CLINICAL

  DIVERSIFY YOUR PORTFOLIO

LEARN NEW ‘TRICKS’

WHEN “EARLY” DIAGNOSIS IS REDEFINED, GET ON BOARD

JEFFRY D. GERSON, O.D., F.A.A.O.

MUCH OF optometry is unchanged from decades ago: We are still on a quest for the perfect refraction and contact lens fit, and we remain laser focused on the diagnosis and management of ocular disease. The bar for the latter has been substantially raised, though some of us continue to practice the way we always have. Let me explain.

Not too long ago, high IOP, greater than 21 mm HG, was, on its own, diagnostic for glaucoma. Thanks to research regarding visual field loss and intrepid manufacturers of technology, perimetry has aided in an even earlier diagnosis of the condition and, thus, an improvement in visual outcomes for those patients who have glaucoma. Yet, despite the clinical evidence of perimetry, some in the profession were reluctant to use it, as something “new” made them uncomfortable.

Here, I discuss recent changes in the diagnosis of other conditions that should compel us, as a profession, to replace our diagnostic habits and, thus, improve patient outcomes.

AMD

Dark adaptation is now considered the earliest sign we can use to detect AMD, based on several studies, including one in Investigative Ophthalmology & Visual Science that revealed, “high diagnostic sensitivity and specificity.” As a result, once we identify patients who have dark adaptation defects but without AMD clinical signs or symptoms, we need to be proactive in regard to assessing for further decline, including any initial changes in vision or symptoms.

DRY EYE DISEASE

We can now diagnose this condition via the identification of high osmolarity, tests for the presence of inflammatory markers, blood tests and meibography. Why, then, are some of us pursuing this diagnosis only when patients are overtly symptomatic for the condition? We need to treat these patients earlier.

GLAUCOMA

Today, screening retinal photography, especially with wider than traditional fields of view, can enable us to pick up pathology not otherwise seen. Similarly, assessing OCT images can reveal macular pathology or glaucoma that may have otherwise been missed. OCT can help us find glaucoma in an objective manner before any subjective test can reveal it.

A DISSERVICE

It’s important to note that these tests not only do their job medically, but many are also billable to a patient to supplement revenues. This makes them a “win-win” proposition! So, when we remain stuck in our ways, we are not only potentially hurting patient outcomes, we are also hurting our bottom line. We need to change how we treat our practices, not just our patients, as opportunities present themselves for improvement. OM

DR. GERSON practices at Grin Eyecare in Olathe, Kan., a full-scope combined O.D./M.D. practice. Email him at jgerson@hotmail.com or visit tinyurl.com/OMcomment to comment on this article.