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Prepare patients for cataract surgery

Three practices describe how they take the opportunity to educate at each encounter.

An educated patient leads to informed health decisions that elevate health care and increase patient satisfaction. The pre-operative process of cataract surgery presents several educational opportunities.

Here, three surgical practices of varying sizes share their tips on how they effectively prepare their patients for cataract surgery.

Before the patient arrives

A recurring theme of all three practices is the importance of patient pre-education, i.e. education before the pre-op consult.

“The education process begins when patients schedule their consultation,” says Lauren Dunford, practice administrator at Collins Vision in Fort Myers, FL. Collins Vision is a two-location practice that has one cataract surgeon, Michael J. Collins, MD.

Prior to the pre-op visit, the practices relay educational information about cataracts and cataract surgery via mail or e-mail. The practices tell patients that they are getting “homework.”

Additionally, the surgeon encourages referring optometrists to educate their patients on the pre-op process at the time of referral.

“Patients from an outside referral are quickly briefed over the phone on what to expect at the evaluation to limit surprises and lower patient anxiety,” says Corinna Aviles, director of surgical administration at Horizon Eye Specialists and LASIK Center (Horizon Eye). Horizon Eye is a multi-location practice that has four cataract surgeons, Robert R. McCulloch, MD, Jonathan J. Levin, MD, Angela Herro Kovacik, MD, and Joshua K. Duncan, DO.

EYES, the ophthalmology practice of Mamdouh Zeini, MD, in The Villages, FL, requires patients to attend a cataract seminar prior to the pre-op visit.

Dr. Zeini hosts the comprehensive two-hour seminar to educate on all aspects of cataract surgery, such as pre-op and post-op eyedrops, IOLs, expectations, and surgical equipment along with a cataract surgery video. He concludes with a question-and-answer session to address any patients’ questions.

At Collins Vision, two days prior to the pre-op visit, a surgery counselor contacts the patient to explain their role as the patient’s advocate and to set expectations, says Ms. Dunford.

Pre-op visit

Horizon Eye also utilizes surgery counselors. Its counselors meet with cataract patients for a three- to five-minute “pre-counseling” prior to testing and their pre-op visit with the surgeon. “We strive for our patients to be familiar with the lens options by the time they meet with the surgeon,” says Ms. Aviles.

The surgery counselors dispense a simple brochure, which includes types of IOLs, that patients are encouraged to read. Pre-counseling also covers surgical fees and insurance.

Expectations after surgery

All three practices interviewed stressed the importance of the surgeon’s role in setting realistic patient expectations.

Michael J. Collins, MD, proactively discusses the potential results after surgery during the consultation, says Lauren Dunford of Collins Vision.

At EYES, patient expectations are initially set at a seminar through a detailed presentation and individually reviewed by the technician and Mamdouh Zeini, MD, during pre-op visits.

Pre-counseling allows the patient to recognize the types of IOLs by the time the surgeon enters the exam room. This “prevents patients from feeling overwhelmed and gets them ready to talk with the surgeon about their lens options,” says Ms. Aviles.

The surgery counselors also meet with the patients again at the conclusion of the patient’s pre-op visit. During this 30-to-45-minute interaction, they review the surgeon’s recommendations and educate patients on surgery preparation.

“The surgery counselor is their point person,” says Ms. Aviles. “The patient leaves with the counselor’s direct phone line for any future questions or concerns. The patient never feels like their opportunity for questions or education is over.”

Pre-op testing at Horizon Eye includes a manifest refraction for BCVA, eye dominancy, degree of lens opacity to confirm correlation with acuity, optical coherence biometry, topography, immersion A-scan biometry, and dilation. Testing presents an opportunity to educate the patient. For example, to explain the purpose of biometry, technicians at Horizon Eye say: “This is technology that helps the doctor calculate the dimension of your eye for accuracy,” Ms. Aviles says. “We use ‘accuracy’ quite a lot.”

Pre-op visit education at Collins Vision takes the form of reviewing a packet of information. “We prepare the patient during their pre-op appointment by reviewing a ‘Preparing for Your Surgery’ packet. This includes pre- and post-op instructions, a map, and consent forms,” Ms. Dunford says.

The surgery counselor also reviews all aspects of cataract surgery to prepare the patient.

Time with the doctor is valuable at this encounter as well. (See “Expectations after surgery,” page 18.)

“At their consultation, Dr. Collins takes an active role in educating the patient, discussing his or her expectations after surgery and explaining the reason for his top lens recommendation based on the health of their eyes and lifestyle,” says Ms. Dunford.

Collins Vision pre-op testing includes optical coherence biometry (Lenstar, Haag-Streit), endothelial cell count (ECC), OCT of the macula, and corneal topography.

“Patients really enjoy learning about how the tests impact their surgery,” says Ms. Dunford. “The patients find the ECC to be one of the most interesting tests, since they view such a magnified image of their cornea on the screen. The corneal topography also gives them a great visual to help illustrate the cloudiness and density of their cataract.”

Simple explanations with images are key for effective patient education during pre-op testing.

At EYES, a technician obtains measurements on patients using optical coherence biometry (IOLMaster, Zeiss), corneal topography, autorefraction, and applanation A-scan biometry. To explain the various tests, the technician says, “We are going to perform tests that the doctor uses to calculate your proper lens power. These tests only take a few minutes, and we may have to redo a test a few times,” says Barbara Cardelli, COE, practice administrator at EYES.

Industry representatives can provide training on what to say as well, she adds.

Phone calls before and after surgery

Pre- and post-op calls are other opportunities for education. For example, the surgery counselor at Collins Vision calls the patient the day before surgery to review aspects of the surgery and answer any questions, says Ms. Dunford.

At Horizon Eye, surgery counselors handle all post-op phone calls from patients, sometimes two weeks after surgery, to review eyedrops. (See “Education on eyedrops.”)

“Our surgery counselors really build a nice rapport with patients,” says Ms. Aviles.

Education on eyedrops

Both EYES and Horizon Eye dispense an instructional sheet for the instillation of three post-op eyedrops (antibiotic, steroid, and NSAID). The technician or surgery counselor and the doctor verbally review the instruction sheet and medications with the patient, say Barbara Cardelli, COE, and Corinna Aviles, respectively.

Patient compliance increases with visuals. Therefore, EYES instructs patients to bring their prescribed eyedrops to the final visit prior to surgery, at which time the surgeon and the technician “review all ‘bottles in hand’ with the patient,” says Ms. Cardelli.

Schedule for education

Lastly, one cannot discuss proper education of patients without discussing how practices allot clinic time for education.

EYE provides these seminars in a single two-hour session every other week. The idea for the seminars specifically came from a time study, which revealed that the doctor spent about 15 minutes explaining cataract surgery with each patient, says Ms. Cardelli. Additionally, the practice schedules pre-op testing on the weekday that their doctor is in surgery to utilize that time to be productive.

Horizon Eye is able to schedule cataract evaluations on any day that a doctor is in clinic because of its large staff.

“We are mindful of the doctor’s extra time needed with each patient during the consultation. So, we space out these longer appointments for the doctor,” says Ms. Aviles.

Collins Vision prefers a one-hour appointment slot for each evaluation.

“Having a designated pre-op technician allows our office to offer flexible appointment times throughout the week without it impacting our clinic schedule,” says Ms. Dunford.

Educate at every encounter

Each encounter with a patient offers an opportunity to educate. Verbal communication by each member of the health-care team is paramount in preparing a patient for cataract surgery. OP