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AMD: CREATE A CENTER OF EXCELLENCE

Consider implementing these three key strategies

We know the leading cause of vision loss in those age 60 and older is AMD. What’s more, 11 million people in the United States suffer with some form of AMD, and by the year 2050 (a blink of an optometrist’s career), it is estimated to double, according to Archives of Ophthalmology.

Unfortunately, as many as 78% of patients are first diagnosed with AMD after suffering irreversible vision loss, and nearly half of them are first diagnosed with a VA of 20/200 or worse, according to Ophthalmology. Although there is a high prevalence of vision loss from AMD on initial diagnosis, good scientific evidence has taught us ways to prevent functional vision loss if we intervene as early as possible.

Practices committed to early detection and intervention can implement three key strategies to efficiently create an AMD center of excellence:

1 IDENTIFY WHO IS AT RISK

It is important to identify those at highest risk for AMD and to differentiate between risk factors we can and cannot change. This is an important distinction, as it guides what testing is appropriate and what treatment plan works best. (For a list of risk factors that can be changed, see “Managing AMD,” p.14)

Known risk factors we cannot change:

  • Age (older than age 60)
  • Gender (females have twice the incidence than males)
  • Concurrent diabetes
  • Concurrent cardiovascular disease
  • Genes (family history)
  • Race (specifically, Caucasian)
  • Light-colored eyes

Statistically, the number of patients with one or more of these attributes is sizeable in most optometric practices. Those offices with EHR systems can readily identify these folks, but to easily get a feel for how many patients are at risk, simply keep a tally sheet for a few patient days. Manage these risk factors by using the latest technologies to aid in early diagnosis and proper management. (See “Diagnose AMD With Technology,” p.16.)

2 INVEST IN TECHNOLOGY

Equip your practice with the tools necessary to identify and monitor AMD risk factors. An example of such a tool: genetic testing to determine risk for progression of AMD. There is no overhead costs for these tests, and the information is especially useful for properly managing the high-risk patient. Knowing the patient’s “genetic role of the dice” lends itself to a more tailored treatment plan. Timely, efficient management of patients improves outcomes and enhances office production.

Other technologies, which can be found in “Diagnose AMD With Technology,” p.16, can range from $40,000 to $75,000, presenting what some practitioners have identified as a barrier to entry. Certainly, there is an initial capital outlay when purchasing equipment, but if newly implemented equipment is utilized efficiently and appropriately for a robust number of at-risk AMD patients, the financial impact to a practice is surprisingly positive. A study currently underway by Jeffry Gerson, O.D., shows nearly 40% of patients age 60 and older with normal macular structure and 20/20 vision test positive for sub-clinical macular degeneration because they have delayed dark adaptation.

Baby boomers (those born in 1946 to 1964) are the largest patient demographic currently at risk for AMD, and many other retinal conditions, such as macular holes, epiretinal membranes and vitreo-macular traction. Baby boomers not only make up 74.6 million people in the United States, according to the U.S. Census Bureau, they also have the most disposable income; boomers embrace technology and remain active as they age. Obviously, keeping this group healthy and independent is essential for their optimal quality of life. Generation X (born in 1965 to 1984) is approaching the high-risk age for AMD and is projected to pass the boomers in population by 2028. Gen Xers are well versed in technology and embrace staying active. Any practice that caters mostly to these two patient demographics will reap the personal and financial rewards from early AMD detection and treatment.

PROCEDURE CODES ASSOCIATED WITH AMD DIAGNOSTIC TESTING

Dark adaptation 92284
Fundus photography 92250
OCT macula 92134
pERG 92275
Visual Field 10-2 threshold 92083

DIAGNOSTIC CODES ASSOCIATED WITH AMD

Degeneration of macula and posterior pole H35.3
Unspecified macular degeneration H35.30
Nonexudative age-related macular degeneration H35.31
Exudative age-related macular degeneration H35.32
Drusen (degenerative) of macula H35.36
- right eye H35.361
- left eye H35.362
- bilateral H35.363
- unspecified eye H35.369
Age-related degeneration of retina H35.44
- right eye H35.441
- left eye H35.442
- bilateral H35.443
- unspecified eye H35.449
Serous detachment of retinal pigment epithelium H35.72
- right eye H35.721
- left eye H35.722
- bilateral H35.723
- unspecified eye H35.729
Hemorrhagic detachment of retinal pigment epithelium H35.73
- right eye H35.731
- left eye H35.732
- bilateral H35.723
- unspecified eye H35.739

Asymptomatic 59-year-old female with 20/20 VA. FAF of left eye shows a healthy macula.
Courtesy of Professional Eye Care Center

Corresponding positive dark adaptation test shows >6.50 minutes to dark adapt in the same eye.

3 EDUCATE. EDUCATE. EDUCATE

Education in primary care optometry is three-fold. Of course, doctors need to keep informed of the latest studies that provide valuable information on disease prevalence, diagnosis and treatment. Equally, optometric staff need to become knowledgeable about identifying who is at risk for retinal disease and how to get the message out to patients. Ultimately, together, doctors and staff play an essential, synergistic role in educating patients; an informed patient takes ownership in her wellness, working as a team with doctors and staff for timely diagnoses and treatments, which lead to more successful outcomes.

Regarding doctor and staff education, traditional routes are often utilized (CE seminars, trade shows, national/local meetings, webinars, journals) and are very effective. It’s important to seek out CE courses and/or presentations that focus on the most current diagnostic and treatment options for AMD. Follow up the education with the hands-on use of diagnostic equipment either by visiting the exhibit hall at meetings or asking appropriate vendors for in office demonstrations. Also useful is patient education in the forms of posters and pamphlets.

In educating the patient, everyone in the office — front desk reception, pre-testers, doctors and optical staff — should present a consistent and passionate message about prevention.

For example, the doctor proactively prescribes blue-violet and UVA & B protection on all eyewear. The optician reinforces that prescription with a discussion in the optical of their benefits. Receptionists could take note of these protections on patients, as they appear in the office, and pre-testers could fall back on this knowledge and information, as they hold casual discussions with patients. Other examples that could follow a similar pattern: smoking cessation programs, proper diet and exercise classes, nutritional supplement prescriptions, etc. Patient access to practice-generated social media and/or patient-facing vendor sites that enhance the awareness of AMD prevention and detection.

MAKE AN IMPACT

AMD is one of optometry’s biggest opportunities to impact patients’ lives positively, as well as build stronger, more profitable practices. Identifying risk factors, educating patients on diet and nutrition/ocular nutritional supplements and using the latest technology for the earliest detection and management is a winning combination. OM