Recent study findings show selective laser trabeculoplasty (SLT) is a more effective first-line treatment for open-angle glaucoma and ocular hypertension patients than IOP-lowering eyedrops.

SLT, it is important to note, does not eliminate the need for drops altogether, as they may be necessary later in the treatment protocol, acknowledges Inder Paul Singh, MD, of Eye Centers of Racine & Kenosha in Wisconsin.

Thomas M. Brunner, president and CEO of the Glaucoma Research Foundation explains: “It’s a much less invasive way for these patients to maintain their target pressures while simultaneously solving the long-standing patient-adherence-to-drops issue.” (For the full study, see https://bit.ly/2NWna9y .)

So, how can the allied health staff contribute to the success of a practice in which the doctor decides to incorporate SLT as a first-line treatment choice? Here, we provide tips from those who have successfully adapted.

Prepare for patient questions

Allied staff should undergo training on how to answer common patient questions about SLT, say those interviewed.

“Patients expect surgeons to succinctly describe the laser and discuss the procedure’s safety to help them make a decision,” points out Mark A. Latina, MD, of Advanced Glaucoma Specialists, in Reading, MA. “They expect staff to help with any additional information they may desire.”

Dr. Singh agrees. He says he takes the lead on educating patients on the two treatment choices. He may lay out the options as such: one or more IOP-lowering drops, which are used daily and have potential side effects, such as stinging, or a “light source” procedure that “naturally rejuvenates” the eye’s drainage system and also has potential side effects, such as postoperative inflammation and temporary IOP elevation.

 

 

“After briefly explaining that an IOP-lowering drop may still be needed as an adjunctive treatment to SLT down the road — drops remain a crucial treatment for glaucoma — I hand off the patient to my scribe, introducing her as someone who can provide more detail, and then I leave the exam room to see the next patient,” he remarks.

Dr. Singh says his practice has both held and sent allied staff members to attend courses on what, specifically, occurs during SLT, so they can satisfactorily answer patients’ questions.

Pam Lightfield, laser technician and research coordinator at Eye Centers of Racine & Kenosha, explains that when asked, “What can I expect when I have the procedure?” she provides the following basic steps as an answer:

• A tech provides and receives the patient consent signature and answers any remaining questions. A pupil constriction eyedrop (such as pilocarpine) is also administered.
• Second, the tech instills an anesthetic drop in the eye.
• Third, the doctor adjusts the chair and slit lamp, inserts the gonio lens, adjusts the laser, calibrates the power, and performs the procedure.
• After the procedure, the tech places another drop in the eye to ensure stable eye pressure.
• Following roughly 10 to 15 minutes, a final pressure check occurs, before the patient is released.

Other common questions to prepare for include: “Does insurance cover SLT?” “Will SLT wear off?” and “What will my eyes be like right afterward?” those interviewed say.

Put office procedures in place

Offering SLT as a first-line treatment requires one or more specific time slots for the procedure per week, due to patient demand and pre-and post-SLT patient care (explained above), say those interviewed.

“Surgeons who have lasers in-house but who aren’t offering SLT as a first-line treatment are probably performing two procedures a week on the same day as the patient’s appointment, because they can squeeze them in between patients scheduled to undergo other laser procedures,” explains Nathan M. Radcliffe, MD, a glaucoma specialist at New York Eye Surgery Center in New York City. “When offering SLT as a first-line treatment, many more patients will be interested because of the procedure’s safety profile, its efficacy and convenience. So, squeezing them in between other patients won’t be feasible.”

In recognizing this, allied staff at Eye Centers of Racine & Kenosha schedule all laser surgeries, including SLT, for two days a week in the morning, says Dr. Singh.

“The patients present in blocks, sign their consent forms, receive their pilocarpine, and we begin calling patients in, one by one, with a designated tech obviously cleaning the equipment between each procedure,” he explains. “The whole process takes roughly two-and-a-half minutes per patient. Then, we have the rest of the day for our normal clinic.”

Dr. Latina says he, too, schedules SLT patients on the practice’s “laser day,” which is one afternoon a week, or patients can be booked at the surgery center during a regularly scheduled surgical block time. “[Doing so] is very easily incorporated into the normal flow of the practice,” he says.

A caveat: Practices that contract with ambulatory surgical centers (ASCs) that house lasers or that rent lasers from fellow practices need to plan ahead when creating laser day schedules, as these schedules are based on the availability of these entities, says Dr. Singh.

Dr. Radcliffe adds that, as SLT is incorporated as a first-line therapy, the workload with scheduling and billing these procedures and, in rare cases, prior authorization process, will increase. However, as this is a compensated part of the practice, an administrator should be able to take funds from the performance of the laser treatment and apply them to bringing on additional help to accommodate.

Ms. Lightfield describes that SLT administrative tasks are as basic as providing the diagnostic code to the insurance company and finding out the patient’s co-pay in addition to the scheduling of the procedure.

Simplifying the service

Ophthalmology practices that have thrived in offering SLT as a first-line treatment have successfully utilized staff by preparing in advance to answer patient questions and scheduling laser days.

Given the procedure’s positive effects on patient quality of life, it certainly makes sense that ophthalmology practices are seeing the light. OP