Article

Opening Lines

The art of networking

What networking looks like, where and how to do so

By Lauren Levine

Nine years ago, Jane Shuman invited me to a Florida Society of Ophthalmic Administrators (FSOA) meeting in Tampa. I had returned to the industry and she thought it would be good for me to attend. Jane and I were catching up and she said to me: “Sherri Boston lives in Tampa. You know her, right?” Before I knew it, there was Sherri, whom I hadn’t seen in 15 years. Sherri was the Eye Care Business Advisor for Allergan and involved with the FSOA. She brought me to a meeting a few weeks later.

Here is what networking looks like. There are over 100 individuals that belong to the FSOA. They have a common goal, operate independently, but are willing to share their knowledge and experience with each other. How do you reward your staff? Who do you use for HIPAA training? Which EMR system has the best customer support? It’s a great free resource.

Where to network

Networking can occur in multiple spaces and is not limited to administrators. If you are a technician, programs that offer continuing education credits (think IJCAHPO) are wonderful opportunities for you to network. Many state societies also offer these programs as well as local and regional meetings. These are all opportunities to make connections that might help you solve common problems and become resources.

In the age of social media, networking has become easier than ever. It’s like free marketing of yourself! I ran into a friend at an AAO meeting who was looking for a job. I had seen another industry buddy who worked for an executive search firm. I had them meet at my booth, took a picture of them talking, and tweeted it. All day long my friend kept getting stopped. “I heard you were looking for a job.” Magic.

How to network

Start a conversation. At continuing education seminars, industry meetings and other face-to-face spaces, start talking to people. Ask questions: “What do you do?” “Where do you work?” “What brought you here?” If they share something that you would like to know more about ask an open-ended question, such as “Tell me about that.” People love talking about themselves.

Sit somewhere new. Another tip for in-person networking is to sit next to someone you don’t know and strike up a conversation. Think about what you are good at and share that knowledge and they will do the same for you.

Participate in social media. Once you’re a member of a social media group, ask questions, provide answers, if you have them, and share anything you feel is pertinent to others, including articles and industry happenings. Share, like, retweet etc.; it will get you noticed!

Don’t forget the basics

Networking is all about connecting in a social way, but you also need to be professional. Make sure to get enough information so you can reach out to the person you met (I find email works best), remind them of where you met, what the conversation was and why you are reaching out (even if just to say you enjoyed meeting them). Fulfill any promises or suggestions you may have made in the moment. Most important — don’t forget to pay it forward!

In Brief

Optovue introduced its NetVue Cloud image management software. NetVue provides access to patient images and data without the need for device-specific applications. Images can be viewed from any device and any web browser.

Novartis’ BEOVU (brolucizumab-dbll) received FDA approval for the treatment of wet age-related macular degeneration. BEOVU’s approval is based on results from the Phase III HAWK and HARRIER studies in which BEOVU demonstrated non-inferiority in average change in best-corrected visual acuity from baseline to week 48.

Johnson & Johnson Vision introduced three innovations. TECNIS Simplicity Delivery System, now FDA-approved, is a preloaded, disposable IOL delivery system. The FDA approved the use of wavefront-guided PRK for the iDESIGN Refractive Studio. Also, J&J Vision’s CHiME Manage is a smart inventory management system intended to streamline ordering, provide actionable reporting, reduce human picking errors, and assist in expiration management.

Optos launched Silverstone, which combines ultra-widefield retinal imaging with integrated, image-guided, swept source OCT. Silverstone produces a 200° single-capture optomap image with guided OCT to aid in the detection and monitoring of retinal disease.

The AAO and Verana Health are facilitating no-cost genetic testing and counseling for patients with certain inherited retinal diseases through Verana Trial Connect, a cloud-based application that facilitates physician and patient awareness of clinical trial opportunities. This application leverages information found in the AAO’s IRIS Registry.

Norlase announced the FDA 510(k) regulatory clearance and launch of LEAF, the company’s laser product for the treatment of retina and glaucoma disease. The laser unit attaches to an existing slit lamp, eliminating the need for a cart or counter space to house the laser console.

How ocular surgery impacts dry eye disease

Marjan Farid, MD, answers questions, posed by OP editors, on the role allied health professionals can play in identifying and educating patients on dry eye disease.

Ophthalmic Professional: Please explain what effects dry eye disease (DED) can have on surgical outcomes.

Marjan Farid, MD: Ocular surface disease (OSD) or DED is being shown to have a significant impact on surgical preoperative measurements and biometry as well as postoperative outcomes, specifically on patient satisfaction after surgery.

Epitropoulos et al. showed that biometry on patients with DED, as defined by hyperosmolarity, had significantly higher variability of their average keratometry compared to normal eyes.1 Two biometry measurements done 3 weeks apart showed a higher likelihood for having a significant variability of >0.5 diopter change in the predicted IOL power of dry eye patients as compared to normal eyes. That degree of variability is actually is huge in the world of cataract and refractive surgery where precise outcomes are what patients expect — especially with premium IOL technology.

When there is an unstable tear film and a rapid tear break up time (TBUT), it translates into higher order aberrations and irregular astigmatism. We often pick this up on topography, which most cataract surgeons will obtain preoperatively to look at the corneal surface and astigmatism. Irregularity in placido disk Meyer’s rings, part of anterior corneal evaluation, can provide a red flag when there is OSD. This provides a signal that you can’t rely on the topographical measurements or biometry needed for cataract surgery.

OP: How can a technician help to educate patients about DED?

Dr. Farid: Research from Bill Trattler, MD, and others, has shown, about 2/3 of patients who come in for cataract surgery don’t necessarily know they have DED.2,3 And asymptomatic dry eye patients turn into to symptomatic dry eye patients if we don’t address it preoperatively.

