Tools for Patients’ Education

BY DARRELL E. WHITE, MD

Educate cataract patients before they even arrive at your office for the examination.

Cataract surgery is one of the most successful surgeries in all of medicine. It also enjoys a very low

complication rate. With the aging population in this country, most patients know someone who has undergone the procedure. In addition, the newest IOL technology offers patients the possibility of excellent

vision at all distances without glasses. Efficiently and effectively educating patients on cataracts and the options for IOLs, however, can still be a challenge. In my practice, we have found that an effective patient education plan starts as soon as the individual contacts our office. The plan provides patients with ample opportunity to familiarize themselves with their pathology and the treatment

options before they have any decisions to make.

PATIENTS’ EDUCATION STARTS EARLY

When a patient makes an appointment with our office, whether he or she was referred by an optometrist,

a patient who is a friend or family member, or is following up from a previous experience in our office, the front office staff member always asks for certain demographic information including age and e-mail address. For the 50% to 60% of patients from whom we are able to obtain an e-mail address, we send them an introductory message before they come in for their appointment. For patients in the cataract demographic, the e-mail message they receive includes information about our office and links to interactive educational software (ECHO, Eyemaginations, Inc.) about the pathophysiology of cataracts as well as an introduction to premium lens options for the patient to view.

When the patient arrives at the office, the file is “flagged” to identify him or her as a cataract patient. A technician escorts the individual into the examination area, takes the history, and begins a diagnostic evaluation.  If it is clear that the patient has a cataract, his or her visual function is measured in several different ways including tests to determine the level of astigmatism. While the patient is waiting for the dilating drops to take effect, the staff has him or her watch a simple video of me explaining the cataract process, what the experience is like, and informing him or her about lens options. I emphasize that all of the implants are good options and he or she will see well with each of them. Then, I outline the differences between what we call the basic high-tech implant, the advanced distance high-tech implant (a toric IOL), and the advanced distance and near implant (a presbyopia correcting IOL). During the dilation, the staff will also play educational videos on the Eyemaginations LUMA platform in the examination rooms to reinforce the information that the patient has already received.

PRE-EXAMINATION BY THE OPTOMETRIST                     

Once the patient is dilated, an optometrist performs the pre-examination to determine whether or not the patient can be corrected with spectacles and also evaluates the cataract’s size and severity. The optometrist expands on the information provided in the educational video, reintroduces the concept of choice, and alerts the patient to whether or not all three options are available. For example, we know that if the patient has macular degeneration, a presbyopia-correcting IOL is likely not an option. The optometrist also encourages patients to fill out a lifestyle survey and dives a little deeper into their visual life: how do they use their eyes, what activities do they participate in, and what is most important to them. The goal is to find out what will make patients the happiest.

SURGEON’S ROLE

This is the point at which I come in, confirm the diagnosis, determine whether the patient is a surgical candidate, and answer any questions. After I review the IOL options, I ask the patient to make a choice regarding which implant he or she would like to receive.

Nationwide, approximately 9% of cataract patients choose a premium IOL, according to Market Scope. Our conversion rate was consistently 22% until about 3 years ago when we made two distinct changes. First, I created the video that we have all cataract patients watch while their eyes are dilating. Second, we started e-mailing all possible cataract candidates the ECHO educational software about cataracts and the premium lens options. Since we have implemented those two strategies, the percentage of patients that choose premium IOLs has increased to 35% and has remained at this figure for the last 2 to 3 years. 

Our patients’ experience has always been centered on trying to access their learning strategies in as many different ways as we can. We interact with them verbally, we provide printed material, and because we know many people are visual learners, we offer interactive media as well.

TIMING OF EDUCATION

In addition to the specific materials, timing is a very important element of patients’ education. The first time

patients hear that they have a cataract, they are not really able to pay attention to anything else. Although they may have friends or family members who have undergone successful procedures, they are still trying to mentally digest the diagnosis. By our office sending an email and starting their educational process at home before they ever come into the office, we have moved that emotional reaction upstream from the decision point.  When I meet with cataract patients in the examination room, they have accepted their diagnosis, they have been educated on the disease’s pathology and the surgical procedure, and I am able to answer any remaining questions.  I can then help them decide which IOL is right for them. I spend less time explaining what a cataract is and more time discussing what constitutes their visual life, what things are important to them, and how they use their eyes. I believe that my patients now are more comfortable with the decisions they make.

