Ординатура / Офтальмология / Английские материалы / Diagnosing and Treating Computer-Related Visual Problems_Sheedy, Shaw-McMinn_2003

24 Diagnosing and Treating Computer-Related Vision Problems

A well-trained assistant can prepare the patient for future treatment recommendations and position the practice and the doctor properly so that the computer-user patient recognizes value in the services and products he or she receives.

Positioning the Practice during the Examination

Most of positioning a computer-user practice does not directly involve the doctor. The examination is one place where the doctor can influence the perception of the computer-user patient. The doctor’s appearance, demeanor, and explanations do much to convince the computer-user patient that the prescribed treatment is in his or her best interest. The examination room appearance, development of carefully worded scripts for the doctor to use, availability of visual aids for explanations, and patient education materials enable the doctor to properly position the practice.

Examination Room Appearance

In addition to being clean and well organized, the examination room can be decorated to promote computer vision, similar to the reception area or pretesting room. Certification as a doctor versed in treating CVS should be framed on the wall, as well as any awards or other recognition. You can obtain certification through http://www.CVSDoctors. com. Photographs of conditions related to CVS, such as dry eye or binocular vision problems, should be posted. Article reprints on CVS diagnosis and treatment should be kept close at hand to give the patient. Explanations of symptoms, diagnosis and treatment of binocular dysfunction, accommodative dysfunction, and convergence insufficiency can be obtained from the College of Vision Development and should be handed to the patient when appropriate. Pamphlets from the American Optometric Association, Optometric Extension Program, and the American Foundation for Vision Awareness should be available to give to the patient to reinforce the prescribed treatments. A handout to include in the examination room could be “Improving the Ergonomics of Your Computer Workstation” (see Appendix 11-1, page 202).

Positioning Your Practice to Care for Computer-User Patients 25

Explanation of Examination Procedure Scripts

Many successful doctors explain the benefits of the procedure during the examination and relate them to computer use. For example, during the pursuits and cover-test you may say,

“We have six muscles going to each eye. By moving them in these directions, I can isolate the muscles and see if they are working well together. Your eyes naturally assume an outward position when looking at close targets. This can cause your eyes to tire when doing near work, such as working on a computer.”

Case Presentation Scripts

Often you will discover many possible causes of the CVS signs and symptoms. As with any other case, educate the patient and develop a treatment plan that covers the possible causes. Develop scripts and visual aids to assist you in conveying the need for treatment. If you’ve been discussing the findings with the patient all along the course of the examination, it will be no surprise for him or her to learn he or she needs assistance. Here is a sample presentation to a patient, Ms. Apple:

“Ms. Apple, I will present my examination findings to you now. Here is a picture of an eye. We have a lens on the front of the eye called the cornea that gives us two-thirds of our focusing power. Then we have a lens inside the eye that is connected to strings called zonules, which connect to muscles. This is the lens we use to change focus. Perfect vision means that light from 20 ft or more will focus on your retina when the muscles are relaxed, so there is no effort in seeing. In your case, light from 20 ft focuses behind the retina, thus it is spread out when crossing the retina. We call this far-sightedness, because when you are young you can change focus using the lens inside the eye to focus the image onto the retina.

26 Diagnosing and Treating Computer-Related Vision Problems

Usually, you do not notice problems far away, but you do up close, because then these muscles have to focus an extra amount. When using a computer 8 hours per day, these muscles are in continuous use; they weren’t made for this. That is why your eyes tire by 1 o’clock in the afternoon. Also the muscles tend to “cramp up,” causing the distance to blur at the end of the day. Now, whenever we change focus with these muscles, nervous energy is automatically sent to the outside muscles of the eye, causing them to turn inwards toward the target. In some cases, people’s eyes turn in too much, in others they don’t come in enough, like yours. That means you must compensate using another nervous system to the eyes. You don’t do that very well, contributing to your tired eyes.

This is a picture of the back of your eye, with the nerve going to your brain and blood vessels coming into the eye. In diabetes, we can get new abnormal blood vessels growing that can cause a severe loss of vision. You don’t show any hemorrhages or other indications of diabetes problems in the back of your eye, but we’ll monitor that for you. When sugar levels are elevated, diabetes can also cause the lens in your eye to swell and cause you to become nearsighted, as well as contribute to dry eyes. Carefully check your glucose levels and listen to your internist concerning diet and exercise. I don’t believe this is affecting your focusing or dry eyes at this time, but we’ll watch for it.

