Post-LASIK Education: Let Patients Know They Still Need You

Providing ongoing care for post-LASIK patients keeps them in your practice and ensures that they receive the services and products they need.

LASIK has become a common procedure improving the lives of many of those who undergo it, but many of those same patients don’t realize that they still need to visit their eye doctor annually. In addition to co-managing pre- and post-operative care for LASIK patients, ODs need to educate these patients about why they still need to visit for a comprehensive exam each year. Education also is needed about which products, such as sunwear, are still beneficial, and why a successful LASIK procedure doesn’t mean a patient won’t need to address presbyopia.

Vision and Eye Health Could Change

Although patients can now see well, they need to be examined on an annual basis. For those getting close to presbyopia, they may need reading glasses in the near future and need to continue monitoring their eye health for such issues as glaucoma, cataracts and macular degeneration. Other LASIK patients are very non-compliant and literally disappear after their surgeries, either showing up rarely or never again.

Monitor and Treat LASIK-Related Dry Eye

Many LASIK patients are people who have had dryness issues that affected their ability to wear contact lenses and require treatment methods for anyone who has dryness including lubricants, Omega 3 supplements and punctal plugs when necessary.

Educate On Added Need for Sunwear and Driving Eyewear

LASIK patients are more prone to glare problems after surgery, especially at night. Many patients have LASIK with a monovision modality, so their eyes are unbalanced for distance vision and these patients can often benefit from night driving eyeglasses, as well, that balance both eyes to distance.

Monitor Eye Health Long-Term

Continue to monitor post-LASIK patients for the same medical eyecare problems that can affect anyone such as glaucoma and cataracts. Also monitor the cornea for any signs of a condition called ectasia, which is an abnormal thinning and bulging of the cornea. Since the surgery leaves the cornea thinner, this can happen, although it is uncommon.

Anticipate the Rare Poor LASIK Outcome

In most of these cases, the problems were not medical, but a result of a patient with unrealistic expectations. Some patients who had the oldest refractive surgery, radial keratotomy (RK) have had massive shifts in their refraction over the years, ending up extremely hyperopic. In addition, their best corrected visual acuity is often not correctable easily to 20/20 vision.

Generate Post-LASIK Patient Referral

Ask for referrals of the patient’s friends, family and co-workers who may be interested in LASIK surgery. Often, the patient’s happiness and enthusiasm is highest right after the surgery, so this is a good time to ask for referrals. The referred patients will not necessarily be excellent candidates for surgery, but will then continue coming to our office for their eyeglasses and contact lens needs.

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Work with MDs to Treat Ocular Conditions with Specialty Contact Lenses

Specialty contact lenses can help to improve vision for patients with eye conditions such as kerataconus, cornea ectasia and post-surgical corneas. Co-managing  these conditions with MDs can take you down new avenues in patient care.

As most ODs know, patients with  corneal conditions are often treated by ophthalmologists through surgical procedures but, often, when surgery is not the best option, they can find improved vision through the use of custom contact lenses. You have a chance to partner with MDs to manage these patients with appropriate contact lenses. Doing so will enable you to better the lives of these patients while opening up another growth sector for your practice.

Consider if this Opportunity is Right for Your Practice

There is a cost to providing specialty contact lenses, so you need to consider whether this opportunity is right for your practice. Diagnostic kits are sometimes required to fit specialty contact lenses. While some of these kits are available as “loaner sets” from your preferred vendor, most have to be purchased, ranging from several hundred dollars to several thousand. To be truly capable of handling most complex cases, you’ll need to own several designs, leading to higher cost to the practice.

More importantly, an OD thinking about offering  specialty contact lenses services should consider that these are complex cases that require many office visits from the patient (most doctors would charge one global fee for prescribing and managing these lenses rather than charging per office visit), with hand-holding often required. Patients with difficult corneal issues understandably are already frustrated, so as a doctor, you need to have the patience to work with them until the proper physiological fit is achieved. This experience is far from your typical contact lenses management experience.