It is very frustrating for physicians and patients when a  patient chooses a standard IOL and then has “non-buyer’s remorse”—they wish they did not have to wear reading glasses, for instance. Today, that does not happen as often as it did previously because patients have been presented with the information on the IOL options several times before they are required to make a final decision.

CONCLUSION

After discounting the first 2 years of explosive growth in the practice, we have consistently grown 8% to 11% each year with no external marketing and a very small, dedicated base of referring optometrists. Although it is difficult to measure exactly, our best guess is that our growth has come from referrals from satisfied patients: we simply encourage our patients to send their friends, family, and colleagues to our practice. I believe a large part of our success is that we very openly make every effort we can to educate our patients about their disease process. Our patient-education plan is a central part of what our version of a patient-centered medical experience should be. 

Darrell E. White, MD, is the founder of Skyvision Centers of Westlake, Ohio. He is a consultant to Eyemaginations, Inc. Dr. White may be reached at dwhite2@skyvisioncenters.com.

Advanced Ocular Care Magazine March 2013

Treating Astigmatism In Patients With Cataracts

Modern cataract surgery is not your grandfather's surgery! If you have asigmatism we can not only make you see better over-all, but we can also treat your astigmatism. Dr. Darrell White is an expert in using Intra-Ocular Lenses (IOL's) that correct astigmatism.

A cataract is a clouding of the natural lens inside your eye. The lens sits in back of your pupil. As we get older the lens becomes harder, making it harder to focus. This is why we need reading glasses in our 40's. As we get even older (and sometimes in younger people, too), part or all of the crystalline lens becomes cloudy, sometimes yello-brown, too. This makes our vision blurry even with glasses or contact lenses. When that happens the only treatment is to take the cataract out.

If you have astigmatism you can choose to NOT HAVE TO WEAR GLASSES for most (maybe all!) of your far-away vision. You can choose to have Dr. White put in a Toric IOL, an implanted lens to give you clear vision AND correct your astigmatism. Imagine...after a life of glasses and contact lense for astigmatism...after cataract surgery you could choose not to have to wear glasses for lots of your far-away vision!

If you live in the Cleveland area Dr. Darrell White and Skyvision Centers in Westlake are the people and the place for expert treatment of astigmatism when you have cataract surgery!

Eye-opening Facts and Myths about Eye Health

If you live long enough, you will get a cataract.

Cataracts can limit the ability to see bright colors, read and, most frighteningly, drive a car – especially at night. Although more than 20 million Americans 40 years and older have a cataract in one or both eyes, there is a surprising lack of knowledge about the condition among U.S. adults. In fact, a recent survey found that 22 percent of Americans did not think that they were at risk for developing cataracts in their lifetime, when in reality, more than half of all Americans will either have a cataract or have cataract surgery by age 80. 

This graphic illustrates similar myths and misconceptions about cataracts and eye health, along with some eye-opening facts. 

© 2013, Journal Sentinel Inc. All rights reserved.

Trends In Treating Astigmatism

The surgical revolution in treating astigmatism began with the onset of Radial Keratotomy (RK) in the late 1970's and continued into the era of Laser Vision Correction. When a cataract was to be replaced, if you had astigmatism you either had to undergo a procedure like RK called a Limbal Relaxing Incision (LRI) during or after the surgery, or a laser procedure like LASIK or PRK. These all work well.

About 5 years ago there was a new development in Intra-Ocular Lenses (IOL) that not only improved vision after cataract surgery, but also treated astigmatism: Toric IOL's. A study of refractive cataract surgeons like our Dr. White recently reported that 75% now prefer to use these new IOL's rather than LRI's in patients with astigmatism.

"We really like the Alcon Toric IOL when we are aiming to make our  Cleveland patients independent from glasses for their distanc vision needs like driving or watching TV," said Dr. White.  "Our golfers are particularly happy!"

Extra pre-operative measurements like corneal topography are necessary to choose both the power and the orientation of the IOL. Once it's in the eye it is amazingly stable!

The technology of cataract surgery now includes multiple ways to address astigmatism. Dr. White and a majority of the top surgeons in the United States are now opting for a Toric IOL in cases where astigmatism is treated during the surgery.

What Everyone Should Know About Cataract Surgery

Here are some thoughts on preparing for Cataract Surgery from Connie, our sugery counselor:

"Having worked with hundreds of patients now who I have counseled through their pre- operational instructions;  it is the darn eye drops that cause the most stress and inconvenience for people.  Imagine that!    

The most performed surgery in the U.S. and one that is so streamlined now that literally 24 hours later the patient is back to their regular routine . . . and if we receive complaints they typically are about the eye drops they have to take for up to 30 days after the surgery, not the procedure, not the doctor or surgery center, not how they are seeing but . . . the eye drops!

