By Suzanne LaKamp, OD, FAAO
July 13, 2016
Your patients want you to be the authority on eye health and vision. Using the photos taken with your instrumentation to educate them about their eyes and vision needs shows them the value of your services, and why they should return every year.
PRESERVE DOCTOR TIME. Have pre-testers take the majority of photos, and have the doctor review and interpret the image with patients in the exam room.
OUTLINE INSTRUMENT USE. Let the patient know which condition the instrument is being used to screen, and what it will tell the doctor.
DISPLAY IMAGERY IN EXAM ROOM. Use computer monitors, or large display screens, to review imagery with the patient, making it easy for them to see what you see.
Patients often arrive in your office having researched their eyes and vision needs in advance online. When in your office that’s all the more reason to literally show them your expertise, and what your advanced instrumentation tells you about their eyes and vision needs. In my shared OD-MD practice, photos from instrumentation are reviewed with patients, with the connection between their eye health and annual comprehensive examinations made.
All patients who get a comprehensive examination have photos taken from the front to the back of the eye. Pentacams demonstrate corneal topography. Photographs are taken of the adnexa to include lids, lashes and lenses. The HD analyzer is helpful in looking at image scatter from either problems with tear film, or changes to the natural lens. There is a fundus camera to image the retina and optic nerve. The OCT images the macula. Our newest addition is the LipiView II, which images tear film and meibomian glands. The imaging is useful because it enhances patient education, and for some eye conditions, helps with treatment compliance. All of the imaging is reviewed with the patient. Patients are always reassured when they receive news that their vision and eye health is normal and stable, and they appreciate the information when the doctor notices an area of concern.
Thorough examinations enhanced with the latest advancements in technology really wow the patient. Patients enjoy the visual, appreciate the longer time spent with the doctor during education, and are more likely to refer friends or family based on a positive experience. Patients will eagerly return for an examination that goes beyond the basics.
Dr. LaKamp keeps the above photos on file in the exam room to educate patients on what normal meibomium glands should look like. Dr. LaKamp says that instrumentation allows her to show the patient evidence, and a concrete representation, of what she would otherwise be explaining in the abstract.
Preserve Doctor Education Time
Imaging should be done prior to the doctor seeing the patient to ensure efficiency. The technicians or staff should explain to the patient that the doctor will further review the testing and imaging in the exam room.
If possible, the doctor should be responsible for imaging review, interpretation, and then discussion with the patient. In general, patients prefer to spend more time with the doctor. In my current practice, the staff and technicians are cross-trained to use the instrumentation. The doctor does the educational portion of imaging.
Let Patients Know Why the Instrument is Being Used
The verbiage for each instrument is different. Our newest addition, the LipiView II, has been the most valuable tool in patient education. Working in different refractive surgery practices, the focus is on attaining the best possible vision, in addition to monitoring eye health.
For many patients, that means addressing dry eye. Tear film is largely important for patient success in a refractive surgery practice.
For years, practitioners have discussed dry eye with patients, without many tools to reinforce the dialogue. Slit-lamp photography can be beneficial in some instances where there is evident dry eye, but not very practical. Evaporative dry eye, which accounts for an estimated 86 percent of dryness, used to be a challenge in patient education.
Now with LipiView II, we can better assess for some forms of dry eye. We tell patients: “LipiView images tear quality, blinking and structure of the meibomian glands. The meibomian glands make the oil layer of tears, which is very important, and accounts for the majority of dry eye symptoms if not functioning well.” It is helpful to keep a printout sample photo of normal meibomian glands on LipiView II when reviewing the patient’s own photos in the exam lane. During the exam, the doctor can then evaluate meibomian functioning during gland expression, using the Korb evaluator, or a cotton-tip applicator, among other testing for dry eye.
The pictures are mostly helpful in demonstrating to the patient with meibomian gland disease that there is a reason for their dryness. In the past, it was hard to convince our patients about these glands in the eyelids contributing to blurry vision or scratchy eyes. It just didn’t make sense without a visual. Now our patient compliance with treatment including warm compresses, for instance, is much improved. The success of treating dry eyes is largely due to improved imaging, and our clinic has now expanded to include a specialized dry eye clinic.
Don’t Alarm, But Let Patients Know About Concerns
Always describe the findings in the photo to the patient, including what appears to be normal and healthy, or not. It is also important not to just focus on the finding, but to have a course of action. For an abnormal eye finding, our patients are told why the new imaging is helpful to the documentation of the finding, the diagnosis of, or treatment. Most people fear the unknown. Describing the plan, and next steps going forward, instills patient confidence.
Patient education describing the overall function of instrumentation is the same whether it is for standard imaging, or for a new finding on an exam. During an eye examination, it is possible a doctor can find something not normal with a patient’s eye health or vision. The presentation of these findings to the patient is very important, and care must be given not to alarm the patient to the point of shutting down. The doctor should always be honest and forthcoming, but adopt a calm affect as well: “Mrs. Jones, I’m glad we took these photos today. I see an area in the back of your eyes that concerns me, that I would like to get a second opinion about from one of the ophthalmologists in our practice who is a retina specialist.”
Use Computer Monitors to Display Imaging
Images are sent from the instrument to an image drive, which can then be uploaded into the patient chart. The technician can perform these tasks prior to the doctor entering the exam room. Exam rooms should have computer monitor, display screens or handheld digital devices. In my current and previous practice, we use computer monitors to display imaging, and can also chart from all rooms.
Train Staff to Discuss Instrumentation
Using the instrumentation is necessary to truly understand it, and to explain its purpose to the patient. For new equipment, manufacturers can send out training staff to assist the practice. Imaging should not take away from patient flow, and should easily export into a drive or patient file.
Consultants can also be helpful, especially with any troubleshooting in staff use of equipment. The technicians and staff should train on equipment with the consultant prior to fully incorporating it into the workflow. Well-trained staff, with a great script for the patients about the technology, greatly enhances the patient experience.