Otometry In The News - E2
This month's Review of Optometry was the 11th annual retina report. Now this is just my opinion this is about as exciting as a ham sandwich at a steakhouse. The closer we get to the brain and neural function, the less we can do in regards to treatment in my opinion. Additionally, I would rather work with the anterior segment than the posterior. With that being said the information that I found relevant and will apply to my office was limited. The first was in regards to diabetic eyecare. Have you ever asked a diabetic patient what they are seeing you for? Or why we are dilating their eyes? I would say that 7 out of 10 of my patients have no clue or are just doing what their endocrinologist or PCP told them to do. I think in addition to explaining what I am looking for, I could have a handout with the details as well as tips/advice to help maintain their blood sugar levels and hopefully lower their A1c. In that same vein, I send the patient's chart notes to the referring provider/provider responsible for treating their diabetes. I think a simple 1 page summary on top of the notes may be beneficial; a quick resource that gives any pertinent findings, so they do not have to search for the results. Overall, it will hopefully provide better patient care and better communication which hopefully leads to more referrals.
The second piece of information I gathered was from the magazine CE course regarding pregnancy (obviously I got a lot of great posterior segment news from this month). I see many patients that are pregnant or nursing, so I found this very relevant, and directly applicable to what I do. The statistics on refractive change fit what I feel I have observed, but did not actually have the hard data on. They said that 51% of patients will have a change in distance vision by the 2nd trimester and 75% by the 3rd trimester. Only 8% of those patients will still have the change postnatally. The moral of this story is unless a patient NEEDS contacts or glasses in the middle of pregnancy, you should be fine to wait until after the baby is delivered and may have to touch it up postnatally. Just let the patients know the stats and take care of them. As a father of 3 girls under 4 years old, and seeing the changes my wife has gone through, adjusting their glasses/contacts after the fact is the least of a mothers’ worries.
Additionally, I found it interesting that both xiidra and restasis are not recommended during pregnancy, lastacaft is the only approved allergy drop, and for nursing mothers, you should advise the patient not to nurse for 8-12 hours after installation of sodium fluorescein dye. I definitely was not aware of that nugget of fun.
The Power Hour - Wednesday July 8, 2020 -Leverage Technology to enhance patient experience and increase revenue
This was a great episode. It was packed with knowledge and little nuggets you could apply to your office regardless if you have any of these technologies or not. The basis for the episode was as follows: Optometrists have been pinched and squeezed every which way. Reimbursements are being reduced for medical and managed care plans, pillagers are raiding the village and attacking the foundation of the profession (think 1800-contacts, Warby Parker, Zenni, etc.), and we are in the middle of balancing productivity and efficiency with quality of care and patient experience.
The solution that the 4 panel team and Dr. Gerber were offering was to get out of managed care and offer more cash pay options for patients. To make this effective we need to shift the paradigm from having a product to sell and marketing it to finding a group of people that all share a problem and offering solutions to these problems. The options that had me intrigued were the Neurolens and Myopia Management.
Lastly, two other easter eggs hidden in the show were that when analyzing orthodontia to get a gauge on the market for myopia management, orthodontia is a 15 Billion dollar industry while Myopia Management is merely a 400 million dollar market cap, yet there are twice as many myopic patients as there are patients in need of braces. Chew on that for a bit! Throw in all the major players investing money into myopia management strategies (J&J, Coopervision, and Pentacam to name a few) and you’ll see the writing on the wall. Regardless of your technique, WE need to find alternate forms of revenue and these were a glimpse of some really interesting options.
The Myopia Meeting Webinars - How to add myopia management without losing your mind, your staff, or your primary care practice presented by Dr. Gary Gerber
If you enjoy myopia management or are in the process of starting to find out how you can offer this therapy at your practice, this was a pretty straightforward lecture with some practical information. I will summarize the 4 main points I took away and will apply to my office.
We need to understand that Myopia is a disease and blurry vision is a symptom. Let me say that again. Myopia is a disease and blurry vision is a symptom. We are comfortable and well equipped at treating ocular disease such as glaucoma, macular degeneration, dry eye and the like, but we have a slight disconnect when it comes to myopia. Changing our mindset that glasses and contacts lenses with an updated prescription is not enough will serve us and our patients well.
Refer, refer, refer. Hopefully you refer to yourself, but once you see myopia as a disease, a referral to be evaluated for treatment is the logical next step. This logic is extended to the patient's parents as well. If there is an issue, they need to be treated. As a profession we do not bat an eye when it comes to making glaucoma, macular degeneration, or cataract referrals, but when it comes to myopia management our advice is much more muted and tame. “You should consider”, or “please think about getting an evaluation” need to be replaced with “We are making a referral for additional testing and will come up with a gameplan after we have that.” If you do not treat myopia or have the ability to take axial length measurements, refer to someone that does the therapy or talk to your cataract surgeon about getting the measurements done. Just be proactive.
You are going to get pushback. Any therapy or treatment in its infancy is going to be questioned and other healthcare professionals advice will be sought after. Don’t let this deter you, in fact embrace it, and prepare yourself now. Pediatricians, Ophthalmologists, and the patient's own internet resource are the 3 most common opinions a patient will seek out. Be confident in what you know and what you advise, have resources from sources other than yourself and know without pain, the movement cannot grow.
The last bit of advice Dr. Gerber gave in regards to myopia management was do it for real and do not merely dabble in it. If you are one foot in and one foot out, you are going to bail the moment any kind of pushback happens. That does not serve you or the patient's best interest. Invest in the technology, have protocol in place, and keep your patients happy and their eyes healthy for years to come.
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