines on criteria to cover additional testing for these patients. Diabetes and glaucoma are two diseases that commonly allow for additional testing.

Depending on the disease, the decision could be made simply from risk factors such as patient or family history or a specific demographic for a particular disease, or could result from findings on a routine eye exam.

In my experience, the most common additional testing is for diabetes and glaucoma. Depending on the insurance, coverage for testing was possible by simply having a family history of glaucoma or a diagnosis of systemic diabetes. It also was common for me to base additional testing on findings from a routine eye exam.

Explain the Need for Regular Exams Even Greater with Family History of Disease

Patients with certain illnesses in their family history are also at greater risk of developing disease and there are some illnesses, such as glaucoma, in which certain patients are more at risk simply due to ethnicity. When it comes to family history, use the summary you provide patients with at the end of annual exams to reiterate how important annual examinations are for all patients, and especially for those with a family history: “Mrs. Jones, your eyes look healthy. I didn’t see anything in my examination that concerns me. But I see in my records that your mother and grandmother both were diagnosed with macular degeneration. That means we have to keep a very close watch on your eyes. It is important that we continue to monitor any changes in your retina. I also want to discuss some nutraceutical supplements that are on the market that may be a help to you.”

Explain the Role Factors Like Age, Gender and Ethnic Group Play

It is necessary to tread very carefully so as not to offend, but it also is important to let patients know about the conditions and diseases that they may confront simply because of their demographics. That means making patients aware of everything from the likelihood that most people in their late thirties through 40s will develop presbyopia to the decent chance that a middle-aged woman will experience dry eye: “Mrs. Jones, your eyes appear to be very healthy and your vision is stable, which is great! I would like to see you again in 12 months, but don’t hesitate to come in for an appointment sooner if you notice that you are having trouble reading or are having difficulty working on the computer for long hours. Likewise, feel free to come in earlier than a year from now if your contact lenses become less comfortable for any reason.”

Educate on Need to Closely Monitor Diagnosed Conditions

While many patients will understand the need to return consistently for monitoring after being diagnosed with a serious eye condition or a threat to their eye health, others will require convincing.
Patients with systemic illness have a greater risk of developing ocular disease. Common illnesses such as diabetes and hypertension are the cause of a significantly high percentage of ocular complications that when caught early could prevent vision loss. There are many systemic conditions and systemic medications that put patients at risk. Patients with advanced or uncontrolled systemic illnesses may need to be seen more frequently.

It also is not uncommon for systemic illnesses to be diagnosed from findings found on an eye exam. I have diagnosed numerous cases of diabetes and hypertension in addition to rosacea,herpes, chlamydia, myasthenia gravis, multiple sclerosis, arteriosclerosis, carotid artery disease, giant cell arteritis, hyperthyroidism, pseudotumor cerebri and brain aneurysm.

You don’t want to frighten or panic patients, but educate them about the need to closely follow their condition: “Mrs. Jones, your intraocular pressure is stable right now, but we need to follow your glaucoma closely. Glaucoma is a serious ocular condition that may lead to permanent vision loss. Luckily, we caught it at an early stage but it is very important that you not miss any of your follow-up appointments. We need to monitor this condition through regular visits to make sure the condition remains stable and prevent progression.

Talk to Patient About Preventative Eyecare for Whole Family

Educate About Need to Care Preventatively for Children, Too

More than 60 percent of cases of blindness among infants are caused by inherited eye diseases such as congenital cataract, congenital glaucoma, retinal degeneration, optic atrophy and eye malformations. Children can also be diagnosed with systemic illnesses that can have ocular manifestations. It is not uncommon to see children with type I diabetes. Pediatricians also often refer their patients for prevention of amblyopia.

Explain to parents who are patients why it is important that they take their children for annual examinations: “Your eyes are healthy, Mrs. Jones, but don’t forget to also bring Suzy in. Children need to be examined and refracted each year to ensure their vision stays sharp and their eyes remain healthy.”

Document Patient Education
Proper documentation of patient education will help the OD medicolegally, as well as cause the patient to realize that their condition could be serious. Having the patient sign a document that they have been educated is a good way to do this. It is also possible that insurance will cover many additional tests with proper documentation of risk factors. Having an understanding of what the patient’s insurance covers and explaining this to the patient will increase the patient’s compliance with additional testing.

Equip Your Practice with Instrumentation

Make Necessary Instrumentation Investment

Having common instrumentation is enough for anyone to practice preventative eyecare for most patients. Having additional instrumentation would increase the opportunity to conduct additional testing when warranted. For example, having the ability to check a patients’ blood sugar in the office will surprisingly result in patients who would qualify for additional ocular testing. A relatively inexpensive piece of instrumentation that can aid in preventative eyecare is a retinal camera. This is useful in documentation that can be compared regularly and make it much easier to find subtle changes and an earlier diagnosis.

A visual field machine is also extremely useful for many types of testing–certainly for glaucoma, but also for conditions where the etiology is unknown such as headaches, decreased visual loss, visual field loss, as well as to rule out differential diagnosis in patients with certain signs and symptoms that warrant additional examination. An OCT is a more expensive piece of instrumentation, but in a practice that serves an elderly demographic, or where systemic disease is prominent, it is a valuable tool that can be greatly utilized. These are the types of instrumentation that will provide a great ROI since they can be used to monitor very common conditions. Editor’s Note: Check with your state optometric board to make sure any test you are doing is approved/allowed.

Develop Networks with MDs to Feed Your Preventative Practice

Co-Manage with MDs

Co-management can play a significant role in preventative eyecare. When I was in practice, I worked with several general medicine and family practice physicians and endocrinologists who referred their hypertensive and diabetic patients for ocular examination based on their systemic illness. When the patient’s general doctor refers them, compliance is high for the initial exam as well as follow-up examinations scheduled by the OD. It is important that the referring physician receive a thorough report every time the patient is seen. It was not unusual for me to receive the full medical history for these patients when referred. Some referring physicians will send this automatically or you can request the patient’s medical records. Electronic health records make it very easy to receive patients’ medical records, as well as generate the report to send back to the referring physician. Medical records are not always necessary, but are never a bad idea to review.

Build a Preventative Medical Eyecare Practice

Build relationships with local general practitioners, internal and family medicine practitioners and pediatricians. Meet with them and educate them on the conditions you can test for. Provide them with easy-to-fill-out referral forms that can be faxed to you.

Give patients written materials for more common diseases. Train your staff on how to discuss preventative eyecare to patients and provide them with the materials available. These materials could include a list of web sites where the patient can go for more information.

Have the staff schedule the patient’s next appointment several months in advance. The appointment can always be changed later if needed. Getting the patients on the schedule will prompt the return visit. The patient may put it on their calendar and your staff will call to confirm the appointment which will increase compliance.
Provide primary carephysicians with reports on patients with risk factors–even if patients were not referred. Reach out to that physician to possibly co-manage other patients. Primary care physicians appreciate this additional documentation for their records, and it will increase your credibility.

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JeanMarie Davis, OD, is manager, technical, Global Performance Development for Alcon. To contact her: drdavis2020@yahoo.com.

 

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