You also will need to sharpen your knowledge of surgical and non-surgical cases that will be coming to you, and you will have to fully understand the process of selecting the appropriate contact lens design. Consider the time you will need to spend reading articles about corneal conditions and specialty contact lenses fittings and the time you will need to invest in hands-on training for both you and your staff.

Prepare Practice

If you decide to move forward with this opportunity, the next step is deciding on the types of specialty lenses you will offer, and you will need to establish your budget for purchasing the diagnostic sets  required for medically managing these patients. You also will need to decide how your fee structure will work. Fees usually are derived from the complexity of the case, the number of anticipated follow-up visits and the skill level of the practitioner. Gain an understanding of third-party billing policies, benefit availability, and reimbursement for services and products from EACH plan regarding specialty contact lenses. After you’ve completed that process, create proper patient communication documents and procedures. You’ll need a professional quote sheet in order to explain all services, fees and product pricing. You should also be able to explain to patients warranty information and limitations.

Solicit Referrals

Your practice should build relationships with ophthalmologists who perform corneal or refractive surgery. You can send a letter to all corneal or refractive specialists located near your practice. You should then followed up with a call and a personal visit, bringing each of these doctors a few samples of specialty lenses that illustrated the newly designed, innovative lenses now available to improve vision for patients with conditions that cause the cornea to lose its proper shape. Typical candidates for custom-made contact lenses are patients with Keratoconus/Keratoglobus, post-surgical ectasia, corneal degenerative diseases, corneal trauma, high myopia and/or astigmatism or irregular astigmatism.

When an MD agrees to refer specialty contact lenses cases to you, commit to sending the doctor regular patient updates and final treatment reports.

Along with ophthalmologists, you should reach out to other ODs in your community. Many are not interested in taking on specialty contact lenses cases, and will be happy to refer this work to you.

Don’t forget to thank each doctor for referrals. You can do this by regularly calling them, taking them out to lunch or dinner or sending a gift basket to the staff or to a key referral coordinator.

Market Specialty Contact Lenses Services

Once you decide which specialty contact lenses vendors you will work with, find out if they have web sites with doctor-locate functions. If they do, ask that your name and contact information be included. Also consider adding a page or section on your practice’s web site that is devoted to specialty contact lenses. You also can advertise these services in your reception area, and you can do search engine optimization of your site so that your practice comes up nearer to the top of the search results for specialty contact lenses in your geographic area.

By providing specialty contact lenses services you can expand your medical eyecare by developing relationships with local MDs leading to more co-management opportunities and, most importantly, you can improve the quality of life of more patients.

Inturned Eyelashes: A Temporary Fix With Adhesive Tape

Inturned upper eyelid eyelashes can cause uncomfortable symptoms and even damage the eye in some cases, but relief may be as close as a roll of adhesive tape. A study published in the Archives of Ophthalmology studied a prospective, consecutive, comparative, nonrandomized, interventional case series consisting of 50 patients (100 eyes) with turned eyelashes and at least 1 of the following symptoms: tearing, itchiness, and/or sensation of a foreign body.

Inturned eyelashes affect the elderly, as the eyelid margins sometimes turn inward as people age. Other changes can occur at the same time, including eyelid tissue laxity, disinsertion of eyelid retractors, tarsal plate shrinkage, downward displacement resulting from the effects of gravity, and enophthalmos or orbital fat. In addition to foreign body sensation, tearing, and itchiness, eye pain is also a symptom of inturned eyelids.

Chronic lateral conjunctivitis, corneal abrasions, and lateral angular excoriation of the eyelid margin are ophthalmic findings that sometimes accompany inturned upper eyelid lashes. In the most severe cases, the corneal epithelium can become ulcerated from prolonged contact with the eyelashes, causing permanent corneal opacification or blindness.

Surgery not Always Possible

Surgery is the standard treatment for this condition, but it may not always be feasible, as in cases in which an ophthalmic surgeon is not available or surgery cannot be performed for some other reason.

