Download Managing Patient Expectations After Cataract Surgery

Nort h w e st Ey e Su rg e on s
Insight
July 2013
Managing Patient Expectations After Cataract Surgery
We appreciate our partnership with the optometric physicians in our community. Together we do
important work caring for patients with cataracts.
We all know that patient expectations regarding vision following cataract surgery are changing.
Fifteen years ago, for example, a patient was thrilled to be able to see 20/40 or better with new
glasses after cataract surgery. This improvement, with the help of glasses, restored functional
vision for activities such as driving.
Patient expectations, however, changed as advances in surgery technology with smaller incisions
and foldable IOLs led to improved outcomes. Many patients desired the ability to drive without
glasses following cataract surgery.
Expectations continued on the upswing with refinement of refractive surgery techniques leading to
modern LASIK and PRK. Today, many patients with decreased visual function due to cataract make
no differentiation between cataract surgery and LASIK. In fact, they expect perfect uncorrected
vision after cataract surgery.
Tips for framing patient expectations (there will be glasses)
All patients will still require glasses after cataract surgery for at least some of their daily activities.
However, because many patients know technology is available to reduce their need for glasses (for
distance vision, near vision, or both) they may not be satisfied with this reality.
A typical cataract consultation in our office includes surgeon review of information and
recommendations from the referring optometric physician and a lifestyle survey completed by the
patient. This information helps the surgeon recommend the best procedure and implant for each
patient. We always do our best to provide an excellent result with cataract surgery.
When an appropriate candidate chooses Vision Correction with cataract surgery, we use the best
available technology to deliver the best possible uncorrected vision. We also educate patients that
they will not be glasses-free, and that their primary eye care doctor will continue to care for their
refractive needs (prescription sunglasses, reading glasses, night driving glasses) in addition to
ongoing primary eye care.
Continued on page 2
NWES posted its first online CE course on the www.
nweyes.com website in June. The two credit course,
approved by the Washington State Board of Optometry,
reviews cataract surgery and co-management
protocols. Optometric physicians will learn about
patient selection criteria, IOL options, post-operative
care including managing complications, and
co-management billing.
The free course requires a password to access; contact
Christina O’Connor for more info at [email protected].
FREE ONLINE COURSE:
Cataract Surgery
& Co-management
Continued from page 1
Meeting expectations, postoperative and beyond
The postoperative care of a patient who chooses Vision Correction
with cataract surgery is critical to not only the eye health, but also to
meeting the patient’s expectations by achieving an excellent vision
result. Communication is also important when we partner to
co–manage the Vision Correction patient.
Residual conditions that affect final visual outcome must be
addressed in order to meet patient expectations. Additional
postoperative procedures, such as PRK and IOL adjustment or
exchange, are included in our fee for Vision Correction. In September
we will also include ORA (intraoperative wavefront aberrometry) to
fine-tune our IOL power selection and positioning. We will do this to
better meet patient expectations, and to help achieve our common
goal of taking the best possible care of our mutual patients.
Please stay tuned for additional information and CE opportunities
regarding Vision Correction technology, co–management and
postoperative billing for vision correction.
Patient Satisfaction
By Bruce D. Cameron, MD
Patient satisfaction is a key factor in measuring our
success. In April, 118 patients completed surveys.
More than two-thirds of survey respondents said their
experience exceeded their expectations. We take
patient feedback seriously and credit much of their
satisfaction to the excellent customer service our
staff strives to offer patients every day.
With customer service moving in the right direction,
we will continue to focus on reducing wait times for
patients. Wait times, as you know, are closely linked
with how a person evaluates their experience in our
offices. Reducing wait times also helps improve the
efficiency of our practice overall.
We hope that in sharing a recap of our wait time
goals across our practices, we are also demonstrating
our commitment to provide your patient the best
experience possible. If you have any questions or
concerns, I hope you will reach out to me.
FOCUSING ON SHORTER WAIT TIMES
A recap of our wait time goals across our practice from April 2013
<2 HRS INCLUDING
DILATION & TESTING
<1 HR WITH DILATION
84.4%
53%
<45 MINS FOR
TESTING ONLY
<1/2 HR WITHOUT
DILATION
17.6%
29.3%
Nort h w e st Ey e Su rg e on s
Spring Symposium in Review
This year’s Multi-Disciplinary Medical Symposium focused
on cardiology and vascular disease. The symposium was a
great success. More than 200 attendees gathered at the
Lynnwood Convention Center to learn about the latest in
cardiovascular care, retinal vascular disease and more.
The topic for this year’s gathering was selected by you and
your peers. We encourage you to submit topic ideas for
future symposiums. Here we offer a brief synopsis from
each presentation.
