WITH AN EXPANDING ARRAY of tools to treat presbyopic patients, now including eyedrops, clinicians must balance the strength of offerings against their limitations while understanding the specific needs of the patient to find an ideal fit. Pharmaceuticals represent an important new opportunity, but even with a growing number of products soon joining Vuity, some patients may not be right for any drop. Indeed, patient needs are diverse. If you have seen one patient with presbyopia, you have seen one patient with presbyopia.

We should probably think of presbyopia not as a single condition but as a disability with an impact that affects different patients differently. For patients inclined toward surgery, how do we identify those who might benefit from these solutions, as patients don’t often “complain” about presbyopia? The conversation itself can take more time than most clinicians are willing to invest. If we could automate the conversation about presbyopia before patients reach the office, it would reduce patients’ fears while enhancing their understanding of options and give them confidence in their choices. For doctors and their staff, an automated solution would mean less time spent having repetitious conversations and increased revenue from more patients undergoing surgery.

We have evaluated and used a variety of options to engage with patients and distribute educational materials. Solutions like Rendia and Phreesia, and products from Patient Education Concepts all have value, but we wanted a package that handled both collection and distribution of information from and to the patient. MDbackline best met that need.

MDbackline is a secure, cloud-based platform that interfaces with our EHR system. It identifies patients with upcoming appointments. Prior to the appointment, it contacts patients, displaying the name and picture of the doctor, and it invites them to click a link to a website where they briefly verify their identity and answer questions related to their upcoming appointment. It can be configured to use “gating questions” to serve patients with dry eye, glaucoma, macular degeneration, and other diseases, but we have found its best use is for patients with refractive needs.

MDbackline collects information from patients while delivering educational material before their visit. For a potential cataract surgery patient, it takes about three minutes to complete the questions regarding current visual challenges, lifestyle, and visual desires. After completing the questionnaire, patients are presented with general information on surgery with a non-branded reference to the range of refractive options that are offered by the particular surgeon who will be treating the patient. Information on femtosecond laser-assisted cataract surgery is included for practices that offer this option. Toric lenses, or for practices who use them, presbyopia-correcting lenses, are also described without reference to manufacturer name, so patients can understand the offerings at a high level.

Educating patients on options prior to their appointment elevates and shortens the conversation once the patient reaches the lane. The complex information about the patient is conveyed to the practitioner with a highly concise, colorful Visual Profile Report (VPR). The VPR is a one-page graphical depiction of the patient’s responses along with a summary of the patient’s likelihood to elect a premium procedure or treatment. The average clinician takes about 15 seconds to review all this information. The high, medium, or low likelihood score is based on the combination of the patient’s responses using a proprietary algorithm that has been validated against responses from previous patients who did or didn’t choose a refractive lens upgrade option.

“I love seeing MDbackline’s Visual Profile Report, telling me each patient’s visual challenges and desires. It makes it so much easier for me and my staff to match the best technology to each patient, and MDbackline’s educational material goes way beyond other platforms in helping my patients understand their treatment,” said one colleague, Dr. Robert Melendez of Juliette Eye Clinic in Albuquerque.

Following the visit and the clinician’s recommendation for a specific lens, MDbackline contacts the patient to reinforce what was discussed. It is also able to check in at various points during the cataract surgery journey to give just-in-time information on what to expect and how to navigate the postoperative period most comfortably. About a month after surgery, the system contacts patients to see how they’re doing and alerts staff to any patients that might need follow-up. Finally, MDbackline directs happy patients to social media sites to leave positive reviews.

Treatments for presbyopia will continue to evolve over time (new drops, new lenses, new procedures like SMILE). At the same time, doctors will continue to have limited time for conversations. Automated solutions that enhance communication while saving doctors and staff time position us to succeed as our practices evolve to offering an increasingly complex array of new treatment options. ■

Dr. Hovanesian is a refractive cataract and cornea specialist in private practice at Harvard Eye Associates in Laguna Hills, California, and he is a member of the clinical faculty at the UCLA Stein Eye Institute.

Disclosure
Dr. Hovanesian has a financial interest in MDbackline.