We educate our patients before meeting the doctors, during their examination and after the examination with the surgical counselor.  We send educational videos via email or send them home with written information.  Education is the key to a successful procedure so the patient feels comfortable, not only with the doctor but the procedure.

Feeling good when they leave the office, patients leave with 3 prescriptions for eye drops they will be taking throughout the pre and post operative period.  Then, they go to the pharmacy and the whole experience leaves our practice and the pharmacist gives them the news on how much the drops will cost them.  Out of the hands of the doctor!  But, after the prescriptions are filled and they go home, the regimen is started.  

Then the patient comes into the surgery center and the procedure lasts a few minutes and a couple of hours later the patient goes home and clearly sees better!  The post operative visits begin and drops are continued for up to 30 days after the procedure.

I am writing this for those who are nervous about cataract surgery. It truly is the eye drops that I get most of the questions about.  So, don't despair, if you are getting ready for cataract surgery, we will take good care of you, you just have to be prepared for the eye drops!"

Cataract Rates Rising In U.S.

Here's some more information for you during Cataract Awareness Month. It appears that the rate of cataract diagnosis has risen ~19% in the U.S. since the year 2000. Remember our post from the other day about cataracts? Everyone who lives long enough will develop a cataract! At least 50% of those people who develop cataracts will go on to have surgery, and it's probably also true that if you live long enough you will need your cataract out!

There are some risk factors for cataract growth, especially for early onset of cataracts. Family history is important as is your medical history. Diabetes is a very strong risk factor for the development of cataracts. Exposure to ultraviolet light can also increase not only your risk for developing a cataract, but also the speed with which that cataract may get worse.

Thankfully, cataract surgery is one of the most frequently performed, successful, and safest surgery in the United States. Not only is it possible to improve your vision once the cataract has caused it to decrease, but there are also implant options that you can choose that will reduce your need to wear glasses after your cataract surgery like the Crystalens from Bausch & Lomb.

Here's the link for the recent story with info from the AAO. Give us a call at SkyVision Centers if you have any questions about cataracts!

Astigmatism 101

What is Astigmatism? It's a funny word, isn't it? Lots of people think the word is "stigmatism" and that you have "a stigmatism". That of course means that you could have one or more "stigmatisms", but that's not really how it works!

Astigmatism is an optical term that relates to how an optical system focuses, or doesn't focus, light. In our situation the optical system is the eye! There are three different parts of the eye that make up the focusing elements of our vision system: the TEAR FILM that sits on the very surface of the eye (that's why Dry Eye causes vision problems!), the CORNEA or window to the eye, and the LENS that sits in back of the pupil. Astigmatism is present when the combination of these pieces parts creates two or more focused images from a beam of light.

Most of the time astigmatism is caused by the shape of the CORNEA. In a normal eye, one without astigmatism, the cornea is like the front of a sphere; it's round like a basketball or a soccer ball. A cornea that has astigmatism is longer in one direction than the other. It's STEEPER in one direction and FLATTER in the other. In other words the astigmatic cornea is shaped like a football instead of a basketball.

Whether you are nearsighted or farsighted, if you have astigmatism you will have at least two images focused in the eye. There are lots of ways to correct this, and we'll talk about all of them as time goes on. Be sure to check here, and watch for the videos on the Dr. Whiteboard over on Youtube for more info on ASTIGMATISM.

Skyvision Docs Have Another Skyvision EDU Meeting

Skyvision Centers Docs had another Continuing Education meeting for area optometrists.  This is the second meeting in the Continuing Education series called Skyvision EDU.  The local optometrists met at The Surgery Center on Bagley Road in Middleburg Heights.  The Surgery Center, owned and operated by Barb Draves, is one the excellent surgery centers used by Dr. White for his cataract patients. 

Leading off the was our very own Dr. Scott Schlegel with a presentation about the very popular Toric Intraocular Lens implant.  He discussed the protocols used in the post operative period of toric IOL cataract surgery. 

Finishing up the meeting was Dr. Darrell White presenting information on the establishment of a Dry Eye Center of Excellence.  The doctors were thoroughly entertained by Dr. White's weaving of stories and technical information.  

Skyvision EDU #3 is scheduled to be held late this summer with topics TBD as the area docs were asked to submit their topics of interest.   The Skyvision doctors have enjoyed connecting with the other area docs and look forward to the continued interaction via the Skyvision EDU meetings.