Plumbing, Pumping and Electricity:
What’s Current in Cardiovascular Care
MARGARET HALL, MD, CARDIOLOGIST
Hypertension (HTN) affects as many as 30 percent of
adults. Current strategies for drug therapy recommend
diuretics as a first line, followed by ACE Inhibitors/
Angiotensin Receptor Blockers, Beta-blockers and Alphaagonists. Research shows that the amount of blood
pressure reduction is the major determinant of reduction
in cardiovascular risk in both younger and older patients
with HTN. Sleep apnea is linked to hypertension, stroke,
myocardial ischemia, arrhythmias, cardiac events and
pulmonary hypertension.
Current Concepts in Retinal Vascular Disease
PAUL B. GRIGGS, MD
Retinal vascular disease is commonly associated with
systemic disease processes. Diabetic retinopathy is the
most common of these disorders. Retinal venous occlusive
disease may be associated with systemic hypertension,
cardiovascular disease and diabetes mellitus. Retinal
arteriolar occlusive disease may be associated with
cerebrovascular arteriosclerotic and cardiac valve
disease. It is important to consider these conditions when
assessing patients with retinal vascular disorders.
Vascularity of the Ocular Surface
VICTOR M. CHIN, MD
The anterior segment of the eye receives its blood supply
from a complex network of vessels. The arrangement
of these vessels results in a ciliary flush for deeper
inflammation, and more diffuse conjunctival injection for
more superficial inflammation. Understanding the vascular
supply and appearance can be extremely helpful in
properly identifying and treating various types of anterior
segment pathologies.
Diagnosis and Treatment of Neovascular
Glaucoma
Image–Guided Vascular Interventions
AARON A. KUZIN, MD
RAY JENSEN, MD, INTERVENTIONAL RADIOLOGIST
Neovascular glaucoma is a secondary glaucoma
with elevated intraocular pressures occurring when
fibrovascular tissue proliferates onto the chamber angle,
obstructing the trabecular meshwork. The underlying
cause is almost always retinal ischemia. The three main
causes of the ischemia are central retinal vein occlusions,
diabetic retinopathy and carotid obstructive disease. Early
detection and treatment, using anti-VEGF agents, PRP
and glaucoma surgery can now lead to much better visual
outcomes than previously possible for this potentially
devastating disease.
Less invasive procedures like angioplasty and stenting
can be excellent treatments for arterial vascular disease,
while intravenous thrombolysis can be used for acute
stroke treatment. Indications for treatment of carotid
stenosis include >50 percent stenosis and symptomatic
or >80 percent and asymptomatic. Research shows no
long term difference between Carotid Stenting and Carotid
Endarterectomy in the rate of post-treatment stroke, heart
attack or death.
To download each presentation and submit topic ideas
for next year, visit our website nweyes.com/previouspresentations
Nort h w e st Ey e Su rg e on s
10330 Meridian Ave. N.
Suite 370
Seattle, WA 98133
Nort h w e st Ey e Su rg e on s
CONTINUING EDUCATION
AUGUST 14 | WEDNESDAY
ORA: Improving Refractive Outcomes After
Cataract Surgery
Billing and Coding Seminars in Review
Dinner 6 p.m.
Program 6:30 p.m.
A total of 192 ODs and staff attended our Billing & Coding seminars in
June in Seattle and Mount Vernon. Kirk Mack of Corcoran Consulting
Group charmed the audiences with his good humor as he reviewed the
documentation, coding and reimbursement updates for optometry, and
made a somewhat dry subject highly entertaining. Several attendees
appreciated distinctions and clarifications between codes for billing.
AUGUST 19 | MONDAY
Should I Treat or Monitor? A Discussion on
Difficult Glaucoma Cases
Both physicians and staffs welcomed the opportunity to learn about
the updates and commented so on follow-up surveys. NWES hopes to
offer this type of seminar regularly in the future.
Dr. Cameron
Shoreline Conference Center
Drs. Cameron and Hoki
Renton clinic
Dinner 6 p.m.
Program 6:30 p.m.
SEPTEMBER 4 | WEDNESDAY
ORA: Improving Refractive Outcomes After
Cataract Surgery
Dr. Kuzin
Mount Vernon clinic
Dinner 6 p.m.
Program 6:30 p.m.
OCTOBER 2 | WEDNESDAY
Ocular Manifestations of Systemic Disease
Drs. Kuzin and Osgood
Mount Vernon clinic
Dinner 6 p.m.
Program 6:30 p.m.
NWES Co-Management Manual
Available Now
Questions on post-op protocols? Wondering what markers to look for
on one-month post-op exams? Referring optometric physicians who
choose to co-manage patients after cataract or refractive surgeries
can find these and other answers in the NWES Co-Management
Manual. This PDF document is available for printing and as an online
resource for all. In addition to pre- and post-operative protocols, the
manual provides prescription drop regimens, patient selection
guidelines, physician profiles, and current consultation and post-op
forms. The manual contains current contact information for all NWES
physicians and locations. Check out the Co-Management Manual at
www.nweyes.com/manual on the NWES website.