Resources to Remember
What to know about fitting scleral lenses for dry eye patients.
Do you have a good fit but poor vision in a scleral lens patient? Here is your guide to troubleshooting these and the rest of your dry eye patients with scleral lenses. Screenshot and print out Table 1 for a cheat sheet in your exam lane. Well done, Zachary Reynard, OD, and Jeffrey Sonsino, OD. Optometry Advisor
It's a bit of the wild west with PBM and AMD.
Only one FDA-approved option exists for using photobiomodulation to treat AMD. However, several other modalities are being touted as equally effective for AMD patients. The evidence is observational and anecdotal, but still compelling. Here are two optometrists sharing their success by using a different platform and protocol for their patient population. The Power Practice
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Build a consistent protocol for every AMD patient
A one-day working session to systematize your AMD management and get your full team aligned for a higher standard of patient care
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Articles to Apply
Systemic vascular risks after RAO and RVO.
This new article analyzed the incidence of systemic vascular events after retinal artery and vein occlusions, both central and branch varieties. Unlikely news to you, artery occlusions were found to significantly increase the risk for all types of systemic vascular conditions: ischemic stroke, ischemic heart disease, myocardial infarction, atrial fibrillation, and mortality. Retina
Quotes to Consider
"A good system is more than a bunch of rules you try to keep in your head, principles you promise yourself that you'll remember and obey in the future. In fact, a good system is not in your head but outside of it. A good system is a setup with tangible, visible features designed to guide your future choices - even when you forget, and regardless of your motivation at the moment. A physical setup is more enduring - and more powerful - than any promise. - Angela Duckworth, Situated
My Observations
Protocols are hot right now.
Or, protocols are cookin’, as my teenager would say.
There’s a protocol for your optimal morning, your mood, your brain function, your longevity. Everyone’s selling one.
For eye care, we've been teaching protocols for years, whether that's myopia management, glaucoma, dry eye, or AMD. Whatever the disease state, I’m confident we were the OG of protocols in this space.
Now every consulting group and doctor network has one. If yours isn’t teaching you to build and refine real protocols, ones that actually increase medical management, leave and find one who does.
So what makes a protocol good?
I’ve built enough of these with practices to know the answer isn’t more detail, nor is it less.
A good protocol has to be prescriptive enough that a doctor can actually implement it, while staying loose enough to flex around your team, your patient flow, your demographics, your insurance mix, and the equipment you already own.
There’s a real sweet spot here. Hand a doctor a protocol with every decision made for them, and you get zero ownership. Nobody follows a script they didn’t help write. Hand them a vague set of principles and no structure, and you get inertia. Too much confusion, not enough momentum, and the protocol dies in month two.
So here’s the 4-part structure I’d recommend to get started, using AMD as the example.
Protocol trigger, or cue. What will compel you to act if you see or hear it? Family hx? Macular drusen? RPE changes? Choose what your standard will be for you and your team.
Initial treatment/education plan. What will be your standard recommendation for initiating intervention for this patient? Supplements? Education? Amsler Grid? How long will you wait until you have them back? Write that down for the entire team to remember.
Problem-focused eval. What will be your standardized AMD eval? Which special tests will you perform at every eval? What will be your typical E&M level and testing codes used, so the front desk isn’t guessing?
Ongoing care plan. For AMD, it is best to set a care plan that is disease stage-specific. The Beckman classification for AMD is best: normal aging, early, intermediate, late. Each stage carries a different progression risk, and your follow-up cadence should reflect that math, not a blanket “see you next year.”
Following these 4 steps is enough structure to get you started and build some momentum. So get after it and get it out of your head and onto a document.
However, you may have lingering questions: what if I want to do OCT and photos on the same day? Can I bill for that?
Or, how do you integrate annual refractive care into the mix of my AMD patients?
Which patients will have the best outcomes with anti-VEGF and GA treatments? Can I or should I recommend supplements for both at-risk and early AMD patients?
Or, how do I integrate photobiomodulation into my practice, and how do I charge for it?
All those questions and more will be part of our one-day AMD Implementation Workshop on October 29 in Grapevine, TX. There are only 50 seats available, so act fast.
Regardless of what you choose, the call is clear: create a system that works for you and your team. Use the 4 steps as outlined above, or let us guide you with more direct applications to you and your unique practice.