THE ENGAGED PRACTICE

Better Flow Means Faster Diagnoses

By adding advanced testing to the initial screening, one practice limits retesting and makes more complete diagnoses.

AN INTERVIEW WITH JONATHAN H. TALAMO, MD
BY ERIN MURPHY, CONTRIBUTING EDITOR

Is it really possible to spend less time with patients while adhering to the same rigorous standards of care? Your ability to do so may reside in your screening tests.

Typically, patients who enter an ophthalmic practice go through a series of standard tests performed by technicians before they continue to the doctor’s examination. If the exam reveals a problem such as cataracts, keratoconus or retina disease, or if patients express interest in refractive surgery, then they return for more extensive testing. The physician evaluates those tests for a more complete diagnosis and starts a treatment plan.

At Talamo Hatch Laser Eye Consultants in Waltham, Mass., a busy cataract and refractive practice that also treats many patients with keratoconus, founder Jonathan H. Talamo, MD, decided to change this process. For the past 18 months, he’s been using the OPD-Scan III (Marco) as part of his first-line testing for all patients. The OPD-Scan III simultaneously performs autorefraction, keratometry, placido disc topography, wavefront aberrometry, angle kappa measurement and pupillometry.

This approach allows Dr. Talamo to deliver a faster diagnosis and initiate treatment planning for most patients in a single visit.

“We wanted something that would combine and automate testing in an inline fashion that allowed comparisons between important aspects of the refractive and anatomic states of the eye. It also had to be quick and efficient to use so we could screen every patient who came into the practice. The OPD-Scan III fulfills those needs,” he explains.

Saving Time

The inherent speed and automation of the OPD-Scan III are key to its value at Talamo Hatch Laser Eye Consultants, as is the workflow Dr. Talamo has designed around the system.

“The OPD-Scan III saves a tremendous amount of time. It gives us high-quality images very quickly, and we obtain results that would normally require three or four instruments as well as manual testing,” he says. “Getting an accurate refraction, pupillometry, topography to view the anterior corneal curvature, wavefront and other interpretive data are all within the system’s capabilities. And the combined diagnostic suite is very easy to use.”

Many patients in the practice are referred for cataract or pathology, but doctors also see many healthy patients who express interest in corrective surgery options. Dr. Talamo has the data he needs when these patients walk in the exam room. “With the OPD-Scan III, when I see patients for the very first time, I already have much of the information I need without tying up staff to perform more testing. We can have a conversation about refractive or cataract surgery options immediately.”

When Dr. Talamo trained his technicians on the OPD-Scan III (training is also available from Marco), he made sure they understood not only how to perform the tests, but also how to understand what the results meant. He explained what he was looking for on the system’s maps, customized the displays for their needs and taught technicians to use the software to its full potential.

“We find the OPD-Scan III very easy to use. We have a large population of elderly patients, and the device is a very quick and easy experience for them,” explains Emily Woodcock, senior technician at the practice. “Now we use the OPD-Scan III on every new patient who walks through the door. The system has become the first choice for screening. Refractive and cataract evaluations and dry eye confirmation are quick and clear, and we get additional important information for surgeons, such angle kappa and internal versus external astigmatism.”

Used as part of routine testing, the OPD-Scan III’s capture and processing speed and its role in smart workflow coordination have proved very rewarding.

“This improves patient flow tremendously because technicians aren’t guessing what tests I might want. No matter what established problems or complaints a patient has, or if it’s a new patient, or someone who wants surgery, my technicians know that I want the OPD-Scan III,” says Dr. Talamo. “We have evaluation matrices set up on the OPD-Scan III for cataract, refractive surgery and keratoconus, as well as for new patients whose status is unknown, and the technicians have the knowledge to perform additional testing based on the results. For example, if a patient comes in for refractive surgery and the device shows astigmatism or topography, our technicians are trained to recognize what is normal versus abnormal, so they can redirect the workup and the conversation.”

Gaining Information

The automated OPD-Scan III not only has trimmed workup time at Dr. Talamo’s practice, enabling him create a faster and more favorable patient flow, but it also has given him additional key data to support clinical decisions.

“The system gives us efficiency as well as diagnostic capabilities that aren’t routinely available with other devices,” he explains. “And while I would normally have to put together data from different devices in my head, the OPD-Scan III does it for me seamlessly. For example, I’m able to look at aberrations and see where visual distortions originate. The point-spread function separates aberrations due to the corneal shape or ocular surface changes from those inside the eye.”

Dr. Talamo also uses the device to assess patients who have had toric lens implants but don’t meet expectations for visual acuity after surgery. “I dilate the patient and perform a scan with the OPD-Scan III, and we see if the lens has rotated,” he says. “If so, the rotation may explain the residual astigmatism.”

Graphic displays on the OPD-Scan III make it valuable as a teaching tool as well. When patients visualize the problem, they understand the necessity of treatment and support the doctor’s recommended approach. It is also valuable in managing patient expectations concerning outcome limitations.

“It’s very helpful to show patients their dry eye, especially if they don’t have overt signs of severe dry eye. I also show patients retroillumination images of their cataracts, and if patients with wide angle kappa are interested in a multifocal lens, I can show them why that may not be a good choice,” explains Dr. Talamo, adding, “Whether I’m diagnosing a problem, planning treatment or engaging my patients in that process, the OPD-Scan III is a very valuable system.” ●

Jonathan H. Talamo, MD, is founder of Talamo Hatch Laser Eye Consultants in Waltham, Mass.

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