THE ENGAGED PRACTICE

How a Perfectionist Cuts Chair Time

The OPD-Scan III plays a central role in one surgeon’s pursuit of best outcomes.

BY ERIN MURPHY, CONTRIBUTING EDITOR

The word “best” comes up often when talking to Cynthia Matossian, MD, FACS, founder of Matossian Eye Associates, an integrated ophthalmology-optometry practice with three offices in Pennsylvania and New Jersey.

“I always say my first priority is what is best for my patients. I want to try my hardest with whatever technologies are available to get them their best potential visual outcomes,” the surgeon explains.

In Dr. Matossian’s practice, the means of achieving the best have been methodically thought out from start to finish. In addition to her surgical skills, technology and staffing strategies ensure the practice consistently meets her exacting standards. The OPD-Scan III (Marco) has played a central role in helping meet her clinical goals and engaging high-level technicians in the process helps to reduce her patient chair time.

Doctor Knows “Best”

Clinically, Dr. Matossian wants data that will help her produce the best outcomes. She uses the OPD-Scan III to both measure and explain these key factors to her cataract patients:

K values: Dr. Matossian uses the OPD-Scan III wavefront analysis to determine Ks and checks the values against those obtained through at least three other methods. “If there’s a > 0.5D difference in the overall amount of cylinder or a larger than 10˚ difference in the location of the steepest axis, I stop and reevaluate the test results,” she says.

Corneal spherical aberration: Dr. Matossian reviews the corneal spherical aberration of every patient with the OPD-Scan III, and then matches the best IOL to the patient’s corneal data if the patient selects a monofocal IOL.

Astigmatism pattern: By reviewing patients’ astigmatism pattern with the OPD-Scan III’s axial map, Dr. Matossian and her staff can show them their astigmatism and recommend a toric IOL, if appropriate. “It’s hard for a patient to understand the concept of astigmatism, but it’s easy to see a color bowtie pattern on the map. Once patients visualize the astigmatism on our large screen monitor, they understand the need for correction with a toric IOL, and they select one if they are financially able,” she says. “I recommend toric IOLs for patients with 1.25D of astigmatism or greater as long as it’s symmetrical and the patient is a good candidate.”

Irregular corneas: Like astigmatism, irregular corneas are important to show patients, according to Dr. Matossian. “Patients who have very irregular corneas aren’t candidates for multifocal or toric IOLs, but I still need to mention those lenses and explain why they wouldn’t be effective,” she explains. “I don’t want patients to wonder why I didn’t offer them the IOL that a spouse or friend has.”

Dry eye: With the placido disc map, she shows her patients, who often don’t know that they have ocular surface problems, the evidence of chronic pre-existing dry eye disease. “The placido disk map shows concentric circles on the cornea, which should be equal and perfect. I explain that if those circles are warped or irregular or vary in width, then the tear film is not healthy. That can affect surgical outcomes,” explains Dr. Matossian. In her practice, “compliance with dry eye therapy leading up to surgery has improved because patients can see the problem. And if they have symptoms after cataract surgery, patients know that it isn’t a result of the cataract surgery.”

Angle Kappa: The angle kappa measurement and higher order aberrations determine, in part, whether Dr. Matossian recommends a multifocal IOL. “It’s one of several ways that the OPD-Scan III not only gives us the information we need to make decisions, but also helps us educate patients,” she says. “When patients have a very large positive angle kappa, I can show them that they may not be a good candidate for multifocals. I might recommend an accommodative lens to achieve good distance and intermediate vision.”

The “Best” Techs Cut Chair Time

Dr. Matossian only has trained senior technicians perform cataract surgical testing. Two of those technicians, head technician Nicole Thompson, COA, and Kristina Farley, COA, spend a typical day seeing general ophthalmology patients, cataract consults and postoperative patients, as well as cataract surgical testing appointments that are scheduled every 45 minutes.

For surgical testing patients, Ms. Thompson and Ms. Farley must be both technician and educator. While performing the OPD-Scan III and other tests, they discuss each patient’s IOL options based on extensive training they’ve received from Dr. Matossian.

“Dr. Matossian is very precise about what exam data tells us about IOL options,” Ms. Thompson says. “Just by looking at test results for our cataract surgery patients, Kristina and I know if we should talk about multifocals, torics or limbal relaxing incisions.”

“The OPD-Scan III removes any guesswork from determining a patient’s visual potential,” says Ms. Farley. “I can show patients that potential with graphic maps of their astigmatism, corneal dystrophy or keratoconus. It helps me engage the patients and explain why they have certain IOL options and why they can, or cannot, expect a 20/20 outcome.”

All of this work by Dr. Matossian’s highly trained staff reduces the surgeon’s chair time.

“We list all the IOLs for which a patient is a candidate. We don’t go into what the lenses are, but we explain what vision the patient will achieve from each lens,” Ms. Thomson says. “Next, the patient sees Dr. Matossian. During the exam, she hears the patient’s thoughts on the options we’ve laid out, gets more information about the patient’s lifestyle, and recommends an implant. By explaining the options to patients in advance, we reduce Dr. Matossian’s chair time.”

Training the “Best” Methods

Dr. Matossian has put thought and work into building this system around the OPD-Scan III. All of the eye care practitioners in her practice can use the OPD-Scan III for a variety of purposes, including advanced clinical evaluations or placido disc imaging for dry eye. But for cataract cases, only four technicians are trained to determine IOL candidacy based on the results... and have that discussion with patients.

“Dr. Matossian does a good deal of training with us,” explains Ms. Thompson. “We don’t want to tell someone that they’re not a candidate for multifocal IOLs and find out we were wrong. Dr. Matossian clearly lays out what numbers exclude multifocals, what a toric candidate looks like, and so on. She goes over guidelines and teaches us to have that conversation with the patient. It’s a very smooth series of discussions that work well for our patients.” ●

Cynthia Matossian, MD, FACS can be reached at cmatossian@matossianeye.com.

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