By Timothy Earley, OD
and Stephanie Mateosky,
Director, Macular Degeneration Center of Excellence,
Medina Vision and Laser Centre, Inc.
August 14, 2019
The U.S. population is aging, with people living longer and better lives. However, the many opportunities of a long life can also be accompanied by an increased risk of disease. One of the diseases that seniors are at an increased risk for is macular degeneration. As many as 11 million people in the U.S. have some form of AMD, and this number is expected to double to nearly 22 million by 2050.
The growing prevalence of AMD requires a proactive approach by eyecare providers that targets earlier diagnosis and active disease management. Fortunately, there is advanced technology—the AdaptDx dark adaptometer from MacuLogix—that does just that.
As the only commercially available automated dark adaptometer, the AdaptDx measures a patient’s Rod Intercept (RI). RI is the number of minutes it takes for the eye to adapt from bright light to darkness. This RI number provides a clear and objective measurement of retinal function with 90 percent sensitivity and specificity.i Basically, an RI of less than 6.5 minutes indicates a healthy dark adaptation function and no signs of AMD. However, an RI higher than 6.5 indicates impaired dark adaptation, identifying the presence AMD with 90 percent accuracy.
Timothy Earley, OD, and Stephanie Mateosky, Director, Macular Degeneration Center of Excellence, at Medina Vision and Laser Centre, Inc., share with ROB how both their patients and practice are benefiting from AdaptDx, and how they prepared the practice to make the most of this technology.
How did you get staff ready to support doctors in optimizing this technology?
Dr. Earley: “We knew that using this instrument to its fullest potential would require the doctors and technicians to work together. Our approach was to select one of our strongest technicians (Stephanie) to become the director of our practice’s Macular Degeneration Center of Excellence, acting as a liaison between the practice’s ODs, our AMD patients and the vendors/device companies with whom we work.
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The director’s role requires a person who is able to be present at every planning meeting about the new instrument. The director is tasked with scheduling and performing all diagnostic testing, reviewing treatment protocols, scheduling follow-up appointments, managing our patient-testing database and ensuring patients are provided with education to make informed decisions. In addition, the director manages our carotenoid supplement inventory, which we prescribe to those diagnosed with, or at risk for, AMD.”
How do you educate patients and deliver this test?
Stephanie Mateosky: “AdaptDx offers two dark-adaption tests, the Rapid Test and the Extended Test. The Rapid Test protocol takes less than 6.5 minutes, providing a pass/fail outcome. Those who fail (timing out at 6.5 minutes) return for the Extended Test protocol to determine the severity of their dark adaptation impairment.
There were several days when 50 percent of our patients failed the test, and we started them on supplements right away. We also bring these patients back again for follow-up testing to continue monitoring the severity of their dark adaptation impairment.
I track patient results over time with an Excel spreadsheet to ensure the accuracy of our data. The spreadsheet contains patient ID, name, DOB, AMD/No AMD, pass/fail results including which eye, which eye supplements we recommended and recall date.
One of the great things about the AdaptDx technology and testing is it helps patients understand the need to return to our office for ongoing care. If patients pass the test, I explain to them that we will test them in a year with the opposite eye. I let them know that if they notice drastic changes in night vision, we can test them again sooner.”
What steps did you take to implement AdaptDx in your practice?
High-Quality Staff Training
Stephanie Mateosky: “The initial and ongoing training of the entire staff is critical – and MacuLogix has done a great job of helping us with this by providing a dedicated Practice Management Consultant as well as an online AMD Academy. Team members (from receptionists to technicians to doctors) must be knowledgeable about all technology in the practice and “speak the same language” to provide patients with a consistent and accurate message.
All the staff is well educated on how the AdaptDx works and how beneficial it is for patients. It is important that everyone can answer questions and confidentially tell patients about the test because the more they hear it from the staff, the more it sinks in for them. It also helps because if patients think of any questions from the time they saw the doctor to optical or billing, they can ask them and get the answer they need without having to pull the doctor or myself.”
Development of an In-Office System
Dr. Earley: “The testing system must be clearly defined, scalable as the need and demand for additional testing grows, and be clearly communicated to all staff. MacuLogix did an incredible job of assisting our practice in setting up a system that integrates into our office work flow and provides the doctors with the information they need to provide timely treatment protocols.”
Delegate Oversight to a Director
Dr. Earley: “Having a single person (or persons) trained and responsible for “owning” the technology, its day-to-day usage and the communication between the office, patients and vendors, is critical.
Often, the biggest barrier to proper usage and implementation of new technology is the lack of ownership. Because every member of the vision-care team is so busy, no one person steps up to assure that proper implementation and follow-up are performed. Appointing a director for our AMD services and technology avoids that common challenge.”
Benchmarking and Data Analysis
Dr. Earley: “We pay attention to those aspects of our practices in which we set growth and implementation goals. The same is true for managing our diagnostic equipment. We have found that it is important to set goals and train team members to ask good questions that ensure patients get the testing they deserve. Setting usage goals and tracking those goals assures practices don’t have an excellent piece of equipment gathering dust!”
Dr. Earley: “All new developments and updates to equipment, or changes in testing philosophy and procedures, need to be communicated and implemented in a timely manner. This can only be accomplished by keeping open lines of communication with vendors and being flexible as changes occur.”
i Jackson GR, et al. Invest Ophthalmol Vis Sci. 2014;55(3):1427-1431.
Timothy Earley, OD, is a partner with Medina Vision and Laser Centre, Inc., in Medina, Ohio., and Stephanie Mateosky, is practice’s director, Macular Degeneration Center of Excellence.