Injured upper eyelid lashes are very common in Asian people. The researchers noted that Asian women often use tape to create a double upper eyelid fold, and they wondered whether a similar technique might provide temporary symptom relief for patients with inturned upper eyelid lashes.

Tape Application

The upper lateral area of excess skin and muscle was lifted, elevating the lax tissue taht caused the eyelashes to turn inward. While holding the excess eyelid skin upwardly taut, the tape was firmly placed horizontally across the length of the eyelid about 5mm above the eyelid margin. This corrected the overriding preseptal orbicularis.

Slit lamp examination confirmed that the intruend eyelashes were no longer in contact with the globe. No other treatments were used for symptom relief. Patients were told to remove the tape once it no longer held the eyelid up and to record the length of time the tape remained in place. All patients were seen for a follow-up examination 2 weeks after tape placement.

Symptoms Relieved

Comparative results indicate an effective decrease of symptoms while the tape was on the eyelid as compared with both before and after adhesive tape placement. Because surgery is currently the only option available, the use of adhesive tape as described  could benefit patients with inturned upper eyelid eyelashes who may be unable to undergo surgery or when no surgeon is available to treat the condition.

Topical Anesthesia Preferred for Cataract Surgery

Worldwide variations in the use of anesthesia for cataract surgery are underscored in a Chinese meta-analysis of published randomized clinical trials that did not consider the most popular method applied in the United States. Ophthalmologists at the Shanghai Jiao Tong University School in China evaluated 15 randomized clinical trials comparing the performance of topical and regional anesthesia during phacoemulsification with lens implantation, study published in Ophthalmology.

The study concludes that topical anesthesia falls short of matching the ability of regional anesthesia (including retrobulbar and peribulbar anesthesia) for sparing patients from pain. But overall, the clinical trials indicated the topical approach led to similar clinical outcomes, eliminated injection-related complications, and mitigated patients’ fears about needle injections near the eye and orbit.

Thus, the findings suggested that topical anesthesia before cataract surgery is an inevitable trend for ophthalmology and its use will grow because of improved performance of phacoemulsification machines, better surgical techniques that lead to reduced incision sizes, and effects on the anterior chamber and iris. There were less frequent anesthesia-related complications such as chemosis, periorbital hematoma, and subconjunctival hemorrhage.

By contrast, intraoperative and postoperative pain was higher in the topical anesthesia group, compared with regional anesthesia. Also, inadvertent intraoperative ocular movement was observed significantly more often among patients who received topical anesthesia than among patients in the retrobulbar group and those in the peribulbar group. Those in the topical anesthesia group more often needed an additional intraoperative dose. Still, patients far more often preferred topical anesthesia over other pain-stopping options and the meta-analysis uncovered no significant differences in the surgical complication rate for the topical and injected regional approaches to anesthesia.

These findings do not reflect how phacoemusification is performed in the United States. The standard of care here has involved topical anesthesia supplemented by intracameral lidocaine for more than a decade. The protocol calls for the injection of a slightly dilute solution of nonpreserved lidocaine and epinephrine, which facilitates pupil dilation into the anterior chamber immediately after incision to instantly anestehtize the eye internally.

Long-Term Success of Trabeculectomy May Be High

The performance of trabeculectomy over a 20-year period indicates that this procedure is adequate for controlling intraocular pressure, according to a retrospective cohort study published in Ophthalmology. No previous study has evaluated the long-term efficacy of trabeculectomy and express outcome in terms of complete and qualified success, and blindness factors simultaneously.

Among 330 trabeculectomies performed, 60% of surgeries were classified as complete success, as indicated by a reduction in the intraocular pressure to less than 21 mmHg for high-tension glaucoma or a greater than 20% reduction in intraocular pressure for normal-tension glaucoma without the need for additional medication after 20 years of follow-up. 90% of surgeries were classified as qualified success, as indicated by a reduction in the intraocular pressure to less than 21 mmHg for high-tension glaucoma or a greater than 20% reduction in intraocular pressure for normal-tension glaucoma with the requirement for additional medication after 20 years of follow-up.