By Frances Bynum, OD
Dec. 1, 2021
Every practice is different. If your patients are predominantly physically-fit 30-year-olds, your testing protocol might look a little different than mine. My practice has grown with me, and many of my patients are over 50, Caucasian and have a little extra around the middle. I’ve even heard bacon referred to as a vegetable! Because of this, I strongly maintain that diagnostic and screening standards can and should vary based on practice risk demographics. In short, there is no one-size-fits-all in eyecare—nor should there be.
Carrying the Weight of the World
When I started thinking about the risk of age-related macular degeneration (AMD) in my practice, it worried me. Because I practice in rural Tennessee, there is no retina specialist for miles and many of my patients have never been to another eye care professional. In many respects, this is an honor, but it’s also an enormous responsibility. If my patient has AMD, it’s up to me, and me alone, to find it and monitor it.
Because my patients often have multiple risk factors, I would expect the incidence of AMD in my practice to be high. However, until recently, I had no idea how high it really is, even in younger patients.
Why I Cast a Wider Net
Like most of my colleagues, I used to wait to perform dark adaptation testing until my patients turned 50 or had a night vision complaint. Then I met Maggie. She was 42-years-old when she first came to see me because she was having trouble seeing up close. As is our standard with comprehensive exams, we suggested an Optomap screening, but because Maggie’s insurance wouldn’t cover it, she refused. When I dilated and looked into her eyes, I couldn’t believe what I saw.
I remember telling her, “Maggie, we’re going to go over my findings. But before we do that, I’m going to have my staff take some retinal scans. I know you didn’t want to have this done, but these pictures are going to show you what’s going on.” I did this because I needed to impress upon her why she would need to see a retina specialist. She had advanced macular degeneration in both eyes, requiring injections. Maggie is why, in my practice, we start looking for signs and symptoms of AMD starting at age 40.
Affordability is Multidimensional
AMD is a disease we can’t afford to miss. Yet a 2017 study published in JAMA Ophthalmology revealed that both optometrists and ophthalmologists are missing AMD about 25 percent of the time.1 That’s a terrifying thought when you consider the prevalence of AMD—it is at least three times more common than glaucoma. This begs the question: how can solo practitioners like me afford to implement dark adaptation into our practices and dedicate technician time for additional testing? I would preface my answer to this question by saying that no one should go blind from AMD because they live in an area where the right technology isn’t available.
Essential technology, like dark adaptation, isn’t just for big-city practices. If patients are relying on you to manage their overall ocular health, it is your responsibility to catch blinding eye diseases like AMD as early as possible, actively monitor, and make the timely referrals to preserve their vision if the patient converts to wet AMD. Then it is your responsibility to actively monitor progression so that if that patient converts to wet AMD, you can refer for injections before significant vision loss. The presenting vision at the time of those initial anti-VEGF treatments is crucial for preserving function and patient quality of life, and optometrists are the official gatekeepers. Of course, in many cases, we also have the opportunity to share good news. Often, patients with a family history are very concerned and we can provide relief when testing reveals no decrease in DA along with no structural signs.
Free Up Technician Time
Another key consideration relating to affordability is the misconception that dark adaptation is a time-consuming endeavor. This hurdle was largely overcome with the introduction of the AdaptDx Pro, featuring Theia, an artificial intelligence-driven onboard technician.
The AdaptDx Pro is a self-contained, custom-designed wearable headset that was tested for patient comfort and requires no dark-room—so patients can take the test anywhere in the office, in any light. After the office technician selects the testing protocol and places the device on the patient, Theia takes over using automated instructions and adaptive feedback spoken directly to the patient. My technician just needs to get the test started and then they can focus on other things – like updating charts or preparing for the next patient – while Theia runs the test. The screen will alert my technician when the test is coming to an end, so she can put her attention back on the patient and their test results. This is radically different from other functional tests that require the technician to sit with the patient and provide constant instruction and feedback.
Other Articles to Explore
This process automation makes it easy to fit dark adaptation testing into any practice workflow. Not only is the entire experience improved for everyone involved, but the addition of Theia’s artificial intelligence helps ensure consistent, reliable testing results. The AdaptDx Pro is truly a revolutionary way to quickly and effectively measure dark adaptation in virtually any clinical setting, without eating up too much staff or doctor time.
Patients are also impressed with our advanced technology. Even my patients in their 70s and 80s are used to talking to Siri and Alexa, so they are comfortable having a similar personality as part of their medical testing. Plus, the device is mobile and untethered, so we can bring it directly to the patient while they sit back in a comfortable chair.
The Snowball Effect
Dark adaptation is a good fit for our patients and for our staff, but it’s also great for our practice because the revenue we generate isn’t tied exclusively to the test itself. When a patient’s Rod Intercept® from their AdaptDx Pro® Rapid Test is greater than 6.5, that indicates impaired dark adaptation. This prompts me to investigate further with an OCT to look for structural abnormalities. I’m surprised to be doing OCTs for patients I never would have selected for this test if they hadn’t failed the Rapid Test. We then schedule these patients for an extended dark adaptation test to obtain their baseline Rod Intercept that I now follow for progression. All of this generates additional medical revenue, while fostering patient loyalty.
My practice may always be small, but the impact we have on the community and individual patients’ lives is enormous. To achieve this by providing a high level of care, while simultaneously strengthening our practice’s financial wellbeing, is an opportunity we warmly embrace.
1. Neely DC. JAMA Ophthalmol. 2017;135(6):570-575
Frances Bynum, OD, is the owner of Northwest Tennessee Eye Clinic, P.C., with locations in Martin and Greenfield, Tenn.