PHOTOGRAPHY BY ABIGAIL VOLKMANN PHOTOGRAPHY

Loden Vision Centers recognize that comfort plays a significant role in the satisfaction of post-cataract surgery patients. That’s why the five-location Tennessee practice employs these two action steps: comprehensive staff training and comprehensive patient education. James Loden, MD, founder, and president of the 24-year-old practice, explains:

“Cataract diagnosis and cataract surgery can be scary to patients. We use comprehensive staff training and comprehensive patient education to allay these fears and manage patient expectations regarding the surgery itself and the IOL options. The desired final outcome is postoperative patient satisfaction.”

Here, the staff at Loden Vision Centers describe the components of the practice’s staff training and patient education programs.

Comprehensive staff training

“The practice provides a nine-week staff training program that, in part, focuses on educating our allied staff,” explains Meghan Kriner, COA, OSC, the practice’s clinical director, who oversees the curriculum.

This education enables staff to “impart this knowledge to patients who have cataracts. Knowledge creates patient comfort,” she says.

This curriculum includes a basic knowledge of cataracts, cataract surgery, and the IOLs the practice provides. This prepares staff to answer basic patient questions, such as:

• What is a cataract?
• How will the doctor fix my cataract?
• Can the doctor do anything for presbyopia?

“Staff are taught about our IOLs with the use of PowerPoints and given literature,” Ms. Kriner says. Morning huddles and group trainings are another avenue of dissemination.

Of note, Loden Vision Centers offers the following IOLs: Eyhance (Johnson & Johnson Vision), Light Adjustable Lens (RxSight), PanOptix Trifocal (Alcon), Tecnis Symfony (Johnson & Johnson Vision), and Clareon Vivity (Alcon).

“A common question cataract patients ask me during pre-testing is, ‘Can cataract surgery correct my astigmatism?’” offers Kiana Hodge, COT, the lead technician for Dr. Loden. “I, among other staff members, have the education to reply that the practice offers a laser-assisted cataract surgery option that can help correct some astigmatism, and that toric IOL options are also available for this purpose.”

The education also provides a full understanding of the purpose and operation of each related diagnostic device. Ms. Kriner says allied staff undergo this education via recorded videos of techs using the devices; role-playing as a patient (so they can empathize with the patient); operating the devices on a fellow tech under the stewardship of a senior tech; and using the devices on patients under the senior tech’s supervision before operating the devices solo on patients. (Incidentally, the practice uses the IOLMaster [Zeiss], iTrace [Tracey Technologies], and the Pentacam [Oculus]).

“It’s super uncomfortable being positioned behind or within some device without any explanation,” acknowledges Ms. Kriner. “In knowing why the device needs to be used, how it’s used, and how it feels to be the patient, allied staff are primed to explain these things to patients as well as commiserate with them. This calms patient fears.”

Lauren Poole, senior lead ophthalmic technician at Loden Vision Centers, points out that the staff’s skillset in acquiring accurate data helps pacify anxious patients:

“We are not trained with a ‘point-and-shoot’ mentality,” she explains. “Patients recognize and appreciate this, as we explain to them the importance of, as examples, positioning their heads a certain way and following our directions, so we can obtain the most accurate data.”

In addition to the initial nine-week staff training program, Ms. Kriner explains that the practice provides continuing education every quarter through webinars via BSM Consulting (www.bsmconsulting.com/webinars ) and the International Joint Commission on Allied Health Personnel in Ophthalmology (www.jcahpo.org/certification/ ), as well as monthly meetings during which topics such as customer service are discussed.

Comprehensive patient education

Studies reveal preoperative patient education works to increase patient satisfaction with cataract surgery.^1,2 The staff at Loden Vision Centers provide the following to assist with patient education:

A patient questionnaire. “We use a preoperative patient questionnaire to inquire about what the patient does for a living, their hobbies, desired vision, and their personality type,” points out Ms. Hodge. “It serves to educate the patient that their answers will be used in determining IOL selection and, therefore, play a significant role in the outcome and, thus, their satisfaction with their cataract surgery.”