Underneath your eyelids are hundreds of glands. You show hundreds of bumps. That is an allergic reaction to something like pollen. The glands do not secrete their tears, causing the eye to get dry and develop a burning sensation. Then your crying glands up here may flood the eyes with tears. They dry up and you go back through the cycle—dry, burn, flood. Normally, we blink 16–20 times a minute. When using a computer, this often drops to 5–7 times a minute, causing the eyes to dry out. I’m going to give you drops for the allergy condition and artificial tears to use during the day. We’ll see if that takes care of the dry eye.”

Positioning Your Practice to Care for Computer-User Patients 27

In our example, Dr. Gates may finish his case presentation by saying, “In summary, I’m prescribing non-glare lenses for you to use at the computer, eye exercises to correct the muscle problem, and drops to improve the dry eye. I’ll see you in 3 weeks and evaluate how you are responding to the treatment. Meanwhile, look over these suggestions for improving your workstation and watch your glucose levels.”

In summary, doctors commonly use routing slips to indicate the prescribed treatment to staff, examination summaries, or additional testing, as explained in the computer vision evaluation form mentioned earlier in the chapter. Proper examination room decorating, use of carefully worded scripts by the doctor, and availability of patient education materials to reinforce the doctor’s prescribed treatment will position the practice as the premier site for computer vision care.

Positioning the Practice in the Dispensary

The dispensary is the ideal location to demonstrate products available to treat CVS. It is often helpful if the dispensary can be seen from the reception area. Patients waiting for the doctor may hear happy, satisfied patients receiving their new computer eyewear. They can witness how the optician empathizes with the patients and relates to them. The dispensary can properly position your practice to the computer user through appearance, scripts for the optician, demonstrators, and patient education materials.

Dispensary Appearance

In addition to the décor options used for the reception room, pretesting room, and examination room, the dispensary should also have dispensing mats with computer vision themes as well as demonstrators, such as antireflective-coating demonstrators and lenses designed for computer users. PRIO is an optical company that provides colorful displays for their computer lenses and frames. You can review their products at http://www.prio.com.

28 Diagnosing and Treating Computer-Related Vision Problems

Optician Scripts

We do not question the carefully chosen words that appear during a television commercial or movie, yet often we do not attend to how well we communicate in the office. Our computer-user patients are deciding on whether or not to spend a substantial amount of money to gain the benefits presented during the examination. Words chosen by the optician can reinforce those benefits or dismiss them. Phrases should be developed that reinforce the patient’s decision to purchase computer glasses.

“I use the same lens design when I’m on my computer and it allows me to concentrate much better after a long day at the office!” Personal testimonials by the optician can be very effective. “The cost of computer glasses can be minimal when compared to the cost of other items we buy. Think about the cost per hour of that dress you are wearing? You will be wearing your computer glasses 8 hours a day, 5 days a week for 1 or 2 years! And that dress won’t do anything for the comfort of your eyes at work!”

Allow your optician to develop scripts that are effective and give him or her some guidance as to what you believe complements what you are telling the patient.

Patient Education Materials

Most lens manufacturers provide brochures highlighting the advantages of their computer vision lenses. If none were given before this point in the visit, professional association pamphlets on computer vision may reinforce what the optician demonstrates to the patient. Some people use a “Computer Lens” information sheet like Figure 2-9. Hand these to the patient and tell him or her if any of his or her coworkers, friends, and family have any questions to give you a call. Remember, word of mouth is the best promoter of healthcare providers; the patients have the mouths, it is up to you to put the words in them.

30 Diagnosing and Treating Computer-Related Vision Problems

Positioning the Practice at

Checkout at the Front Desk

One of the responsibilities of the checkout person is to reinforce to patients that they made the right decision to invest in eyewear or services. If the front-desk person is using a computer, it is helpful for him or her to be wearing eyewear and to point out to the patients how happy they will be when they get their new computer glasses. A quick glance at the record can allow the receptionist to mention how the new glasses will solve the patient’s problem of headaches, eye fatigue, or near blur (whatever was the chief entering complaint).

Another responsibility of the checkout staff is to reemphasize that the office is there to take care of all the patient’s future vision needs.

“I know computers can be tough on your eyes. With today’s technology, we can keep you comfortable at work and play and protect your vision into your old age. We’ll give you a call in 1 year to set up your annual examination and let you know what new technologies have been developed that can benefit you. During the year, if anything comes up, don’t hesitate to give us a call. As our office theme says, we are here to maintain your vision for the rest of your life!”

Positioning the Practice through Follow-Up

The time immediately after visiting your practice can be just as critical as during the examination visit. It is during this time that the patient questions whether the time and money spent in your office was worthwhile or not. Buyer’s remorse is a common reaction for many of us, especially senior citizens. That is why it is so important that your staff reinforce the purchase decision at checkout and when picking up eyewear or receiving more services.

