Tell Me Your Secrets to Upping Your Game
By Jatniel Rodriguez, BA, MA
Key Takeaways:
Guiding Unhappy Patients- Listen to the patient, be intentional with your word choice, use objective data to show progress, and focus on the future.
Learning New Surgical Skills- Use digital resources, surgical simulations, skill transfer opportunities, and mentorship to acquire new skills.
Glaucoma Procedures- Pay attention to signs of noncompliance. SLT is the first line treatment, choose a technique you are comfortable with to treat your glaucoma patients.
Remote Patient Monitoring- Home OCT provides earlier detection of wet AMD and may provide a paradigm shift in future treatment approaches.
Refractive Procedures- Three leading treatments are PRK, LASIK, and SMILE. Always treat dry eye first before PRK to help the healing corneal epithelium.
“Secrets to Upping Your Game” was a session held at the Spring RWO virtual meeting “Tell Me Your Secrets” in April 2024. Moderated by Dr. RV Paul Chan and Dr. Ogul Uner, speakers discussed professional development in multiple areas including patient interactions, surgical skills, home monitoring, and procedures.
Guiding Unhappy Patients to Better Places
Dr. Eva Liang provided multiple tools to help approach unhappy patients. She emphasized EQ tools, IQ tools, and running the bases. EQ tools include listening, setting a calm mood, using language the patient can understand, avoiding words and phrases like mistake and wrong lens, and if necessary, reminding the patient that we do not process information well when we are mad. IQ tools involve thorough workup testing to further educate yourself and the patient. The analytical objective data can help show the patient they are progressing and getting better. Running the bases involves reminding the patient of the medical problem, reviewing medical and refractive issues, emphasizing positive outcomes and focusing on the future.
Learning New Surgical Skills After Training
Dr. Rahul Tonk highlighted various aspects of professional surgical development after residency training. These included digital resources, skills transfer, surgical simulation, mentorship, and putting all these elements together.
Digital Resources: ASCRS and AAO are two examples of websites providing clinical educational videos and webinars. Other exceptional resources include: Cataract coach, Eyeguru, and Oftalmo university.
Skills Transfer: Attending professional training sessions at AAO is the most effective single use of your time to engage in skills transfer. They provide you with hands-on experience and someone you can contact when you have a case utilizing that skill.
Surgical Simulation: Wet lab models, EyeSi, and HelpMeSee are great ways to practice surgical skills in a simulated environment.
Mentorship: Making new connections, seeking peer and senior guidance, and doing domestic and international observerships.
Putting it all together: Select the correct patients for the procedure, visualize your case, and postoperatively track your patients to make sure you are delivering the best surgical care possible.
Glaucoma Procedures for the Non-Glaucoma Specialist
Dr. Inder Paul Singh discussed glaucoma procedures, medications, patient compliance and safety. He emphasized paying attention to the clues of non-compliance. It is important to recognize glaucoma as soon as possible because the earlier the glaucoma is addressed the easier it is to control. The first line treatment for glaucoma is Selective Laser Trabeculoplasty (SLT). Dr. Singh highlighted patient discussions as a barrier to treatment and suggested using words or phrases like rejuvenation and gently enhances natural drain. He also recommended picking a glaucoma treatment you are comfortable with to make sure you have the skill set to treat glaucoma patients as necessary.
Adding Remote Patient Monitoring: Wet AMD & Home OCT
Dr. Christina Weng discussed the technological advances that allow for monitoring of Wet AMD in between patient visits. The Home OCT allows patients to capture high quality daily scans, processed by an AI that alerts the physician if there is a concerning finding. Home OCT offers daily scans and monitors fluid volume trajectory. It can be used to help avoid undertreatment or overtreatment with anti-VEGF injections and improve patient outcomes. These devices have been shown to user-friendly and provide accurate images. They allow for earlier detection of wet AMD and may provide a paradigm shift in treatment approaches. Although there are still various unanswered questions, there are exciting initial clinical trials such as the DRCR protocol AO, that are currently enrolling.
Refractive Procedures To Up Your Game
Dr. Vance Thompson began his session by emphasizing the importance of asking patients if they rub their eyes. Eye rubbing can cause changes in refraction among other problems. He also stressed the importance of identifying keratoconus early to allow for crosslinking procedures to strengthen the cornea and improve vision. Epithelial mapping with corneal topography is a standard of care at his practice since the earliest sign of keratoconus is epithelial thinning over the top of an area of steepening on topography.
He also highlighted the importance of patient reported outcomes, these go beyond just visual acuity and seek to understand the patient’s quality of the vision. It is noting whether the patient’s vision is crisp or fuzzy and includes asking about their night vision. The answers to these questions inform his next steps in care.
Lens changes are the cause of many lenticular complaints in refractive surgery. The three leading treatments are PRK, LASIK, and SMILE. PRK is a technique with consistent epithelial removal, consistent corneal hydration, and consistent microns removed by laser pulse. It is important to treat dry eye preoperatively for PRK to help the epithelium heal. LASIK and SMILE both involve cutting corneal nerve, however because SMILE cuts less nerve we see improved corneal sensation and less dry eye. Lens replacement is the last refractive option, and it is important for patients to know it has a high rate of satisfaction when employed.
Conclusion
The presenters in this session “upping my game” provided wonderful advice on professional development and answered questions on Home OCT implementation, additional resources, and taking first steps to utilize new surgical techniques and technologies in practice. These presentations are great points of reference, highlighting pearls useful for all ophthalmologists and furthering the coming bright future for ophthalmology.
Join the RWO community of young ophthalmologists to connect with peers, learn from experts, and enhance your understanding of key topics in ophthalmology!
Jatniel Rodriguez BA MA
Jatniel Rodriguez is a third-year medical student at Pacific Northwest University who joined Real World Ophthalmology in Fall 2023. His passion for ophthalmology has led to volunteering at community health events like the Seattle King County Clinic. He actively seeks creative ways to educate his Afro-Latino community on the importance of eye care. In his free time, Jatniel enjoys learning languages, singing, and playing soccer with his brothers.