By Jessica Marshall, OD
Feb. 23, 2022
Optometrists benefit from the help of several national awareness days designed to bolster the messages we want to impart to our patients. Several months of the year, we can jump on the momentum of these highly-publicized campaigns that, in turn, help make our own patient education messages stick.
However, rarely do we mirror the pomp and circumstance of organized events like those featured on the evening news. But who’s to say we can’t? More importantly, just because the calendar month comes to end, doesn’t mean the cause is any less important. I say, let’s keep the momentum going!
While I recognize that few eyecare providers have the bandwidth to throw a parade once a month, I do encourage finding a way to pay special attention to at least one area that you feel particularly passionate about. For me, that’s’ age-related macular degeneration (AMD)—a condition that I commemorate far more frequently than Februaries alone.
I find ways to carry my AMD campaign throughout the year by coupling it with a hobby that I enjoy—namely cooking—making it fun for both me and my patients. My program is community-based and has grown my business through referrals as well as through increased diagnostic testing. These additional tests, specifically dark adaptation and OCT, have grown exponentially simply because we’re finding so much more AMD in our new and existing patients based on the focus we put on discussing and testing for this disease with every patient over 55.
My Approach to AMD Care
We have an AdaptDx Pro in our practice and follow the AMD Excellence Program, which means every patient over the age of 55 undergoes a rapid dark adaptation test as part of the comprehensive exam. If the patient’s Rod Intercept (RI) score is abnormal, we schedule a second visit for an extended test. A concerning rapid test also prompts me to initiate a discussion about what AMD is and what the different phases are—from subclinical to early to intermediate to advanced.
Each of these stages are distinct and my goal is to slow the progress from one stage to the next. To do that, I explain that patients can take steps to improve their diet and lifestyle. I can help too by following the patient more closely. For example, once an impaired RI is confirmed by the extended test, if a patient progresses from subclinical to early AMD, I may need to see the patient more often. If the patient progresses from early to intermediate AMD, the patient may also need to use an at-home monitoring device.
Undiagnosed AMD = Lost Vision & Money Left on the Table
A patient with undiagnosed AMD, who sees me once per year, contributes significantly less to the practice than a patient whose AMD has been diagnosed because now we can take the appropriate steps to protect their vision over a lifetime.
By maintaining a year-long focus on AMD and testing every patient over age 55 for dark adaptation impairment, I’ve discovered additional cases of subclinical and early AMD in my existing and new patients. Each of these patients converts to medical billing, and based on the severity of their disease, I could be seeing them 1-4 times per year to monitor disease progression.
Each medical visit includes a dark adaptation extended test, an OCT or possibly an utrawidefield image, and a medical exam. While I know I’m doing everything in my power to protect their vision, these patients are also contributing more to my bottom line, which in turn, allows me to offer even more programs and outreach to my community.–Jessica Marshall, OD
All of these choices are within our control when we know what we are dealing with and when we have a comprehensive understanding of the patient’s functional and structural findings.
When I find impaired dark adaptation (an RI of 6.5 or higher), I generally collect an OCT and a photo. With these three critical pieces of information, I can start to confidently assess change over time. I don’t want to refer patients to a retinal specialist with 20/60 vision. I want to refer them at the earliest signs of CNV, before vision is lost. My testing protocol is designed to enable me to do that.
The patient’s job is simply to come back for scheduled visits and, hopefully, to follow the diet and lifestyle advice I provide. To reinforce this, I’ve added a community education component to the AMD Excellence Program at my practice.
Don’t Confine Community Education to Just One Month
As an optometrist, I’ve always advocated for better nutrition. There’s so much education on heart healthy food, but there’s really not a lot of education in the mainstream media on eye healthy food. This led me to start an open-house education program called Macula Mondays. These free screening sessions are for patients and newcomers, and we order catered healthy foods. From there, I expanded by renting out a commercial kitchen and hosting evening cooking classes.
My goal is to teach my patients, their friends and other members of the community how to cook healthy foods that have been shown to promote eye health. I start with an entertaining 20-minute lecture on diet and the eyes and then we launch into cooking – and eating, of course! The program has been popular, and my patients and their guests love it—so much so that many of them are eager to make an appointment.
I also started a walking club at a local park, which is a nice workaround when public health conditions aren’t conducive to indoor gatherings. The more resources I can provide my patients to show them how much these small steps can contribute to improving their overall health and preserving their vision, the better. My goal is to demonstrate that prevention doesn’t have to be miserable. It can be fun. And, we can keep big campaigns like AMD Awareness month in the forefront all year round.
Partnering with patients is at the heart of how I practice. It’s what inspires me to think about the patient experience in a more comprehensive way. Of course, the roots of the doctor-patient relationship are in the exam lane, but I believe my message has more meaning when I connect it with my patients’ lived experiences beyond the exam room.
Cooking may not be your thing, but I encourage you to find something that you enjoy and share that passion with your patients. The connections I’ve formed since embracing this new approach have made me more satisfied in my career and more successful in my business.
Jessica Marshall, OD, is the owner of Marshall EyeCare in Aberdeen, N.J.