glaucoma

Add Glaucoma to Your Practice

There’s no time like the present to create a successful glaucoma practice. Here’s how.

Chuck Aldridge, O.D., BURNSVILLE, N.C.

Because everyone is at risk for glaucoma, with senior citizens at highest risk — an ever-growing population, mind you — and providing glaucoma care can increase your practice revenue, there’s no time like the present to create a glaucoma practice.

Here, I discuss how you can accomplish this.

Ground yourself in glaucoma.

To start, attend conferences and meetings on the condition, so you’re up to date on the latest diagnostic methods and devices as well as treatments and surgical interventions. (Although, you won’t be performing glaucoma surgery, you will have to refer patients for surgery, so you want to be able to educate them about the available surgical options.)

In addition to the various optometry meetings, I always try to attend the Yale Glaucoma Symposium in Orange, Conn., the Duke Glaucoma Symposium, in Durham, N.C., and the Bascom Palmer Eye Institute Glaucoma Meeting, in Miami, Fla. These East Coast meetings provide a broad education on the course of the disease along with the latest treatment and device advances. I make a point of networking at these meetings to determine who’s excelling in certain surgeries, so I have that information to help patients.

Further, I have attended various pharmaceutical roundtables and webinars to find out about the latest treatments. I highly recommend attending a bunch of these, which are conducted by various pharmaceutical manufacturers, so you can objectively decide which treatment(s) you’d like to offer.

To find glaucoma meetings, pharmaceutical roundtables and webinars, ask colleagues, conduct an Internet search, and call the various pharmaceutical companies that currently offer glaucoma medications.

Get out there.

Now that you’re up to date on all that is glaucoma, it’s time to attract patients who may have it. As glaucoma is predominantly a disease of the senior population, carry out an Internet search for local senior citizen centers and assisted-living/retirement facilities, write and/or call their managers to tell them about your background, the dangers of glaucoma, and ask whether you can schedule a talk or screening with their members. (A caveat: A screening should be comprised of examining the back of the eye, not just acquiring IOP measurements, as we now know that high IOP is not definitive for glaucoma.)

Also, conduct an Internet search for primary care physicians in your area, especially those known for geriatric care, and send them a letter that illustrates your skills in primary eye care, your desire to work with them in helping their patients and your CV.

In addition to garnering potential glaucoma patients, you’ll likely further grow your medical practice by picking up age-related macular degeneration, cataract and dry eye disease patients, as your O.D. hat is now in the referral ring.

Obtain the equipment.

To effectively diagnose and manage glaucoma, you need the following:

► Slit lamp and slit lamp lenses. These enable you to qualitatively evaluate the optic nerve’s health.

► Gonio lenses. Allowing you to look into the trabeculum and angle, these lenses aid in determining whether the patient has the potential for acute angle-closure glaucoma.

► Digital fundus camera. This is a must as a screening tool, documentation device and patient education aid, due to the fine color detail of its acquired images.

► Tonometer. Regardless of tonometer type (see “Alternative IOP Measurements,” www.optometricmanagement.com/articleviewer.aspx?articleID=107457), consistency, in terms of both method and device, is essential to render an accurate IOP measurement.

► Perimetry. Aiding you in early diagnosis, due to its mapping of decreased and defective vision in the visual field’s periphery, perimetry enables fast intervention.

► Corneal pachymetry. A thin cornea has been shown to be correlated to an increase in glaucoma progression risk.

► Optical Coherence Tomography (OCT). By virtue of its ability to provide high-resolution, cross-sectional and 3D images of the retina and anterior segment, this device provides a quantitative evaluation of the optic nerve’s health.

► Visual Evoked Potential (VEP). The NOVA-VEP Vision Testing System (Diopsys, Inc.) shows the integrity of the optic nerve pathways from the eye back to the brain. Since early glaucoma changes can exist outside the eye along this pathway, the information provided by this test could prove useful in making diagnostic decisions in early glaucoma.

To determine which brand is best in each of the aforementioned categories, sans the VEP, “test drive” equipment at trade shows and conferences, and talk with your colleagues about the equipment they use. Ask, “Why did you get it,?” “How’s the service for it?”, “What don’t you like about it?” and “If you could do it again, would you buy a different one?” The answers to these questions will guide your decisions.

In terms of “when” to buy, no cut and dry answer exists. For instance, one’s amount of retinal disease patients dictates buying a digital fundus camera and OCT, but that’s relative to each practice and based on variables, such as disease type and state-by-state reimbursement. I will say this: Some doctors have told me they’ve chosen to put off purchasing an OCT because the reimbursements have declined too much to justify its purchase. My response to this is that reimbursement hasn’t reached zero, and OCT is not exclusively for glaucoma (see above with retinal disease patient). In addition, ask yourself this question: If it were your eyes, would you want the ability to undergo OCT? I’ve found that if you do the right thing for the right reasons, the rest will take care of itself.

Learn the codes.

The Optometric Glaucoma Society (www.optometricglaucomasociety.org), of which I’m a member, along with other professional groups, optometric meetings, trade shows, practice management consultants, related journals and trade magazines are all excellent sources for the latest glaucoma codes. Simply perform an Internet search, fact-check with colleagues, and you’re set.

Delegate to staff.

Delegation to a well-trained staff is essential when adding any new service to one’s practice. After all, without delegating certain tasks you wouldn’t have time to manage a new patient population. When adding glaucoma, train staff on tonometry, OCT and patient education regarding their condition and medication (why and how to use it and dosage). It’s our job to interpret the results of the devices and form a management plan based on that interpretation.

In my practice, staff performs diagnostic testing while I’m out of the office conducting a lecture, etc. They have been successful in blocking out a session of time for several of these patients. The key to their success: They don’t dictate when the patient can present for testing. Instead, they work with the individual patients to determine a time that works best for them. We’ve found that forcing specific times on patients is the quickest way to get a lack of compliance to follow-up appointments. When I return to the practice, I evaluate the diagnostic results and see the patient for a short visit on the findings and my management plan.

Delegating these actions not only saves me time while producing practice profits, it also precludes the patient from having to wait to see me on the same day of their testing, which they’ve said they appreciate.

Why wait?

While glaucoma primarily affects senior citizens, it does not discriminate. Therefore, we, as primary eyecare providers, must be prepared to diagnose and manage it, in addition to providing stellar vision care. Given our skills, we are in an excellent position to do this. OM

Dr. Aldridge is a member of the Optometric Glaucoma Society. He is in private practice in Burnsville, N.C., where he sees a great deal of glaucoma patients. E-mail him at ccaldridge@yahoo.com, or e-mail comments to optometricmanagement@gmail.com.