Advancements in both diagnostic and surgical technology allow ophthalmic professionals and ophthalmologists to diagnose and treat things we only dreamed about in 2000, when candidacy for LASIK was mainly determined by refraction, topography, and ultrasound pachymetry and many received the same correction. However, the basics still apply to create an experience that is both beneficial for both the patient and the practice.
In this article, I will share some tips on how I approach preop refractive surgery visits.
Triage initial patient encounter
It is often challenging to get patients to visit for refractive surgery evaluations. Some practices bring every patient in for a 2-hour dilated exam on the first visit, without ever knowing anything about the patient and their candidacy. Other practices offer free screenings as a way to incentivize the patient to visit.
I encourage practices to offer both approaches. Reason being: It eliminates the potential roadblock of an arduous paid 2-hour exam and also provides the consumer with options.
When patients call for an appointment, your staff can use language like: “If you already know you are a candidate and are ready to have your procedure in the next 30 days, we can go ahead and bring you in for your full evaluation. If you don’t know if you are a candidate or would like to find out more information, we can bring you in for our complimentary ocular analysis. What day is good for you?”
As competition and cost-per-lead increase, the ultimate goal is to get the patient to visit your practice. Once there, it is important to create an environment that tells patients that your practice is THE practice to have their refractive surgery.
Utilize diagnostic devices
During a free screening, keep things simple. Educate patients that there are three main factors that make someone a candidate for refractive surgery: prescription, shape, and thickness. Today, we can use tools to find out this information quickly and comfortably. For example, during the screening visit, I use a wavefront aberrometer and a Scheimpflug analyzer.
The OPD-III Scan (Marco) is a wavefront aberrometer that provides refraction and topography results to a technician early on in the process. It also provides pupil size in various lighting conditions and gives the provider a retroillumination image. Using it, technicians can often see if a patient has a cataract (especially posterior subcapsular and cortical cataracts), in which case I would immediately change the course of screening. While I’m gathering two of the most important pieces of information, I’m also gathering secondary information that is important. Namely, I also like to use the placido rings to help identify irregularity from dry eye disease or scarring, where the mires will be distorted or spread out (see Figure). When that is the case, I take the patient to the slit lamp. Other wavefront aberrometers are available from companies such as Luneau Technology USA, Topcon, Tracey Technologies and Vmax Vision.
Scheimpflug analyzers (Pentacam, [Oculus] and Galilei [Ziemer Ophthalmic Systems]) give allied health professionals a wealth of information regarding the cornea. Besides the basic topography, they provide pachymetry readings and useful analysis tools for screening for conditions such as keratoconus and ectasia risk.
So, after two diagnostic tools, what information do I have at my disposal? I have, among others, refraction, pupil size, placido rings, topography/tomography, pachymetry, retroillumination, posterior cornea analysis, and angle kappa. I can now give this information to the provider, who uses it to determine candidacy with a very high degree of certainty without the patient ever having to go through a complete dilated exam.
Many other diagnostic devices are at our disposal. Devices such as the iTrace (Tracey Technologies) and HD Analyzer (Visiometrics) provide information on light scatter of the lens. These devices assign numerical values to determine how the crystalline lens is affecting the patient’s vision. Advanced OCT imaging, such as the Cirrus 500 (Zeiss), and Optovue, of both the cornea and retina provide access to information such as epithelial mapping, corneal opacities, and macular pathology. Advanced biometry devices, such as the IOL Master 700 (Zeiss) and the Lenstar (Haag-Streit), help providers to choose the proper IOL for the patient.
All of these measurements and images are important in considering candidates for refractive surgery. It comes down to practice preference with regards to whether the capital investment is worth it.
Provide patient education
As I perform these diagnostics, I explain what the test does and use the information to my advantage when counseling the patient.
For instance, when the patient has astigmatism, we don’t just tell them — we show them. Using a model toric IOL and the corneal topography to show how the toric IOL would line up with the axis of the astigmatism can sometimes be helpful. Topography shows the patient, with some guidance, if his astigmatism is normally distributed or is skewed. This is especially helpful in educating patients on the benefit of topography-guided LASIK. I use an hourglass analogy and show the patient he has more sand in one part of the hourglass than the other.
This diagnostic information is essential to efficient patient education, as it’s best to avoid educating patients on procedures or technologies that they either don’t need or for which they are not a candidate. For instance, I recently witnessed a technician educating a patient about a toric IOL because there was astigmatism in the patient’s prescription. The patient was ready to have a toric IOL but then found out that he had very little corneal astigmatism and therefore did not require a toric IOL. The technician spent a lot of time pulling out model lenses and using an infographic when the time could have been spent educating the patient on other options. The patient was confused because he thought he had astigmatism and did not understand anything about lenticular astigmatism. By the time the surgeon saw the patient, he was thoroughly confused and did not schedule any treatment at that time.
For this reason, among others such as efficient patient flow, we allow the surgeon to review patient information and determine what technology/procedures the patient should be educated on. From here, we can then provide advanced education, via custom videos on tools such as Rendia or Sight Selector. These tools allow for custom playlists so that you educate patients specifically on their refractive needs instead of showing a generic video.
At this juncture I say to the patient: “Dr. Smith has reviewed your information, and he would like for us to show you these videos so you have a better understanding of your vision and what your options are. He will review this with you in a few moments.” This lets the patient know that Dr. Smith has already reviewed his information, therefore instilling confidence. Also, these videos give the patients an idea of what the surgeon is talking about once she comes in to discuss options, instead of the surgeon being the one to introduce the technology.
Grow refractive surgery volume
With so many options in both diagnostic and surgical technology, there has never been a better time to be a refractive surgery patient or a refractive surgery practice. Make 2020 the perfect year to shape up your patient experience and grow your refractive surgery volume. OP