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Article Date: 12/1/2012

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HOW�S YOUR RETINA Display?

How’s Your Retina Display?

Four effective ways to educate patients on their retinal disease, so they return for your care.

LINDSEY GETZ, CONTRIBUTING EDITOR

Patient education plays a vital role in the management and referral of patients who have retinal disease, as failure to do so may lead to losing the patient to follow-up care, say those interviewed for this article.

Taking the time to educate these patients not only instills patient loyalty to you, it also clearly sends the message to these patients that their disease is serious. The latter positively influences patient compliance to the prescribed treatment, increasing the probability of successful outcomes.

“Though we may refer them [retinal disease patients] to specialists, these are our patients. We’re spending year after year taking care of them so it becomes our responsibility to educate them on a problem, even if it’s not something we’re personally treating,” explains Brad Sutton, O.D., F.A.A.O., clinical professor, Indiana University School of Optometry, service chief, Indianapolis Eye Care Center, in Indianapolis, Ind. “Part of that education is letting the patient know what will happen if he/she doesn’t follow through with the specialist or the surgery that might be suggested. Educating the patient may be a matter of whether the patient complies to the recommended treatment.”

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When discussing retinal disease, such as diabetic retinopathy, shown above, be sure to use layman’s terms, and tread carefully.

Here, Dr. Sutton and other optometric retinal disease specialists provide four tips on how to provide patient education.

1 Use layman’s terms, and tread carefully

Break the patient’s condition down into patient-accessible language, as doing so enables him/her to understand their condition better as well as the importance of follow-up appointments, explains Sherrol A. Reynolds, O.D., F.A.A.O., associate professor, Nova Southeastern University, College of Optometry, in Fort. Lauderdale, Fla.

“Unfortunately, it’s not uncommon for some O.D.s to say to the patient, ‘You have advanced diabetic retinopathy. You need to see a retina specialist,’ and leave it at that,” she explains. “Someone who has a four-year college degree and post-education may have some understanding of the term, but even in these cases, we need to take the time to provide an explanation. If we just give the diagnosis and refer out, the patient leaves the practice feeling overwhelmed and confused.”

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Dr. Pohl utilizes both OCT images and digital retinal photos to explain a patient’s condition. All those interviewed for this article agree that visuals are essential in providing patient education.

An example of the diagnosis discussion, by Dr. Reynolds:

“Hi Mrs. Jones: During your exam, we discovered you have (mild, moderate, advanced) diabetic retinopathy. This means you have some bleeding and leakage in the back of your eyes because diabetes makes the eye’s blood vessels weak over time.”

If the case is mild, Dr. Reynolds says she continues with, “I can monitor it for any changes with follow-up visits every three months. It’s very important you make these follow-up appointments and control your diabetes, so we can lower your risk for vision loss.”

If the case is moderate to severe, Dr. Reynolds says she continues with, “because of the severity of the bleeding, I’m going to refer you to a retina specialist for further evaluation and treatment options. If you don’t see the retinal specialist, the condition will get worse, and you could have vision loss. I don’t want this to happen. I want to preserve your vision.”

It’s also important to gauge how much information the patient may require — and can handle, adds Maynard L. Pohl, O.D., F.A.A.O., clinical director at Pacific Cataract and Laser Institute (PCLI), in Bellevue, Wash.

“Some patients will want to know every detail, and others just want to know the basics,” he explains. “To determine how far you should go with your patient education, begin by keeping it simple and then letting the patient respond. The patient will steer you toward the explanation that best suits him or her.”

An example patient script, courtesy of Dr. Pohl:

“Mrs. Smith, there are two components to your decreased vision: the front of the eye and the back of the eye. In front is your cataract, and the back of the eye is your macula, which controls central vision. The macula can start wearing out. This is called macular degeneration.”

“At this point in the conversation, I pause to see whether the patient has any comments or questions, and either answer them succinctly, or continue,” he explains. “If I finish my full explanation without any patient questions in between, I then ask the patient, ‘do you have any questions about this?’ and then again succinctly answer them.”

Treading carefully with regard to patient education is paramount, as some patients who receive too much detail about their condition become frightened and choose not to pursue further care because of this fear, Dr. Sutton adds.

2 Show clinical photos/eye models/animated videos

Seeing is not only believing, it also connects the dots in the patient’s mind, in terms of the verbal education you’ve provided, say those interviewed. Therefore, in addition to providing patient-accessible verbal communication on their retinal disease, also show digital fundus and OCT images, eye models and animated videos.

“Showing the patient a digital fundus photo of their eye, while explaining exactly what’s going on with their eye tends to have the biggest impact on the patient, with regards to following through on your recommendations,” Dr. Sutton says. “This is because the patient is now seeing what you just explained to him or her.”

Consider showing the patient their fundus photograph next to a “normal” fundus photograph, recommends Mark T. Dunbar, O.D., F.A.A.O., of the Bascom Palmer Eye Institute at the University of Miami, Fla. “When the patient can see the difference, he or she not only gets an enhanced understanding of their condition, but also more readily accepts the seriousness of their retinal disease,” he says. “This, in turn, improves patient compliance to the practitioner’s prescribed treatment, increasing the likelihood of a successful outcome.”

