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 By Neil B. Gailmard, OD, MBA, FAAO, Editor May 25, 2011 - Tip #483 
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Develop a "Center for Macular Health" Within Your Practice

  Sponsor: Bausch + Lomb PureVision® 2 HD

As eye care professionals, we know how devastating age-related macular degeneration (AMD) is to people afflicted and we also know the disease is becoming increasingly prevalent with the aging of our population. What might surprise you is that our patients are also much more aware of these factors. Consumers today take an active role in health care issues and they have a tremendous amount of information available to them. They know about diseases, medications and prevention. The news media reports on new medical research findings every day.

In my experience, patients are particularly concerned about AMD. While many people never heard of it ten years ago, today their interest is very apparent when you bring up the topic. Nearly every adult patient you see knows someone who has suffered with AMD.

With all this interest, what is your practice doing to really focus on macular degeneration? Does every patient seen in your practice come away with the feeling that you are on the cutting edge of technology and research on this important topic? This field is changing rapidly with more knowledge than ever about risk factors, prediction, prevention, detection, diagnosis and treatment. Here are some ways you can help your patients and your practice.

Case history
Be sure your patient history process includes a thorough evaluation of risk factors for developing AMD. This information alone will open up an important discussion between doctor and patient. Your focus should be on prevention of macular degeneration and that begins with understanding the risks.

Here is a list of AMD risk factors you can ask about:

  • Age greater than 50
  • Female
  • High body mass index (BMI)
  • Light eyes, light skin
  • Smoker (within last 20 years)
  • Family history of macular degeneration
  • Patient has: macular degeneration, high blood pressure, diabetes, heart disease
  • Inadequate consumption of green, leafy vegetables
  • Current use of nutritional supplements
  • Sensitivity to light
  • Excessive exposure to sun

There are several new instruments that allow you to screen for risk factors of AMD as well as to diagnose and document the condition at earlier stages. Invest in one or more of these technologies to allow your practice to take a step up in your evaluation of macular health. Some of these procedures could be performed as a pretest in your exam routine. You might include the test in your exam fee or make the test a highly recommended option and charge a separate screening fee. Set your practice apart and enhance your reputation with this new technology.

See if you are aware of all these procedures. If not, find out more in journals, on the internet and at major eye care conferences.

  • Macular pigment density screening
  • Photo stress recovery test
  • DNA testing (swab inside cheek)
  • Preferential hyperacuity perimetry
  • Amsler Grid test
  • Slit lamp funduscopic examination
  • Digital retinal photos
  • OCT (Optical Coherence Tomography)

Nutritional supplements
In case there are still any doubters out there, nutritional supplements are part of mainstream medicine and the effectiveness is backed by a plethora of scientific studies. As an eye care professional, it is now your duty to advise and recommend vitamins and neutraceuticals to your patients. To do this properly, read up on the latest research and attend continuing education courses on nutrition.

I think the best approach is to evaluate all the brands of nutritional supplements available and stock the brand you like best in your office for sale. This makes it easy for patients to get the best product and the cost to them is about the same as the major chain brands. I find most patients prefer to buy the supplements from their doctor. You may also want to make the supplements available to order on your practice website.

I know many colleagues have a concern that selling the nutritional products in the office conveys a negative image, but I don't see that it is any different that selling glasses and contact lenses. We seem to be OK with that.

Patient education
Be sure to make macular health a topic of discussion in every case summation with your patient, even when the macula is normal.

  • Tell patients what you see in their maculas.
  • Show patients their macula in a retinal photo.
  • Discuss their risk factors and how to modify those for prevention of AMD.
  • Show patients a short 3D video clip about AMD.
  • Recommend UV protection in eyeglasses and recommend sunglasses.
  • Recommend proper nutrition and supplements.
  • Provide printed materials on AMD.

Follow-up care
Once you have established your "Center for Macular Health," regular evaluations of patients becomes part of the routine. This will vary with the needs of every patient. Your macular testing can be repeated at the six month interval to monitor progress and to evaluate the effectiveness of the nutritional supplement. In many cases, test results improve with the use of supplements.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

A Proud Supporter of

Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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