Follow-up is also critical to the referral of new patients. Sometimes patients are too overwhelmed with information to enable them to recall the “words” necessary for word-of-mouth promotion. Follow-up can give them the “words.” Follow-up can be in the form of a phone call:

Positioning Your Practice to Care for Computer-User Patients 31

“I’m calling to learn how well those new glasses I prescribed for you have taken care of your headaches.”

Rarely do doctors call to see how their patients are doing. This simple act can set you apart as special and caring. Patients are quick to tell their friends, who then question the caring attitudes of their own doctors. For computer users, the best follow-up would be an e-mail to see how they are doing. Complex cases requiring several treatment choices will result in a follow-up visit. Announcements, bulletins, and newsletters can easily be sent via e-mail to keep in touch with the computer-user patient.

Typical Computer-User Patient Flow with Performance Standards

Many offices create a checklist of activities expected during a patient visit to ensure that everyone is working together and supporting each other. Table 2-1 shows a sample computer-user patient flow checklist. From time to time, the list can accompany the patient file to document that each activity was completed. The purpose is to include all the service qualities stated by RATER at the beginning of this chapter. Paying attention to the little things that our computer-user patients value creates the proper atmosphere to encourage loyal, enthusiastic patients who refer coworkers, friends, and family.

The following chapters provide you with the tools necessary to diagnose and treat computer-related conditions.

Action Items

1.Consider how you can position your practice to computer users by designing the practice to be computer-user friendly: Where do you need to improve?

•Before the patient visit

•In the reception area

32 Diagnosing and Treating Computer-Related Vision Problems

Table 2-1. Checklist for computer-user patient flow

Initial telephone call to make appointment

Patient is asked when making appointment about computer usage by Virginia; notes that in file.

Explains special concern office has for computer users.

Smiles when speaking on phone.

Encourages patient to check on office Web site.

Says looking forward to meeting patient.

Entering office

Enters practice and is greeted by Virginia using patient’s name. “You must be Mrs. Gates? Welcome to Woodcrest Vision Center!”

Tells patient about the office and doctor.

Hands the patient a Welcome to the Office info packet.

Watches to see if patient reads it.

Offers a cold or hot drink and cookies.

After patient peruses the info packet, Virginia brings a history form to her to fill out.

Offers assistance and explains reason for history form to be filled out.

Pretesting room

When the technician is ready, Virginia seats the patient in the pretesting room saying, “You’ll like Julie. She explains things well and knows all about eyes and computers.”

Julie greets patient.

Comments on competence of Virginia.

Notes the computer usage on the history form and tells her about new products and services available to assist her visual comfort when on the computer.

Gives her a computer-user–specific history form if appropriate.

Begins pretesting, explaining every test and relating it to computer use.

Hands patient brochures or pamphlets concerning computer vision.

Examination room

Seats patient in examination room and tells her, “You’ll like Dr. MacIntosh, he explains everything thoroughly, has 25 years’ experience here in Woodcrest, and specializes in treating computer-user patients. Ask him about the computer lenses we discussed.”

Dr. MacIntosh greets patient.

Comments on competence of Julie.

Reviews history with patient and presents hypothesis as to cause.

Conducts examination, explaining value of procedures and relating to probable treatment choice.

Presents case to the patient and prescribed treatments.

Completes summary form and hands to patient.

Transfers patient to optician, “You’ll like Marta, she will demonstrate the treatment I’ve prescribed for you and get you all set up! I’ll see you again for a progress check on

_____ to determine if there is anything else we must do for you.”

Positioning Your Practice to Care for Computer-User Patients 33

Table 2-1. Continued

Says goodbye.

Dispensary

Marta comments on how competent and caring the doctor is.

She reviews the treatment plan with the patient and demonstrates prescribed treatment as appropriate.

Completes measurements and reviews costs, explaining benefits.

Reinforces patient decision to purchase products.

Says goodbye to patient.

Checkout at front desk

Returns patient to Virginia at front desk to receive fees.

Virginia comments on the competence and caring of Marta.

She reinforces correctness of purchase decision.

Schedules next appointment.

Says goodbye to patient.

Follow-up

Optician reinforces purchase decision at dispensing.

Doctor or staff calls or e-mails patient to see how he or she is progressing.

Follow-up appointment or additional treatment scheduled.

E-mails sent to patient concerning computers and vision.

Recall date set.

•With office forms

•In the pretesting room

•In the examination room

•In the dispensary

•Checking out at the front desk

•With follow-up

2. Develop a patient flow regimen to use with computer-user patients.

References

Moss GL, Shaw-McMinn PG. Eye Care Business: Marketing and Strategy. Boston: Butterworth–Heinemann, 2001.

3M Optical Systems Division. http://www.3M.com/cws. Accessed on May 2, 2002. 1-800-553-9215.