Patient scripts regarding related devices. Ms. Poole uses this script as an example:

“This test is called the Pentacam. It will measure the front surface of your eye, the cornea. It will let the doctor know how much astigmatism you have and where it lies on the cornea. This test will be very bright and have a blue light that spins around in a circle. I will let you know when to blink and when to hold open your eyes. We will begin by putting your chin in the chinrest and forehead against the bar. Once you see a red light emanating from the device, focus on that light the entire time of the testing, so I can get the most accurate information about your vision.”

Dr. Loden notes that laminated cards containing each script are taped to each device, should a tech forget one or more of them.

A patient script explaining cataracts and the surgery. Iwaz Barwari, a physician assistant at Loden Vision Centers, who oversees refractive surgery evaluations, provides a sampling of this script:

“Inside the eye, there's a lens that becomes cloudy over time, creating blurred vision. We call this a cataract. In cataract surgery, that lens is removed and replaced with an artificial lens of your choosing that will stay with you for the rest of your life. The time to do surgery is when you want to see better. It does not hurt the eye to wait or make the surgery harder.

“However, your vision will not improve until you have the surgery. The surgery will take 10 minutes to perform. Cataract surgery is safe, with the risk of infection one in 5,000, and the risk of severe vision loss one in 15,000. A retinal detachment or macular edema can occur post-surgery. To treat these possible complications, you would undergo another surgery or use special drops, respectively.”

A patient script explaining IOLs. Ms. Barwari notes that she and Dr. Loden also employ a patient script that educates patients on IOLs in general and then the one or more IOL options relative to the patient:

“It’s important to understand that no IOL is perfect. It just doesn’t exist. Therefore, you need to understand both the imperfections and benefits of the IOL options relative to both your vision and lifestyle needs, so you can make an informed decision, and won’t be surprised or dissatisfied with the outcome of your cataract surgery.”

An example of a script regarding an IOL specific to the patient’s visual and lifestyle needs:

“Based on the pre-testing results, questionnaire, and a discussion of your desires for vision, you may be happy with either an extended depth of focus or multifocal IOL. As mentioned earlier, no IOL is perfect. With an extended depth of focus lens, it will provide strong intermediate and distance vision and reduced chance of glare and halos. However, your near vision won’t be as strong. With a true multi-focal lens, it will provide strong near and distance vision. However, you will likely notice both glare and halos when driving.”

Take-home educational material. Patients receive handouts regarding the discussed IOLs as a reminder of what was discussed and to aid them in their decision making, say those interviewed.

A pre-surgery video. “We send a video out to patients that explains what occurs during the surgery, such as the use of the LENSAR to break up the cataract,” points out Ms. Barwari.

Talking patients through the live procedure. Ms. Barwari says she lets patients know what exactly is going to occur, step-by-step, to keep them well-informed and, thus, at ease. For example, she informs patients that she’s first going to place numbing drops in their eye(s) to make them comfortable during the procedure.

“Verbally explaining to the patient what is going to happen and what they’re going to experience every step of the way alleviates their anxiety and makes them feel that they’re being cared for,” she affirms. “Both of these things work to create patient satisfaction postoperatively.”

Reminding patients of their preoperative education. Dr. Loden emphasizes that reminding patients of their preoperative education after their cataract surgery, beginning one-day postoperatively, works to continue to manage the patient’s expectations with the procedure.

Success!

Patient testimonials, found on the Loden Vision Care website, give credence to Loden Vision Centers’ two action steps focused on creating patient comfort. A couple examples:

• “… Everyone puts you at ease, especially the day of surgery, and makes sure you are comfortable.” – MW Johnson.
• “Dr. Loden and his staff were very competent and compassionate. They live up to their credo for providing ‘golden service.’ I highly recommend Loden Vision for excellent service and results.” – Lou Hollars. OP

REFERENCES

1. Nijkamp MD, Nuijts R, van den Borne B, Webers C, van der Horst F, Hendrikse F. Determinants of patient satisfaction after cataract surgery in 3 settings. J Cataract Refract Surg. 2000;26:1379-1388.
2. Pager CK. Randomised controlled trial of preoperative information to improve satisfaction with cataract surgery. Br J Ophthalmol. 2005; 89:10-13.