It’s critical to catch those asymptomatic dry eye patients both from the standpoint of making sure patient expectations are set up correctly and to make sure we have correct biometry and preoperative measurements, which is where the staff comes in. The entire office staff, from front desk all the way to the technician, optometrists, and the physician should align on the message that is given to the patients, which is that this condition needs to be treated aggressively prior to surgical planning. Getting everyone in the office aligned to identify early signs of OSD is critical so that appropriate diagnostics are performed before the physician walks into the exam room. This will also ensure efficiency of the work flow.

OP: How do you communicate DED to patients?

Dr. Farid: One thing I always tell my patients: “Cataract surgery is going to make your dry eyes worse. If you don’t feel you have dry eyes, your eyes will feel dry after surgery. The more we optimize your tear film, the better you’ll feel afterwards.” This explains to patients that the outcome of refractive surgery is at least partly contingent on a healthy tear film.

I will then show them their positive test results that indicate they have DED. A picture is worth a thousand words and the value in meibography and objective testing is to show the patient you are basing this on something real. I’ll even sometimes take a picture of the ocular surface after vital dye staining and show them the punctate “spots” that are impacting their vision. I’ll say: “Look at all those dots or spots on the ocular surface, that’s an indication that you have an unstable tear film. We’ve got to work on clearing those before we get you back for preoperative measurements. I want to do cataract surgery, that’s definitely something we’re moving towards, but we have to stop for a minute and make sure your ocular surface tear film is optimized before we proceed to surgery.” Most patients will really appreciate that we have taken the time to diagnose and address OSD.

OP: What role does staff play in the post-surgery discussion?

Dr. Farid: No matter how much you educate patients preoperatively, they will likely not remember half of what you told them post-operatively.

I always make sure to say, either myself or via the staff: “We still need to continue with your dry eye treatment regimen even after cataract surgery.”

Whether it’s the preservative-free artificial tears and lubricants or the topical anti-inflammatories, they are told that they still need to be continued post-surgery. “Cataract surgery does not cure your DED,” I’ll say.

Sometimes, if they have a premium IOL, I’ll explain to them, “We put a Ferrari in the eye. We have to make sure we take it to the shop, take care of it, to keep it shiny every day.” All that translates to a good ocular surface treatment plan.

OP: What steps can allied health professionals take to be on the lookout for OSD pre-surgery?

Dr. Farid: It starts with just a simple questionnaire or, what we have, is our technicians ask three questions:

  1. Do you have symptoms of dry eye?
  2. Do you experience ocular fatigue at the end of the day, perhaps in the form of fluctuating vision?
  3. Do you use artificial tears more than three to four times per day?

In those three questions, if there is a “yes,” it’s usually indicative that we need to delve a little further.

From there, allied health professionals might have a protocol triggered for the exam to look at: tear film staining, TBUT, and meibomian gland disease (MGD). Other diagnostic tests are certainly helpful, but not essential. Those include tear film inflammatory markers (ie MMP-9), tear film osmolarity and meibography. Usually, I’ll have a technician perform meibography on patients who are positive in the screening.

OP: What protocols, if any, need to be managed if DED is diagnosed in a pre-surgical patient?

Dr. Farid: Treat aggressively and have a multifaceted approach.

I usually put patients on a low-dose steroid to get a rapid improvement on inflammation or something like lifitegrast, which has a rapid onset of action, to get the inflammation settled down.

I will also start them on aggressive lid therapies, hot compresses, and lid hygiene. But, I also offer them thermal pulsation in the pre-operative setting, to see if we can get those oil glands flowing and healthier, when applicable. And then, if they have a lot of punctate keratitis, I also try to do something to heal quickly. This may be a self-retaining amniotic membrane, in severe cases, or autologous serum if we can get that to them quickly so that they can get some healing nutrition onto the ocular surface.

OP: What’s the timeline for this protocol?

Dr. Farid: Usually in four to six weeks I want to see them back. At that point if their tear film looks better, their topography looks stabile and healthy, then I’ll do pre-op measurements. If it’s 50% better, I may go an additional month. At this appointment, surgery is usually scheduled. The date could be six to eight weeks out, if more time is needed in the interim to optimize their tear film and get better measurements.

Usually when we are pretty aggressive up-front, we can make a lot of progress quickly. The patients appreciate the doctor for that, and we get better outcomes.

OP: Do you change the treatment post-surgery from that aggressive approach?

Dr. Farid: There is the immediate period post-operatively, in the first month or two where the ocular surface is exposed to preserved postoperative drops. I’m actually still pretty aggressive during that time. Then, we go into a maintenance regimen.

I make sure to talk about DED every time I see the patient post-operatively. If patients go back to their referring doctor, who is in my network, they also know to keep the patients on their anti-inflammatory medications, to keep up with good lid hygiene and care, whether that means coming in for annual thermal pulsation or preservative-free tears, punctal plugs — whatever is that patient’s particular cocktail of management tools, we’ll continue that. OP

References

  1. Epitropoulos AT, Matossian C, Berdy GJ, Malhorta RP, Potvin R. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41:1672-1677.
  2. Trattler WB, Majmudar PA, Donnenfeld ED, et al. The Prospective Heath Assessment of Cataract Patients’ Ocular Surface (PHACO) study: The Effect of Dry Eye. Clin Ophthalmology. 2017;11:1423-1430.
  3. Gupta PK, Drinkwater OJ, VanDusen KW, Brissette AR, Starr CE. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. J Cataract Refract Surg. 2018;44:1090-1096.