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    Why patient education is bit like fortune telling

    The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

    I saw a new patient today complaining of redness, itching, and burning. When asked how long she had been feeling these symptoms, she reported it had been since cataract surgery. She reported seeing her surgeon about her eyes and was told the surgery was successful and shown the door. That was nine months ago.

    She regrets having surgery, even though she is 20/20 unaided. She dislikes her surgeon and previous optometrist and tells anyone who asks about it. I cannot be sure she did not leave negative posts on Yelp, Facebook, and Healthgrades.com after she unloaded her negativity on my office staff. That is why I treat ocular surface disease—even in non-symptomatic patients—prior to surgery. Also, I don’t like to look like an idiot.

    More from Dr. Swartz: Why it's OK to be bossy

    High patient expectations

    Let’s consider how not treating a patient prior to referring her for cataract surgery may be problematic (and make me look like an idiot). Even mild ocular surface disease (OSD) can alter tear film, changing the keratometry readings used to determine the intraocular lens power. A 0.50 D shift in the keratometry power can affect the residual refractive error. When significant, a larger error can result.

    If you travel back in time to when I graduated from optometry school, this is not a huge problem. Back then, we used air puff to measure intraocular pressure, used glaucoma drops four times per day, and everyone wore glasses after cataract surgery. 

    In 2016, our patients have higher expectations. Patients want to be spectacle free, particularly when their neighbor or friend from church was able to do so after cataract surgery. 

    More blogs: 4 steps to opening a practice cold

    Another reason to treat OSD is ocular surgery’s tendency to exacerbate it. This can result in a list of problems that, honestly, I prefer to avoid. Paying specific attention to surface conditions at the one-week postoperative visit will demonstrate this. If you like patients to whine about fluctuating vision, foreign body sensation, red and itchy eyes, ignore it. Even mild OSD will slow incision healing time, slow edema clearance, and reduce patient satisfaction. Worst case scenario for untreated OSD is infection following cataract surgery. Not surprisingly, this ranks number one on my list of things to avoid. 

    Next: Don't get thrown under the bus

    Tracy Schroeder Swartz, OD, MS, FAAO
    Tracy Schroeder Swartz currently practices at Madison Eye Care Center in Madison, Alabama. She serves as Education Chair for the ...


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