Article

DIAGNOSTIC DEVICES

Consider these scripts to instill in patients the importance of their prescribed management

AMD patients should receive education about the diagnostic instruments and testing we employ in our practices for two reasons: (1) Patients who understand the purpose and results of their testing are more invested in their care and, therefore, more compliant with macular carotenoid supplement prescriptions and follow-up appointments; and (2) patients who understand the technology become impressed by it, increasing the likelihood they’ll refer friends and family.

For these reasons, O.D.s should consider crafting scripts for themselves and staff to explain to patients the practice’s devices that aid in AMD diagnosis and/or management. Here, I provide scripts, organized by device in alphabetical order. (See “Staff Education is Essential,” p.22) and advice on referral (p.23).

STAFF EDUCATION IS ESSENTIAL

As staff members operate most of the diagnostic equipment, it’s essential to ensure they are educated on the individual pieces of technology, along with the scripts the O.D. would like used. The reason: Personnel will be able to answer patient questions and, even become inspired to create their own take on the scripts or provide patient-friendly analogies to strengthen patient understanding.

Consider picking one piece of AMD equipment a week and discussing it at every staff meeting, sending related emails, answering questions and giving quizzes.

It may be helpful to allow your staff to suggest changes to the script’s wording to make the language more understandable and friendly for themselves and for patients. The simpler the presentation and the more your staff and the patients feel personally connected to the message, the greater the likelihood that your diagnosis and prescription will be embraced and adopted into their daily lives.

DARK ADAPTATION

“Because you reported having trouble with night driving and acclimating to light changes indoors, we’re going to use this test to see whether your eyes have difficulty with dark adaptation. AN ABNORMALITY IN DARK ADAPTATION IS THE FIRST DEVELOPMENT OF A CONDITION CALLED AGE-RELATED MACULAR DEGENERATION, OR AMD. AMD occurs when the central portion of the retina, known as the macula, doesn’t work as well as it once did. Once I have your results, I’ll discuss my findings with you and the possibility of supplementation as a treatment. Research reveals certain supplements, along with sunglasses, exercise and other things, can decrease your risk of losing vision from AMD.”

FUNDUS AUTOFLUORESCENCE (FAF)

“This is a special camera that acquires images of something called lipofuscin in the retina, the part of your eye responsible for delivering images to your brain. LIPOFUSCIN CAN BE A SIGN OF AGE-RELATED MACULAR DEGENERATION, OR AMD. AMD occurs when the central portion of the retina, known as the macula, doesn’t work as well as it once did. Before this technology was available, we had to send our patients to a retinal specialist, who injected them with dye, which certain patients are allergic to, and then took retinal photos over a long period of time. Doing FAF is faster and safer.”

FUNDUS PHOTOGRAPHY

“This device acquires images of your retina, the part of your eye responsible for delivering images to your brain. UNDER YOUR RETINA, WE’VE SPOTTED SOME YELLOW DEPOSITS CALLED DRUSEN. DRUSEN IS A RISK FACTOR FOR DEVELOPING A CONDITION CALLED AGE-RELATED MACULAR DEGENERATION, OR AMD. AMD occurs when the central portion of the retina, known as the macula, doesn’t work as well as it once did. We are going to acquire these photos so that we have a baseline, and retake them every year so that we can compare them to make sure your eyes stay healthy.”

MICROPERIMETRY

“THIS TECHNOLOGY PROVIDES INFORMATION ON YOUR VISUAL FUNCTION AND YOUR ABILITY TO FIXATE ON AN OBJECT. THIS INFORMATION IS IMPORTANT TO ANALYZE, AS IT IS ASSOCIATED WITH THE HEALTH OF THE UNDERLYING RETINAL STRUCTURE IN AMD AND CAN INDICATE VISION LOSS.”

Of note: My practice mostly uses this technology on patients who use hydrochloroquine.

MPOD MEASUREMENT

Joseph J. Pizzimenti, O.D., F.A.A.O., who has a good deal of experience in assessing macular pigment optical density (MPOD), offers this script: “We have already measured your eye pressure to help determine the risk for glaucoma. USING THIS DEVICE, WE WILL NOW MEASURE THE AMOUNT OF PROTECTIVE PIGMENT IN THE CENTER OF THE RETINA. This helps us to determine the risk of age-related macular degeneration, or AMD, which is about twice as common as glaucoma.”

SD-OCT

“This technology obtains cross-sectional images of the layers of your retina, adding to data gathered from the standard exam and helping me to make management decisions.

Additionally, THESE CROSS-SECTIONAL IMAGES AID ME IN MONITORING FOR AND IDENTIFYING DISEASE PROGRESSION. The images taken from this device provide great detail and have a higher resolution than an MRI. The only way we could get better cross-sectional images would be if we took your eye out, sliced it up and put it under an extremely high-magnified microscope!”

Optometric practices also employ SS-OCTA and OCTA. The former can capture fine detail of the choroid and sub-retinal pigment epithelium (RPE). OCTA employs several B-scans in one location to provide a look at red blood cell movement in the choroid and retina and, thus, subclinical neovascularization that appears between Bruchs’ membrane and the RPE.

REFERRING TO A RETINAL SPECIALIST

A choroidal neovascular membrane is an immediate referral to a retinal specialist. Additionally, a new symptom of metamorphopsia or central scotoma, subretinal or intraretinal fluid or hemorrhage suggestive of a choroidal neovascular membrane, should prompt the optometrist to immediately refer the patient for initiation of intravitreal anti-VEGF therapy.

Image courtesy of Africa Studio/stock.adobe.com

HELP PATIENTS AND YOUR PRACTICE

Patients’ understanding of the technology used in our practices is important for their compliance to the possible prescriptions of macular carotenoid supplements, compliance with exercise, maintaining or reducing BMI, follow-up appointments, timely referrals to retinal specialists for surgical intervention and referrals for our practices. Why not try these scripts, or create your own? OM