Most ophthalmic societies invest signficant time and resources in providing continuing clinical education for their members. These programs serve both individual members and the eye health needs of patients. As future leaders in ophthalmology, many Leadership Development Program participants develop projects focused on thees educational needs. Recent LDP ophthalmic-education projects include the following.
Improving Community Ophthalmic Care through Urgent Care Eye Exam
Natasha L. Herz, MD, LDP XIX, Class of 2017 - Washington DC Metropolitan Ophthalmological Society
Purpose: Provide training to urgent care providers to improve their ability to assess and diagnose the red eye, enabling more accurate and appropriate referral to ophthalmology and avoiding unnecessary delays in treatment.
Methods: A power point presentation was developed to teach the urgent care provider what signs and symptoms to document, how to perform an eye exam with the equipment available in the typical urgent care setting, and when urgent referral to an ophthalmologist is necessary. Urgent care centers in the immediate 10-mile radius were contacted to offer this education to their providers free of charge.
Results: Increasing demand for access to urgent care with decreased wait times and increased after-hour availability has triggered the development of urgent care centers and minute clinics across the Washington DC Metro area. Unfortunately, the training of urgent care providers to conduct eye examinations is quite variable. Subsequently many patients are misdiagnosed and improperly treated for serious eye conditions including herpes keratitis and dermatitis treated with steroids, unrecognized corneal foreign bodies treated as “pink eye,” bacterial keratitis treated as “pink eye,” and iritis treated as “pink eye.” I found 25 urgent care clinics in my immediate 10-mile radius and contacted them to offer my Eye Exam for Urgent Care course. Three of them chose to have me give this presentation to them and felt they were much better equipped to assess ophthalmic complaints. Since my presentation, I have received multiple calls from these centers and was able to give them much better advice regarding appropriate treatment and follow-up because they had performed a quality urgent eye exam.
Conclusions: The demand for after-hours care has brought a large number of urgent care centers into the Washington DC Metro area. In an effort to maintain a high quality of eye care with this model and continue to keep ophthalmologists as leaders of the eye care team, the Eye Exam for Urgent Care course will continue to be offered to the local urgent care centers. I will encourage the members of the Washington DC Metro Ophthalmology Society to join in this effort as it is beneficial to our community and indirectly to our advocacy efforts.
Implementing Portable Telemedicine for Screening and Management of Retinopathy of Prematurity (ROP) in Mississippi: A Model for the Future
Joel H. Herring, MD, LDP XVIII, Class of 2016 - Mississippi Academy of Eye Physicians and Surgeons
Purpose: To investigate the potential for a collaborative model between Neonatal Intensive Care Units (NICUs) and a portable telemedicine service in order to provide screening and management of infants at risk for ROP in Jackson, Mississippi. Further, to determine if a step by step model for implementation could be devised and transferred to other satellite sites in the state and to other states in need of a long term solution to the growing problem of ROP screening and management.
Background: Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing 1250 grams or less and born before 31 weeks of gestation. ROP can lead to lifelong vision impairment and blindness, and a concerted effort between neonatologist and ophthalmologists has resulted in technology and treatment to increase the survival rates and decrease the vision loss of babies at risk. Unfortunately, this comes at a time when capable and willing ophthalmologists to perform screening exams are more and more difficult to find, while the protocol for level 3 NICU certification requires ROP screening and management. This is a problem for all involved that will only get more complicated and more difficult to solve without a better option for all in a coordinated fashion. The Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) study confirmed that potentially severe ROP can be detected by sending retinal images taken in the NICU to an offsite image reading center as accurately as regular examinations by an ophthalmologist on site in the NICU. This approach combines more efficient diagnostic capability with greater access to patients and improved comparative medical documentation in a format which can relieve physician overload and offer a new paradigm for care in the future in Mississippi.
Methods: To assess the needs of our community and gather perspective on a coordinated care approach, discussions were held with the current pediatric ophthalmologist providing ROP screenings as well as the neonatologists covering the five hospital sites in the area. Next, interviews with potential imagers were conducted to determine abilities and interest. Then, discussions with ROP screening physicians in other cities throughout the state were held to determine interest in a satellite retinal imaging system to cover their hospitals now or in the future if the program is implemented. Finally, on site demonstrations were conducted with representatives of three different ROP retina imaging systems on a sample of neonate patients with the physicians and potential imagers present to capture and review the images for quality and effectiveness, as well as the neonatologists and NICU staff present to evaluate the process.
Results: The response from the screening ophthalmologists and the neonatologists was very positive in concept, and there was agreement that this could be an important issue to address, especially if subsequent screeners cannot be identified after the current screeners are retired or decide not to perform the screenings for any reason. The interest from the imaging system companies and the potential imagers was positive, and we were able to teach the imagers on site how to use the camera about as well as the company representatives present. The main limitation from our results was the quality of the images, especially in the temporal peripheral quadrant which is the most important area to assess. Compared to an exam with an indirect ophthalmoscope by an ophthalmologist, the images did not rate as effective for screening purposes. We are pending another possible on site visit from one company with a designated trainer we are told can capture superior images and better instruct the potential imagers with tips to help them achieve more success in capturing more useful images.
Conclusion: At this time, we do not have either the technology of image quality or the technical ability to capture images locally to establish an image screening service for the area or the state. We remain hopeful that with further training or perhaps another imaging system, the goal of implementing a portable telemedicine screening system for ROP will be possible in our community and our state. And, if successful, this may provide and promote a step by step model available to all ophthalmologists to be incorporated in other states facing the same issues both now and in the future.