An Interview with Rebecca Donnelly
2nd September 2022
We recently caught up with industry leader and optometrist
Rebecca Donnelly from Lynn Fernandes Optometrists to find out how AOS has transformed how she practices. And, as it turns out a lot has changed since they first started using it.
What are the primary benefits of using digital eyecare?
Using Digital eyecare with AOS helps us deliver a better standard of care for patients especially those with any anterior segment issues. We do a lot of contact lens fittings and dry eye treatments and being able to show the patients their images with enhanced objective grading is so educational. It really helps them understand their condition better. For example, when I show a patient a green fluorescein staining image, they can’t really appreciate what it is or what is happening. But when I run that image through AOS 3D analysis, they can see that its raised and red. They instantly connect with what is occurring. And that has become one of the primary benefits of digital eyecare. Going back, AOS was originally brought in for remote care and that will persist as well. It probably is not on optom’s minds as much as it was before but with the call for evidence from the GOC, I believe we are going to see a push toward remote care across all professions. Optometrists need to be involved in shaping that. We also need to deliver as high quality of eyecare as possible remotely and the only way to do that is having both asynchronous and synchronous methods. AOS is one of the only platforms that can do that and is eyecare specific. In addition, the objective grading can be used in clinic or out of clinic. When you use it for assessment in clinic and then for remote care, it creates a consistency that feels familiar to patients. They feel the love when they get that high quality of care even out of clinic.
How does this lead to greater patient satisfaction?
Overall, it Increases level of communication and engagement with patients. Helping us deliver a better standard of care. For example, before AOS, we would have the dry eye assessment and then see the patients back in 6 months. Even though we sent them home with a handout and a printout of their management plan, they often didn’t read it and they fell out of compliance. After 6 months it was like starting over.
Now with AOS we have a telephone or video consult 3 weeks after their assessment to check in to see if things have improved or if more intervention is needed. We discuss options and they are involved in the decision-making process. Video calls are the norm now and they allow for better connection. Since the pandemic, patients of all ages are comfortable with them, especially older patients who Facetime with their grandkids. When following up over the phone the conversation feels rushed but video calls give you the chance to really be present and that is so important. For contact lens wearers especially, increased communication improves compliance and is proven to reduce drop out. In addition, patients want it. One study showed that over 40% of patients wanted more communication during their trial phase from their eye care provider. AOS makes it easy to provide more communication.
How has digital imaging in particular transformed how you interact with your patients?
Only from having AOS did I realize the importance of digital imaging. That wasn’t our original intent for AOS. We brought it in for remote care, but I quickly realized that the photos that patients were sending in were so good and I could definitely see that my patients understood what I was talking about more. It was from that we decided to make it part of our standards and system for all of our dry eye patients. Now I’m having better conversations about the condition itself and don’t have to spend as much time explaining the process. They can finally see the condition for themselves, they can see redness, they can see quality of the oil, and with the AOS enhancement tools, they can see conditions like lid telangiectasia. They finally understand what we are doing now. A picture is worth a thousand words. You don’t have to explain so much when they can see what is happening in the enhanced images. It’s amazing, even patients we’ve seen for years say, Oh I get it now! It’s kind of humbling. I’ve always felt like I’m great at explaining but until they see the enhanced images, they don’t fully understand what’s happening.
We also use digital imaging for referrals. It is standard to include it for posterior segment conditions but not as much for the anterior segment. We know that the referral system is coming from the NHS and that will allow better image transfer. Studies show that referrals are better triaged and handled when imaging is included with the referral. It also leads to less unnecessary hospital visits. It needs to be part of the referral process with any lid lesion or any dry eye patient that you are referring because they all don’t need to end up in hospital.
In what part of the patient journey do you use telemedicine?
Currently we use telemedicine for the 3 week follow up dry eye clinic and also for contact lens care. Anyone that has had a full eye exam within date and is an asymptomatic daily wear soft contact lens patient with no problems is offered a remote contact lens appointment. What’s important with these patients is that we confirm there are no signs of redness or symptoms and that we reiterate proper compliance with the lenses they are wearing. If there are any concerns of redness or dry eye, we will bring the patient in but so far, we haven’t had to do that.
We also started using it for end of trial follow ups specifically for multifocal fittings. I find that a lot of patients will come back in at end of trial to make a change that we could have made remotely. They’ll have to come back to pick up lenses and the schedule another follow-up after 2 weeks. Those visits add up, but they don’t need to be sitting in my chair for every change we make. The contact lens manufacturers give you fitting guides for these lenses and the patient doesn’t need to come into clinic for me to know what lens to try next. We can easily have a 5-10 minute conversation over video call to ask what the issues are and explain the changes we are making.
In the past, I was very guilty of getting a message from the team and making a decision without the patient. I didn’t want those patients tying up chair time when I have all these eye exams to be seen and people who have been waiting for ages to be seen. Scheduling a remote follow up at end of trial is so much better for patient engagement and for setting proper expectations. I’m delivering a higher level of care than I was before.
We are currently reevaluating and restructuring our protocols for myopia management and I believe there should be an aspect of telemedicine in that. I learned about this on one of our webinars when Dr. Andrew Pucker discussed the benefits of getting to speak with the whole family during a virtual consultation.
This makes total sense. Things can be quite repetitive when a different family member shows up to each appointment and we end up saying the same thing 3 different times. Even a remote check in with the patients would be beneficial. It would allow us to ensure that patients are staying compliant with the plan and wear time. Sometimes patients will come back admitting that they forgot and are only wearing their lenses a few times a week. A remote check in would help us stay on top of those types of situations.
We are evolving every day and the benefits of AOS will continue to grow.