Premium Cataract Care

One practice’s approach to education.

An Interview with Jessica Heckman, OD, of Chu Vision.

AOC interviewed Jessica Heckman, OD, of the Chu Vision Institute of Minnesota to find out how she and Ralph Chu, MD, educate their cataract patients.

AOC: How extensive is the conversation that you have with cataract patients? Where do you begin the process of education?

Jessica Heckman, OD: Many of our patients come to us with a baseline level of education about their cataracts. We rely on the referring optometrists to have some of those conversations before the patients come to our practice. We also provide information beforehand so that patients have started the learning process before we see them. Patients scheduled for a cataract workup have already filled out a questionnaire, for example, and have received information that they can consider ahead of their appointment.

AOC: What part of the preoperative cataract evaluation and workup do you perform?

Dr. Heckman: I am involved in performing many steps of the workup. Our technicians and nurses assist with laying the foundation and providing some basic education. Then, I advance that conversation and discuss with patients more specifically about the technology we use and the options that are available to them for their surgery. I really focus on lifestyle: the patients’ profession, hobbies, and visual needs. So, my conversations are about trying to match technology to their needs.

AOC: You are drilling down to the specifics of their lifestyle so you can make proper recommendations?

Dr. Heckman: Yes. I will review their answers on the questionnaire they filled out and use those responses to guide the discussion.

AOC: Does Chu Vision offer cataract packages? When you talk about, let’s say, laser cataract surgery and IOL pricing, how to you explain what is covered and not covered by insurance?

Dr. Heckman: We do offer packages. The presbyopia-correcting IOLs are grouped into a package for patients desiring less dependence on glasses for reading. We have a package for astigmatism correction and the cataract surgery itself, so we break it up into three main pieces.

I tell people what their condition is, for example, how much astigmatism they have. Based on their measurements and their lifestyle, I discuss their choices. The patients’ needs and visual situation helps guide the conversation.

AOC: What else is involved in a premium procedure? Do you offer medical foods or nutritional supplements? Do you recommend these products to cataract patients?

Dr. Heckman: With premium procedures, our focus is on obtaining the best possible outcomes for patients. We love it when cataract patients come to us having already had an evaluation of their macular pigment. In our practice, this is the case with a lot of our patients. Macular pigment optical density (MPOD) testing has been a very effective tool in our primary care/referring optometrists’ offices.

Retinal health is crucial in the older population whether or not they have cataracts. In terms of the importance of MPOD, that discussion is actually about general health. When we have not seen a patient for a while, and perhaps he or she is having visual symptoms suggestive of cataract, this is a great opportunity to discuss his or her overall health.

 

AOC: For patients who have not had MPOD testing and are not taking any kind of medical foods, would this be something you would recommend?

Dr. Heckman: Absolutely. We perform the evaluations in our office. We speak to patients about the benefits of improved macular pigment. Research shows that improved macular pigment is associated with improved contrast sensitivity, decreased glare, and less light sensitivity.1-3 Those factors are critical in the context of cataract surgery and particularly with premium technologies. [See Medical Foods: An Emerging Category.]

Improved MPOD decreases the risk of macular degeneration4 and enhances the long-term health of eyes. I tell patients that they are making an investment in their sight, and we recommend that they take steps to keep them healthy.

AOC: Do you make a specific recommendation regarding medical foods?

Dr. Heckman: Yes. When we perform the MPOD test, it is an easy next step to initiate a discussion about how patients can improve their macular pigment. If a patient has a low score, I explain that there is a medical food option, like Lumega-Z (Guardion Health Sciences) for example, which can enhance their macular pigment density. I believe a doctors’ recommendation goes a long way with patients. Plus, when you can provide a test score with a number, patients really connect with that. We can then monitor their pigment, and the test is relatively easy for the patient to take. When they can see their numbers increase, they are very engaged.

AOC: Do you do offer the supplements in your practice?

Dr. Heckman: Patients can purchase them in our practice, or they can sign up online and receive them in the mail.

AOC: What are some of the barriers to patients taking the test and then purchasing the recommended medical food? These are out-of-pocket costs for the patient.

Dr. Heckman: I think the process of educating patients helps to overcome these barriers. When we describe why we are doing the test, why it matters in terms of their visual performance, as well as the decrease in the risk of macular degeneration, we find this resonates with patients. Our technicians, nurses, and other staff members take a very central role in providing this education. We have been very successful.

AOC: It seems as though educating the entire staff and having them reinforce the messaging is integral to the success you achieve with patients opting for the test and then taking a medical food.

Dr. Heckman: For sure. Every aspect of the cataract procedure, from premium lens options to the available testing, is an educational process that begins before patients even enter the office. There is a lot of information for them to take in.

AOC: How does Chu Vision interact with the external referring ODs in terms of making sure they are on the same page?

Dr. Heckman: We work closely with our referring optometrists and, as I mentioned, many of them use MPOD testing in their practices. When patients come to us referred from a friend or a previous patient, we work to get them back to their community optometrist, one who is close to their home, so they can have their macular pigment monitored over the long term. Of course, we can do that monitoring here as well, but we want to make the process convenient for patients. The community optometrists are our partners. n

1. Nolan JM, Power R, Stringham J, et al. Enrichment of macular pigment enhances contrast sensitivity in subjects free of retinal disease: central retinal enrichment supplementation trials - Report 1. Invest Ophthalmol Vis Sci. 2016; 1;57(7):3429-3439.

2. Hammond Jr BR, Fletcher LM, Elliott JG. Glare disability, photostress recovery, and chromatic contrast: relation to macular pigment and serum lutein and zeaxanthin. Invest Ophthalmol Vis Sci. 2013;54(1):476-481.

3. Piermarocchi S, Saviano S, Parisi V, et al for the Carmis Study Group. Carotenoids in Age-related Maculopathy Italian Study (CARMIS): two-year results of a randomized study. Eur J Ophthalmol. 2012;22(2):216-225.

4. Beatty S, Murray IJ, Henson DB, et al. Macular pigment and risk for age-related macular degeneration in subjects from a Northern European population. Invest Ophthalmol Vis Sci. 2001;42:439-446.

Jessica Heckman, OD
• Chu Vision Institute, Minnesota, Minneapolis
Jessica.Heckman@chuvision.com
• Financial interest: none acknowledged