Providing a Lifetime of Eye Health Care

As eye health care providers, we have a duty to provide care to our patients for as long as they remain in our care. My patient base spans the whole range of life stages. Most patients have been with me between 5 and 10 years; about a quarter have been with me more than 10 years, and a small portion have been in my care for 2 years or less. I have accompanied many patients through the different stages of their lives—from fitting them with multifocal contact lenses to guiding them through cataract surgery. I know exactly what’s happened all these years with their eyes because of this continuum of care. My practice may not offer all the bells and whistles of online contact lens ordering and the like, but it operates on open and frequent communication with my patients, which has built a strong foundation of trust, and that has led to strong patient retention and steady referrals. In this article, I’ll explain more about how communication and trust has really become the foundation on which the success of my practice relies.

THE CONTINUUM OF CARE IN A SNAPSHOT

For my adult patients, I aim to make their eyes and vision as great as can be for work, as well as social and active lifestyle pursuits. I do throw in some preventive discussion in the hopes that, years from now, when they are in the senior category, there’s less need to discuss disease management.

I tend to talk more aggressively to my senior patients about more frequent follow-up visits or their care in general because things can change more quickly for them on the eye health front, as so many eye conditions are age-related.

For my younger patients and their parents, the prevailing topics are worsening prescriptions and what they get at the pediatrician versus what they get from us as eye care providers. So, there’s an education component here. To me, this is a good place to introduce the myopia conversation. We’re so screen-dependent today that we’re seeing nearsightedness in children a lot more prevalently than we used to. While there have been many new technological advances in this area recently, I still think it’s important to discuss options such as MiSight 1 day soft contact lenses (CooperVision) and Acuvue Abiliti 1-Day lenses (Johnson & Johnson Vision), orthokeratology lenses, and plain old progressive glasses—even if a child doesn’t need them at the time—simply to educate parents about the condition and the options.

There are children who don’t need glasses and come in for their wellness exam so their parents can rest easy knowing everything is okay. The goal with these patients is to maintain that perfect vision for as long as possible. I may prescribe blue light protection with no prescription for any child who logs prolonged screen time if they don’t need prescription glasses.

Other points I like to bring up, not only with young kids and teenagers but with all my patients, is screen time, appropriate lighting, digital eye strain, and adhering to the 20-20-20 rule—or at least taking screen breaks. I have different banks of lighting in our rooms to show patients examples of what’s too bright (eg, having a spotlight right over you in a dark room), too dim (where the eyes have to strain, such as when kids read things in the dark under their bed covers), and the ideal balance of (ambient) light in a room. During this discussion with my younger patients, I think it’s important for them to know it’s not just targeted at them. A lot of kids take cues from their parents, and there are a lot of parents who don’t look away from their phones either.

BULLET-PROOF PATIENT MESSAGING

Most patient education happens in the examination room, but when it comes to things like contact lens and lid hygiene, we have written out step-by-step instructions, and we have staff walk patients through them and make sure they understand. Ensuring patients of any age receive consistent messaging throughout their visit starts with appropriate staff training.

More specific messaging, such as those related to makeup use and proper removal, I bring up as necessary, explaining to patients the importance of removing makeup at night to keep their lid margins clean. Additionally, if someone schedules an office visit to be seen for a stye or other meibomian gland or dry eye issue, I discuss washing one’s face in the shower as a general rule, gesturing to show them how to scrub along the eyelids to get a good digital massage to remove anything that cakes on the glands.

I typically wrap up my patient examinations by summarizing best practices. I may explain that, although these aren’t findings I see in their eyes, I do like to remind every one of my patients that sunglass protection is extremely important because the ozone is changing and UV protection is important. I also have a conversation about the importance of a healthy diet and eating across the rainbow of fruits and vegetables to promote the best health for the macula and overall eye health.

AUTOMATION: NOT FOR EVERY PRACTICE

We tested the use of certain automated reminders, and while some patients responded well, others didn’t want to be bothered by the constant messaging. If I have something to recommend to a patient or for specific follow-up purposes, I’ll make a note of it and either call them myself at the appropriate time or have a staff member call them to touch base. Likewise, if there’s a new product, device, or drug that may benefit a patient, such as the newest FDA-approved eye drop for dry eye, acoltremon ophthalmic solution 0.003% (TRYPTYR, Alcon), I incorporate it as part of the patient conversation as I go through the examination, or at the end. It’s a bit more manual of a process, but I think it reassures patients we’re staying on top of things personally and taking the time to reach out in discussion or answer any questions.

As I mentioned, we don’t offer online contact lens ordering. We try to capture most of our annual supplies for soft lenses upfront when patients check out because that is obviously still the best retention. I prefer the in-person transaction, but we also try to educate patients on why they should want to buy their lenses from us. That’s probably one of the harder points, sometimes, especially because we often can’t be as competitive as some of the online sites.

WHY PATIENT RELATIONSHIPS ARE IMPORTANT

Establishing and maintaining a relationship with your patients builds a level of trust and helps them understand where you’re coming from as far as caring for their eyes and for them as a person. It also helps them trust what you’re telling them when there’s so much else out there getting thrown at them. So, hopefully they will seek your advice and ask your professional medical opinion on what to do when they wake up with red eyes, rather than self-diagnosing and using some random drops off the shelf at the pharmacy.

We value our patient relationships and try to give an elevated personalized level of care—one where they call and know they will get a call back with an answer hopefully within half a day, if not a day. I try to keep that call back to 24 hours when possible, so patients know we’re here for them and can answer any questions they have so they don’t resort to asking Google. It’s about building that value into what we do. Patients see and understand that.