Tips4EyeDocs Daily for 12/18/2011 No 4 – Patient Compliance


Would it not be insightful to wonder if a patient’s resolution would ever include compliance to recommendations to either periodic eye care or use of  contact lenses?

Frankly, I celebrate with those patients who do so. But for those who don’t, I find myself wondering what else can be done. It seems that a catastrophic or dramatic clinical event needs to happen before a change in behavior will occur. Even then, what may still pervade is a sense of immortality that any untoward event is fixable by doctors.

I recently saw a patient for bilateral corneal ulcers from either  opportunistic infection or deliberate overwear or under maintenance of contact lenses. Multiple prior scars on both eyes suggested a pattern of abnormal use and care of contact lenses. I was relieved that her clinical course this time was was predictable with medication.

We doctors seem to make patients well without being able to change the underlying behavior of non compliance. So I asked the patient. With a straight face, the patient had a full schedule of of work and home that at bedtime, all that was possible sometimes was to collapse into bed,  often fully clothed and wearing contact lenses.

In summary,  I think technology and medical eye care have changed to accommodate our busy lives.  Without that advance, I fear that similar instances would be more frequent.  It is our job to meet this challenge with our clinical knowledge and skill and even our ears and heart.


This blog post takes a humorous slant on social media by the negative stimuli rather the positive.  Therefore, if you do not believe in social media you don’t need to blov. But social media is not the only method to grow a business. It is complimentary to personal selling and good customer service. Spotted on Twitter   via @SocMedSean: 10 Surefire Reasons NOT To Start A Corporate Or Product Blog

In an interview, Raphael Bostic, Ph.D. talks about one’s zip code of residence strongly influencing individual health behaviour,  beliefs and outcomes.   As primary eye care providers, a parallel with our outcomes is likely.  Spotted on Twitter via @RWJF_PubHealth: Where you live may have just as much or more impact on your health as what goes on in the doctor’s office: ..


El Matri L, Bouraoui R, Chebil A, Kort F, Bouladi M, Limaiem R, Landoulsi H. J.  “Bevacizumab injection in patients with age-related macular degeneration associated with poor initial visual acuity” Ophthalmol. 2012;2012:861384. Epub 2011 Nov 29

Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Boulevard 9 Avril, Bab Saadoun Tunis 1006, Tunisia.

Purpose. To evaluate functional and anatomic effects of intravitreal bevacizumab in patients with neovascular AMD and initial low visual acuity.

Methods. Retrospective case series of 38 eyes with neovascular AMD and initial visual acuity of 20/200 or less, treated with intravitreal bevacizumab injection.

Results. Mean followup was 14.1 months +/-  7.1 (range: 5 to 24 months). Mean logMAR vision at baseline was 1.38 logMAR +/-  0.33, at 6 months was 1.14 logMAR +/-  0.37 (P = 0.001) and at 12 months was 1.22 logMar +/-  0.33 (P = 0.004). Mean baseline central retinal thickness was 431 mum +/-  159.7 at 6 months was 293.43 mum  +/-  122.79 (P = 10(-4)) and at 12 months was 293.1 mum  +/-  130 (P = 0.004). Visual acuity improved in both patients with or without prior PDT treatment.

Conclusions. Intravitreal bevacizumab injection may increase the chance of visual acuity gain in neovascular AMD even in cases with initial low visual acuity.

PMID: 22174999 [PubMed – in process]

About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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4 Responses to Tips4EyeDocs Daily for 12/18/2011 No 4 – Patient Compliance

  1. Wes Harris says:

    About a thousand doctors are using TelScreen’s EyeRes slit-lamp digital imaging system as a tool for modifying patient behaviors. You don’t have to lecture your non-compliant patients; simply show a picture and say “this is your eye” and “this is a healthy eye”. Your patients will get the point, and they will start making better eye health decisions.

    I’ll spare everyone the commercial. Perhaps some doctors will post their experiences.

    • Mr. Harris,
      Thanks for your comment. As a clinician myself I am also attracted to any thing that improves compliance and retention. However, as methods researcher fin little in the literature to support a sweeping conclusion that medical imagery can improve upon the current rate of compliance.

      Do you know of an studies?

  2. Paul Karpecki, OD, FAAO says:

    Richard, there actually is one study in the journal of Cataract and Refractive Surgery that shows compliance improvement with medical imagery. It was very recently published but fairly conclusive. I have attached the abstract. From a personal and anecdotal perspective I can tell you that I am able to see more patients and I feel I can increase compliance to some degree with anterior segment photography in the lane and I too own a number of TelScreen EyeRes systems. Being in the lane helps to orient the patient to what I’m seeing and can help them understand the severity of the findings. I also use Eyemaginations which helps in patient education by also speeding up the process in allowing the patient to understand what I’m talking about through imagery. I believe I’m able to see about 5 patients more per day since adding these technologies and I feel compliance is improved because they know I’m going to take another picture of the involved diseased area when they return! Here is the study from the University or Toronto.

    J Cataract Refract Surg. 2011 Dec;37(12):2201-10.
    Anterior segment imaging in pediatric ophthalmology.
    Mireskandari K, Tehrani NN, Vandenhoven C, Ali A.
    From the University of Toronto (Mireskandari, Tehrani, Ali) and the Department of Ophthalmology and Visual Sciences (Mireskandari, Tehrani, VandenHoven, Ali), Hospital for Sick Children, Toronto, Ontario, Canada.
    Anterior segment imaging in the pediatric population using commercially available equipment is rewarding but can be challenging. Successful imaging requires familiarity with the imaging modality used, a positive attitude, and the ability to quickly develop rapport with children. In this review, we demonstrate how external and slitlamp photography, Scheimpflug imaging, handheld digital fundus camera, ultrasound biomicroscopy, and anterior segment optical coherence tomography can be valuable in the documentation, diagnosis, and management of pediatric anterior segment disease. Families understand their child’s disease process when it is demonstrated photographically and feel more motivated and involved in their care. Compliance with treatment is often enhanced through this process. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
    Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

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