A successful glaucoma procedure takes more than just a surgeon. It requires a team approach with contributions from the ophthalmologist as well as his or her staff members who handle everything the doctor doesn’t.
When asked what the technicians do for glaucoma surgery patients, Steve Sarkisian, MD, founder and CEO of Oklahoma Eye Surgeons, said, “A more appropriate question is what aren’t they doing?”
Not only can all of his techs do all necessary glaucoma testing, but they are also financially incentivized (and required) to get their ophthalmic scribe certification so they can act as scribes during procedures, correctly putting all necessary information into the EHR system.
“I’m really dependent on my team to do everything besides the physical logging in and signing off,” he says. “They’re doing all of the testing and the documentation. I’m helpless without them, and I wouldn’t want it any other way.”
Prepping for and carrying out surgery
A successful surgery starts with the ophthalmic tech, says Dr. Sarkisian, “making sure that when I walk into the exam room or the OR I know exactly why that patient is there, and if there is any other issue that is more behind the scenes, like a relative is sick or something else is affecting them.”
For Christine Larsen, MD, and her practice at Minnesota Eye Consultants, a nurse circulator brings each patient back to the operating room and preps them, applying betadine and cleaning the surgical field before Dr. Larsen drapes the patient.
In addition to the nurse circulator, glaucoma surgery at Minnesota Eye typically involves a nurse anesthetist and a scrub technician. During the surgery, the nurse circulator keeps track of all surgical documents and the time in and out of the room, and he or she is responsible for obtaining anything needed that isn’t already available, opening additional medications and instruments as needed. They are also trained to work in the pre- and post-operative areas. The nurse anesthetist provides the anesthesia for the patient, and the scrub tech primarily hands instruments to Dr. Larsen. “Sometimes they do also assist on the field, although I would say that’s pretty rare,” she says.
Minnesota Eye Consultants also utilizes ASC assistants, who sterilize the instruments before cases. Some of these assistants are cross-trained to be scrub technicians.
Understanding the procedures
Dr. Sarkisian says his surgery scheduler, techs, and scribes all know about the different procedures he performs to treat both glaucoma and cataract. “I think it’s good for the staff to know what their doctor likes to do, to understand that there are different ways to lower pressure. We do morning meetings several times a month where we reinforce our patient-centered approach and also teach them about all the technology and procedures.”
His glaucoma surgical staff may assist with and need
to know about a number of procedures and devices,
• Selective laser trabeculoplasty (SLT)
• Endoscopic cyclophotocoagulation (ECP)
• Transscleral cyclophotocoagulation (CPC)
• Tube shunt surgery (e.g., Ahmed glaucoma implant)
• XEN Gel Implant (Allergan)
• Minimally-invasive glaucoma surgery (MIGS) approaches and devices, such as iStent inject and iStent infinite (Glaukos), Hydrus MicroStent (Alcon), OMNI surgical system (Sight Sciences), iTrack (NovaEye), SION (Sight Sciences), TrabEx (MST) and iPrime (Glaukos).
• Cataract surgery and all the lens types to mitigate presbyopia and treat astigmatism as well as other tools such as femtosecond laser and intraoperative aberrometry.
Beyond the OR
All staff members play critical roles in the entire glaucoma surgery process, says Dr. Sarkisian.
“I can’t stress enough how important the staff is, even the front desk people understanding how I do things the way I do them and why,” Dr. Sarkisian says.
He points out the importance of overall efficiency and says some of this falls to his excellent clinic director and operations director. “While I’m busy seeing patients and doing surgery, these supervisors are enforcing and encouraging that our core mission is being carried out. It starts from the very beginning of the first contact with a patient. Every member of my staff knows that their job ultimately is to be a light in a dark place for my patients. Their ultimate job is to keep the main thing the main thing, and that is to make the patients feel cared for and listened to.”
Techs also write notes on the patient’s primary concern and make sure Dr. Sarkisian isn’t surprised by any recent changes in the patient’s life, whether it be the patient’s birthday, or their spouse was just diagnosed with a health concern, etc. He ensures the techs know the right questions to ask. Dr. Sarkisian even encourages patient-staff interactions outside of appointments and surgery to ensure a positive experience for patients after they leave the office. To do so, he provides all staff members with a personalized business card to give patients, who can follow up by direct email to the tech who worked with them and who will remember them and their issues.
“There’s a person behind those eyeballs,” he says, “and you have to train your staff to treat the person, as well as to fulfill your needs as a surgeon, to have the best outcomes.”
Dr. Larsen agrees that surgery center staff are an invaluable part of providing excellent patient care. “They are outstanding in the multiple roles they perform and make the surgical experience wonderful for our doctors and patients alike.”
As mentioned above, her nurse circulators work not only in the OR, but also the pre- and post-op areas.
“They are the ones bringing the patient back, getting them ready for surgery, placing their IV, hooking them up to monitors, and going over any remaining questions they might have, before they are given anesthesia,” Dr. Larsen says. “And then in the recovery area they go over medications and activity instructions again, typically get the patient something to drink, make sure that they’re feeling okay, and then assist them out to their car when they’re ready to go.” OP