FOLLOW-UP FOR GLAUCOMA PATIENTS

What can an ophthalmologist do to make follow-up visits with their glaucoma patients more efficient? 'Efficiency is not just about time or simply speeding things up. Efficiency is about getting the most out of the time that you have,' said Garfield Miller MD, assistant professor of ophthalmology at the University of Ottawa Eye institute in Canada. he spoke at the recent 51st Walter Wright Annual Ophthalmology and Vision sciences symposium in Toronto. he offered five key points to improve efficiency while maintaining a good quality of care. One is knowing the patient's Visual Field index Plot (VFiP) before walking into the examination room. 'Take a look at this plot before you see the patient. it gives you an idea not only of when changes occur but it also shows the rate at which it's occurring. Knowing the details ahead of time leaves more time to examine the patient,' he said. The second point is to know the target intraocular pressure (iOP) for that individual before walking into the examination room. 'it's nice to know target iOP before seeing the patient so you're not making decisions on the fly,' Dr Miller said.

For the third point, start the patient encounter with the examination. This differs from what some physicians do, who maybe begin with a discussion. instead, consider greeting the patient, but inform them there will be time to discuss and answer questions at the end. Then, start the exam. he suggests doing it this way because it helps the ophthalmologist avoid having to repeat things to the patient. 'People tend to remember what is said at the end of an encounter better than what was said at the beginning. Also, for a glaucoma follow-up, you're going to be doing the same examination of the eye to check iOP, gonioscopy, look at the nerve. sometimes you can avoid the redundancy of having a long discussion before and having a long discussion afterward and repeating some of the same questions,' he said. Fourth, have a good electronic medical record (EMR) system in place. he notes there are a variety of options available, including ones that are web-based. A webbased version is useful in that it makes it possible to review patient information offsite or even the night before. Advantages of EMRs is that all the patient information is in one place and is a great tool to help ophthalmologists with a plan for the patient. 'EMRs and glaucoma work well because you can compare images side-by-side rather than just looking through them on a chart. You can plot iOPs and compare iOP changes to events and treatment changes. With glaucoma, often minimal drawing is required and that works well with an EMR system. Also, prescriptions, letters and the like can be done quickly at the time of the visit,' Dr Miller said.

The final point is delegating the right tasks to the right people. some things, clearly, are delegated to technicians. But with respect to some of the patient education he suggests using educational material such as pamphlets, DVDs and specific websites. 'This is important, especially since there may be only one or two visits per year for most patients.'