In addition to fundus photography, Dr. Pohl says he may show patients their OCT results on a computer screen or reference an eye model to strengthen their understanding of their retinal disease.

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Here, Dr. Pohl employs an eye model to describe how the retina functions.

“I may use all three if doing so will resonate the best for the patient. Some patients may not be that in tune with technology, and may actually prefer the eye model rather than OCT,” he says. “But many really appreciate the use of technology and that alone may carry a lot of value. The patient might not understand everything you showed them, but they may perceive that you have an advanced practice due to your investment in technology, and that may give them confidence in staying with you for their care.”

Dr. Dunbar adds that animated videos of one’s diagnosis also go a long way in providing patient education, as they show and tell in layman’s terms at the same time, he says.

3 Listen to the patient

While it can be easy to get caught up in a diagnostic explanation, don’t forget to listen to the patient too, says Dr. Reynolds.

“A lot of patients are confused and have a lot of questions about their diagnosis,” she says. “So as you’re discussing the condition, pause between explanations and ask, ‘Do you have any questions about this?’ Take the time to have a short conversation.”

A common question Dr. Reynolds says she gets: “Am I going to go blind?”

“I think it’s important for the practitioner to answer this with: ‘Well, the good news is that we caught it [the condition]. And our goal is to preserve your vision and to prevent vision loss, but I need your help in doing this. And that means showing up for follow-up appointments, and [if prescribed], seeing a retinal specialist.”

It helps patients to be able to express their fears, adds Dr. Pohl. That said, remain in professional control of the patient encounter, or you’ll likely be in the exam room a lot longer than you had planned, he explains.

“If the patient breaks down emotionally, pause, give him/her some sympathy, which often times is all the patient needs. Remain realistic yet optimistic, and reassure him/her that you’ll do everything you can to help him/her, briefly go over your management plan again, provide the patient with literature on their condition, slowly guide him/her to the door, and invite the patient to call with any additional questions or concerns,” Dr. Pohl explains. “I’ve found that by following these considerate steps, you are able to give the patient what he/she needs without making the patient feel as if you’re rushing him/her out of the exam room.”

4 Offer take-home materials

Printouts, brochures and other materials on the patient’s retinal disease that he or she can take with him or her after the exam bolster the education you’ve provided, say those interviewed.

“A diagnosis can come as a shock, and anything you say after the diagnosis may be tuned out because the patient has shut down,” says Dr. Dunbar. “So to have some information to take home and review once the diagnosis settles in can be very helpful. This way, the patient can take a step back and learn more about the disease or the condition when he or she is ready to digest the information.”

He adds that by giving the patient handouts, you have a great chance of precluding patients from searching their diagnosis on the Internet, which can contain false, misleading and worst-case scenario information.

In terms of where to find this information, Dr. Dunbar says the American Optometric Association, American Academy of Ophthalmology and the various individual retinal disease associations, such as the American Macular Degeneration Foundation (www.macular.org) are patient resources.

Take Home Points

Break the patient’s condition down into patient-accessible language, so the patient can best understand their condition.

Gauge how much information the patient may require and can handle. You don’t want to overload anyone.

Show digital fundus and OCT images, eye models and animated videos, as seeing is believing.

Don’t forget to listen to the patient, and invite questions.

Provide printouts, brochures and other materials regarding the patient’s condition.

Instead of silently giving the patient take-home materials, say, “Listen, I know this might come as a shock, so I have some information here that once you get a chance to sit down, you can read a little bit more about your diagnosis,” he adds.

“This way, you’re giving the patient a reason to pay attention to the handouts rather than overlooking them or throwing them away by mistake,” Dr. Dunbar says.

Make sure these take-home materials include contact information about your practice, adds Dr. Reynolds.

“The contact information tells the patient that he or she is welcomed to come back to you with any questions, which serves to create patient loyalty,” she explains. “It’s also important to remember that, many times, patients may take brochures from your office for a family member who might have a potential condition, and, by having your office information on there, the family member knows who to see for it.”

Last word

Patient education on one’s retinal disease is essential for optometrists to develop patient loyalty to their practice and best serve the patient, says Dr. Pohl:

“Retinal disease can lead to irreversible loss of vision, and that’s important for patients to realize,” he explains. “What patients perceive during your eye examination can be a matter of whether they go home realizing how important their compliance is or they go home and ignore your advice. By taking the time to educate, even if they don’t understand everything you told them about the retina, they will still leave knowing that you are a knowledgeable provider who cares. This not only gives you a great chance of remaining involved in the patient’s care, but can also be the difference between whether they follow through on what you’ve prescribed.”

When is the last time you really took the time to provide patients education on their retinal disease? OM



Optometric Management, Volume: 47 , Issue: December 2012, page(s): 18 - 22

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