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How to Develop a Retina Niche

Use these strategies to provide patients with prompt management and education

SHERROL A. REYNOLDS, O.D., F.A.A.O., FT. LAUDERDALE, FLA.

An ever-increasing number of patients who have undiagnosed, poorly controlled or risk factors for conditions, such as diabetes and hypertension, that lead to retinal problems, will present to today’s eyecare practitioner. Therefore, optometrists must be properly equipped to provide prompt management and patient education in order to prevent vision loss — and keep patients coming back for care.

Here, I discuss 10 practical strategies to help you develop your retinal niche.

1 Brush up on your skills

Sharpen your evaluation by revisiting some basics skills:

► Employ the Watzke-Allen test for macular hole evaluation and the red-free filter for lesion depth (i.e., choroidal nevus) during slip-lamp evaluation.

► Add to your armamentarium an array of new condensing lenses that provide increased magnification or field of view of the retina.

► Perform a three-mirror retinal evaluation, which provides an excellent view of the peripheral retina (i.e, retinal breaks or tears) and central lens. This evaluation is especially valuable in cases of subtle maculopathies (CME).

► Use scleral indentation (depression) for better assessment of peripheral retinal lesions (i.e., small retinal breaks, cystic tufts or traction).

2 Incorporate ancillary testing

The following can provide vital information and help identify patients who are at risk for retinal problems.

► Blood pressure. This is valuable because early retinal vascular changes may indicate potential cardiovascular risk, particularly risk for stroke.

► In-office point-of-care testing. Blood glucose (CPT code 82947) and hemoglobin AIC (CPT code 83037QW), are CLIA-waived procedures beneficial in diabetic retinal disease management. You may want to offer AMD genetic testing, too.

► Crystalline lens autofluorescence. A non-invasive lens fluorescence biomicroscope can quickly measure this, which is an early indicator of diabetes.

3 Integrate new technology

Achieve better efficiency through technology. Here are options to consider:

► Digital retinal photography aids in diagnosis and management and is an excellent tool for patient education. Some of the newer cameras adapt to your smartphone. Others are available in combination with an OCT system, providing cross-sectional views of retinal layers.

► Spectral-domain optical coherence tomography (SD-OCT) has become must-have technology for practices serious about retinal disease. It provides rapid cross-sectional retinal imaging that leads to early diagnosis, better understanding of retinal disease pathogenesis and monitoring of disease progression, as well as response to therapy.

► Fundus autofluorescence (FAF) detects and tracks changes in the retinal pigment epithelium (RPE) lipofuscin, a metabolic biomarker of disease, such as AMD, or plaquenil therapy. New OCT provides FAF options.

► Macular Pigment Optical Density (MPOD) enables you to identify at-risk patients, as well as gauge the effects of dietary changes and supplementation on retinal health.

► Ultrasound imaging and electrophysiology (electroretinogram-ERG). New generation technology offers high-resolution imaging and precise mapping for a detailed assessment of the health of the retina.

4 Train staff

Staff education is a critical component of building any practice because there aren’t enough hours in the day to do everything on your own. When it comes to retinal emergencies, such as an urgent retinal detachment or tear, staff training is essential so that these patients are seen in a timely manner.

Also, trained and knowledgable staff is paramount when integrating new and pertinent technologies. The staff not only benefits from knowing how to operate the instrument, they also get a better understanding of the retinal disease. For instance, performing Macular Pigment Optical Density (MPOD) testing highlights the importance of nutrition and vitamins in retinal disease management, such as lutein and zeaxanthin for the AMD patient.

Empower staff to answer patient questions or concerns. Not only will it help to provide an exceptional patient experience, it will legitimize you and your practice as experts in retinal disease.

5 Market your practice

Marketing can be expensive, but it’s critical to success. Take advantage of free or low-cost marketing tools to promote your retina niche.

Provide printed materials with education, services offered and your practice information to patients and referring healthcare providers. Use social media and your website to promote your specialty, and send out monthly e-mail blasts about retinal conditions. Not only is it easy, tech-savvy marketing will show your patients how current your practice is.

Also, hold educational seminars or speak to small local groups, such as nursing homes residents, about retinal disease and to promote the importance of diabetic eye examinations.

6 Build a clinical network

Developing a clinical network is vital to managing patients who have retinal disease. Foster an interdisciplinary relationship with referring physicians, as well as local pharmacists, nutritionists, podiatrists and other healthcare providers. This is especially important with diabetic disease management, as the CDC reports that approximately half of U.S. diabetic patients are not getting diabetic retinal screenings.

Shown is a patient with retinal arteriovenous nicking and silver-wiring, an isolated retinal hemorrhage and optic nerve head optociliary shunt vessels in her left eye. A lipid-panel point-of-care test led to a diagnosis of hypercholesterolemia and hypertension in this patient.

Engage with all healthcare providers by supplying educational information about key risk factors for retinal disease, such as smoking, high body mass index, genetics, UV and blue light exposure, diet, lifestyle and nutrition, as well as the services you provide. Be sure to include your practice information for possible referrals.

Establish a relationship with a retinal specialist you can refer patients to obtain timely reports and co-manage your retina patients. Have a trained staff assist in completing the referral paperwork, making the appointments and following-up so that there is no delay in seeing the patient. Patients are more likely to be compliant if there is a relationship of mutual respect, accessibility and partnership between both doctors.

7 Garner referrals

Networking is an excellent way to garner referrals to your practice. Other O.D.s. are excellent sources of referrals, as not all optometrists want to manage retinal cases.

When another doctor refers patients to you, be sure to communicate back to the referring doctor. This helps to build your practice by setting the stage for future referrals. It will also help increase referrals from this doctor of his/her own patients.

Patients are great sources of referral business. When patients are satisfied with your treatment, they are more likely to refer friends and family. Encourage this grassroots marketing by reminding patients to tell others about your practice and the specialty services you provide.

8 Increase access to your practice

Make it easy for patients and referring physicians to make appointments in your office. Some patients, such as those with complaints of “flashes of light” or “spots in their vision,” require an urgent evaluation to rule out a possible retinal detachment. Be sure to allot time on the schedule for these type of visits.

Also, make yourself available to patients and other healthcare providers to address their concerns. This not only improves compliance to follow-up care, it also establishes a strong relationship with your patients. In addition, talking to referring physicians lets them know that you’re skilled, knowledgeable and equipped to provide optimum care to their patients.

9 Provide education

Education is the key to preventing vision loss and building a successful practice. Sight-threatening diagnoses often scare patients, so take time to thoroughly discuss the diagnosis, listen to your patients and address their concerns and questions. Make sure the patient schedules any necessary follow-up appointment immediately after the examination. Provide supplemental printed or online literature about their condition following the examination. And, discuss nutritional supplements and vitamins for patients who have AMD and diabetes and the importance of patient compliance to your directions.

10 Stay up to date

Stay informed about current treatment trends for retinal disease by reading peer-reviewed publications. Also, attend conferences that include CE on retinal disease, and be sure to visit vendor booths to learn about the latest equipment and technologies.

Steps to success

Following these 10 steps will not only help you to build a successful retina niche, it will aid in the proper identification and treatment of retinal problems, and thus, help prevent vision loss for millions of patients. OM

Dr. Reynolds is an associate professor at the Nova Southeastern University College of Optometry. She is the clinical preceptor/attending in the college’s diabetes and macular clinic and a fellow in the Optometric Retinal Society. She serves as the chairperson for the Florida Optometric Association Healthy Eyes Healthy People Committee. Comment online at tinyurl.com/OMcomment.