It’s no secret that time is a precious commodity, particularly in health care where there is no shortage of patients. Optometrists are the primary eye care providers for Americans, putting them at the front line of combating ocular diseases that can lead to vision loss. What’s more, the Centers for Disease Control states the number of Americans with blindness or vision impairment (VI) will double by 2050, reaching 2.01 million Americans with blindness and 6.95 million Americans with VI, and 16.4 million with VI due to uncorrected refractive error.¹ Given these facts, it makes sense for O.D.s to create efficient disease management processes, so they can see and, therefore, help more patients who have ocular conditions.

Here, optometrists who see numerous patients discuss the processes they’ve put in place.

TRIAGING

Leslie O’Dell, O.D., medical director and part owner of Medical Optometry America, in Shrewsbury, Pa., says the practice, which opened its doors close to a year ago, developed best practices in glaucoma, AMD, diabetes, cataract co-management and dry eye disease (DED) and highlights the importance of triaging:

“It all starts with the phone call; knowing exactly what the patient’s needs are, and then we categorize the disease type,” she explains. “Once a patient’s need is established, the exam type will trigger standing orders in the record.”

UTILIZING STAFF

For optometrists to be successful in managing ocular disease in numerous patients, they must off-load as much [of the ancillary operations] as they can to trained technicians, Dr. O’Dell says.

“It is my job to do the exam and interpret the tests,” she emphasizes. “My techs sometimes know more than I do on how to use the technology, and that’s how I think it should be.”

Chris Wroten, O.D., partner at the Bond-Wroten Eye Clinics, in southeast Louisiana, agrees that utilizing staff is crucial when managing many medical eye care patients. “The practice is committed to staff training, utilizing educational programs offered by equipment manufacturers, ongoing webinars, lunch-and-learn sessions and impromptu skill review sessions led by staff,” he explains.

He adds that many members of his staff are certified through the Joint Commission on Allied Health Personnel in Ophthalmology or the American Optometric Association, to ensure accurate patient workups and smooth patient flow.

“With diabetes patients, for example, the technician performing the workup asks about the patient’s A1C level and last blood glucose level, obtains a complete case history, measures VA and confrontation fields, performs autorefraction and subjective refraction, measures IOP and dilates the patient before I even walk into the exam room,” he points out. “Also, staff automatically pre-populate a letter to the primary care physician that contains preliminary findings for their review.”

If there is retinopathy, Dr. Wroten says his staff acquires retinal photos and schedules an appropriate return visit for retinal OCT/OCT-A, if indicated.

When it comes to ocular surface disease, as another example, Dr. Wroten maintains that staff use intake questionnaires, educate patients on related medications and that some staff are even certified to perform in-office procedures for meibomian gland dysfunction (MGD).

He says he believes the reason they are motivated and engaged with patient care is because the practice has invited their input on patient flow processes.

Dr. O’Dell agrees that staff input is crucial to establishing efficient disease-management protocols.

“Starting a practice from scratch, a cold open, is a pretty daunting task,” she shares. “The biggest thing has been continually coaching my staff. We have learned to be flexible because the processes we try for today might not work for tomorrow. We’ve got to pivot and move in a different direction. You need to stay open-minded and flexible and ask for feedback from staff.”

EMPLOYING TECHNOLOGY

Betsy W. Fraser, O.D., of Compass Vision Care, in Mount Pleasant, S.C., says she uses an advanced corneal topographer that contains a built-in keratometer and color camera on DED suspects and patients to facilitate diagnosis and treatment.

“It performs several ocular surface measurements and serves as an educational tool I use with every single patient,” she says.

She says she uses a dry eye report program, as it facilitates her ability to introduce some of the practice’s treatment technology, such as a radio frequency device and an intense pulsed light handpiece.

Dr. Wroten adds that his practice is “heavily invested” in the latest technology for diagnosing, managing and treating ocular disease.

“Without a doubt, OCT has been one of the key technological advances during my career that enables early detection of glaucoma and the monitoring of patients who have diabetic eye disease,” he says. “We also offer radio frequency therapies for MGD as well to reduce periocular fine lines and wrinkles.”

Having the right technology that simplifies the patient workup is very important, Dr. O’Dell says, sharing that her glaucoma suspect workup, for instance, entails corneal pachymetry, corneal hysteresis and applanation tonometry, which obtains serial tonometry and outflow measurements.

“A retina camera that is super easy to use, for example, and an OCT system that takes a high-resolution, quality image without too much patient manipulation keeps the patient flow moving,” she explains.

EDUCATING PATIENTS

Patient knowledge of the severity of their diagnosis and the benefit of specific treatment(s) facilitates and, therefore, maximizes ocular disease management, notes Dr. O’Dell.

“The technicians are educating, and I’m educating through imaging,” she says. “I want to show the patient how complicated the eye is and, as a result, why it’s so important they adhere to the treatment and follow-up intervals that are recommended.”

As an example, she says her staff surveys all patients regarding possible DED symptoms, regardless of the reason for the visit, and that she has a standing order for point-of-care testing. Additionally, Dr. O’Dell says her practice has a unique treatment suite and consult room for DED where the focus is on educating the patient.

“We spend a lot of time educating them about the homeostasis of the tear film and the treatments that we offer,” she explains.

FOUR CRUCIAL FACTORS

It’s clear the discussed four factors allow for practices to efficiently and successfully identify and manage ocular disease, enabling these optometrists to see and, therefore, help more patients stave off vision impairment. OM

REFERENCES

1. Centers for Disease Control and Prevention. The Burden of Vision Loss. June 12, 2020. https://www.cdc.gov/visionhealth/risk/burden.htm Accessed Oct. 4, 2021.