A Vision Monday site which illustrates how integrated technologies improve patient care and build practice success

In the Exam Lane, Seeing Is Believing

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In addition to using educational videos to inform patients about general eye health topics, ECPs are using a new generation of diagnostic instruments to provide patients with personalized perspective. Instruments such as aberrometers, retinal scanners and corneal topographers can capture and display detailed images of a patient’s eye, enabling doctors to spot and point out to patients any conditions that may require treatment.

 
 Optos’s new Daytona retainal imaging system features a Mac-like design.

An optomap taken by the Optos Daytona.
Jerome Sherman, OD, relies on an Optos retinal imaging system to help him spot and diagnose hemorraging in the back of the eye, abnormal looking freckles, or other potential health issues. Using the vivid, 3D-like images of the retina—known as an optomap—that are captured by the system, he counsels patients and educates them about their ocular health.

“If a patient comes in for first time, if it’s a referral, for example, I may not get to see them initially,” said Dr. Sherman, who is a Distinguished Teaching Professor at the SUNY College of Optometry and is also in private practice at the New York Eye Institute and Laser Center. “The staff takes their basic history and performs a visual acuity, air puff tonometry and retinal imaging with the Optos system. When I walk into the exam room, I see the reason for the referral and the best corrected visual acuity. The Optos images have already been taken and are being displayed on a 40-inch monitor.

“I’ll speak with the patient briefly while I have the images in front of me. I might say, ‘Mrs. Jones, this is your optic nerve, this is your macula, these are your blood vessels.’ As I look, I may see a whole series of abnormalities, so I start diagnosing, telling the patient what I’m seeing.”

Dr. Sherman also uses the Optos system to do a “fly through.” “We’re flying through the pupil to show them the inside of their eye,” he explained. “It’s dramatic. I’ve never seen a patient who was not impressed with it or didn’t understand it.” Sherman added that the Daytona also makes it faster and easier for patients to maneuver to get the proper head alignment. “They can almost do the test themselves, and that gets them involved in the experience,” he said.

Patients are not only wowed by the retinal imaging capabilities of the Daytona system, they are also impressed with its sleek appearance. “A lot of patients think it looks like the newest iPad or Mac instead of an eye instrument,” said Dr. Sherman. “It’s very slick. People can relate to its aesthetics.”

 
Dr. Kathleen Andersen.
Kathleen Andersen, OD employs several different diagnostic technologies in her practice, RSM Vision in Rancho Santa Margarita, Calif. “I had a diabetic patient who wouldn’t change his diet,” she said. “So I took a picture of him with my retinal camera, and showed him the bleeding in the back of his eye. I told him that because of his diabetic retinopathy he was at a greater risk for stroke.” He reflected a bit after the exam, and said, ‘My retinal specialist didn’t do that for me.’ It’s so much easier when you can play show and tell with a patient,” she remarked.

Dr. Andersen said she is always on the lookout for new diagnostic tools that enable her to take a broader look at a patient’s overall health. Last year, she became the first optometrist in the country to install Heartsmart, a device that tests the thickness of the lining of the carotid artery, which carries blood to the brain. “It gives us a way to look at what the rest of the patient’s body is doing,” she explained. “For example, we can tell if they’re at greater risk for heart attack or stroke.”

Dr. Andersen recently began using another new tool called DocPIES EyeCare, an iPad application devoted to in-office patient education and communication. Developed by the creators of Heartsmart, DocPIES can also be used to train patients on patient care procedures such as how to put on contact lenses for the first time. The app features two modules. One is an integrated check-in with a patient interview that replaces a clipboard, pencil and paper-based check-in form. It dynamically delivers questions and patient education based on the patient’s answers enhancing the practitioners understanding of the patients’ needs and lifestyle. The other module is a patient experience survey that assists the practice in automating patient feedback.

 
 A technician at RSM Vision scans a patient’s carotid artery with a Heartsmart device.
“I’m really impressed with the technology,” said Dr. Andersen. “I don’t have to write, I can just click off the patient’s health care profile. We also use it for general patient education.” Dr. Andersen said being at the forefront of technology helps her project a positive image of herself and her practice. “The technology lets them know, ‘This is who we are, and this is how we plan to manage your eyecare. Patients sense my excitement about it.”

Although ECPs are using imaging systems, videos and other new technologies to engage and educate adult patients, pediatric patients need to be engaged on a different level. M&S Technologies, a supplier of vision testing systems, offers hardware that lets children watch videos while they are having a fixation test or retinoscopy.

“It can be hard for a child to fixate on a screen, let alone someone with ADD or ADHD,” said company president Joe Marino. “Our technology engages the patient with a video that appears on the whole screen. It replaces a traditional Snellen chart. You simply need the child to focus forward. That gives the doctor the ability to look in back of the eye.” Marino said the eyecare practice provides the video, which will vary by age group. “Babies are going to be fixated by Baby Beethoven. An older child might be interested in Toy Story or Shrek.” He added that M&S’s systems integrate seamlessly with content providers such as Eyemaginations and Eyemotion.