The future will bring an influx of glaucoma patients due to an aging population as well as more patients with angle-closure glaucoma, stemming from an influx of immigrants. Increasing the efficiency of the clinical and business sides of the glaucoma practice is a must for survival in this changing environment. Some procedures that can increase cost efficiency include gonioscopy and tailoring visual field testing to the patient.
Dallas-If you think your glaucoma practice is busy now, just wait a decade or two. By then, the number of patients with glaucomatous optic neuropathy will have doubled worldwide, and efficiency will be the key to survival, according to Ronald Leigh Fellman, MD, OCS.
Efficiency is defined as performing in the best possible manner with the least waste of time and effort, said Dr. Fellman, a glaucoma specialist in private practice in Dallas. In glaucoma practice, the goal is to provide therapy that will preserve vision for the patient's lifetime with minimal treatment side effects. Maintaining or improving efficiency in this setting is a formidable task because the context of therapy includes longer life expectancy and an incurable disease, he said.
Clinicians need to address both the clinical and business sides of their practices to respond adequately to the growing caseload of patients with glaucoma, he said, offering tips for improving efficiency-and, ultimately, preventing blindness.
Gonioscopy is essential to the evaluation and management of glaucoma, he added. Its use can help clinicians to make the correct diagnosis-eliminating waste and improving the medical, legal, and ethical aspects of glaucoma care.
Another reason to make gonioscopy a standard part of the examination exists, however; angle-closure glaucoma will become more common in coming decades because much of the growth in the United States population will occur through immigration, Dr. Fellman predicted. Many of the newcomers will be from populations in which a high incidence of angle-closure disease exists.
Complicating this increasing incidence is the fact that angle-closure disease often is "silent," Dr. Fellman said. "If we're not looking with gonioscopy, we're going to be missing the opportunity to prevent a lot of blindness. There's no excuse for that."
Ophthalmologists with compression gonioscopy skills will have an efficiency advantage as these patients start flowing into their practices, he added.
Dr. Fellman recommended that clinicians who may need to upgrade or refresh their skills seek training to enable them to perform this task effectively. A Web site provided by the University of Iowa, http://www.gonioscopy.org/, is a useful educational resource dedicated to teaching gonioscopy through videography, he said.
Gonioscopy is cost effective compared with many of the new anterior chamber imaging devices on the market, Dr. Fellman added.
Another suggestion he offered for maintaining efficiency while using gonioscopy was to stay current on the coding for this procedure through resources such as the materials and courses available through the American Academy of Ophthalmology (AAO). Dr. Fellman said his favorite is the Ophthalmic Coding Coach (available as a book or CD-ROM) produced by the AAO and written by Sue Vicchrilli, COT, OCS.
Visual field efficiency
One simple method of improving visual field efficiency is to remember that one field does not fit all patients.
"Ordering the same field, patient after patient, is incredibly inefficient at preventing blindness," he said. "We have to perform in the best possible manner with the least waste of time and effort. This applies to both the physician and the patient.
"The physician should create an upbeat atmosphere for patients and set them up to succeed by ordering the optimal visual field test," Dr. Fellman concluded. "We don't do that enough. Select test parameters to match the disease stage. One field for all is not glaucoma-clinic efficiency."