Eyeworld

EW NEWS & OPINION May 2017 19 that improving insurance coverage increased the rate of ED use. One would expect the contrary," he said. Ophthalmologists also should help educate patients and their primary care physicians on what defines an urgent versus non-urgent problem. This could be done with videos in waiting rooms, brochures, access to online information, and a concerted effort by insurance plans to educate enrollees on the impor- tance of seeing an ophthalmologist, Dr. Aizuss said. The latter would be consistent with Preferred Practice Patterns by the American Academy of Ophthalmology. "The removal of ophthalmology from the majority of medical school curricula has resulted in a generation of physicians who have little knowledge of eyecare, and that needs to change," he said. Certain patients should be made aware of their risk for problems. "An example is a patient who is a high myope, who should probably have a conversation with their ophthalmol- ogist regarding floaters and flashes and their risk of retinal detachment before they present to the ED," Dr. Litoff said. An around-the-clock triage system would also help patients get sound advice on when to go to the ED versus when to wait, he added. The investigators also mentioned this, citing an expanded role for teleophthalmology to help evaluate patients. Incentivizing eyecare provid- ers to offer after-hours care and to expand offices where patients can be seen is another solution that the investigators presented. EW References 1. Stagg BC, et al. Factors affecting visits to the emergency department for urgent and non-urgent ocular conditions. Ophthalmology. 2017 Jan 31 [epub ahead of print]. 2. Uscher-Pines L, et al. Emergency depart- ment visits for non-urgent conditions: Sys- tematic literature review. Am J Manag Care. 2013;19:47–59. Editors' note: The physicians inter- viewed have no financial interests related to their comments. Contact information Aizuss: daizuss@oaveyes.com Litoff: david.litoff@iconeyecare.com an established eyecare provider— and they may not be as aware of the higher costs associated with an ED setting, Dr. Stagg and co-investiga- tors wrote. "These persons may be unwilling to miss work to seek care in an office setting and find it more convenient to go to an ED after hours instead," they wrote. Based on research from others, the investigators theorize that pa- tients who are less affluent are more likely to seek ED care due to difficul- ty getting off work for appointments during regular clinic hours, and they may have less of an understanding of what constitutes an urgent visit. "Public transportation to clinics may be more difficult, making it more convenient to go to an ER instead," they wrote. The greater likelihood of patients with established eyecare providers seeking help for urgent problems may be tied to chronic ocular diseases that flare up, such as diabetic retinopathy leading to neo- vascular glaucoma, the investigators wrote. Still, this finding surprised David Aizuss, MD, Ophthalmolo- gy Associates of the Valley, Encino, California, who would have thought this subset would have contacted their provider instead. "What would be even more interesting would be the breakdown of those patients whose eyecare provider was an ophthalmologist versus optometrist, since generally ophthalmology is more available for the care of emer- gency patients," he said. Solutions This kind of research draws atten- tion to the costs associated with healthcare and the need to find solutions to lower them. "Healthcare costs are astronomically high, and we have to determine ways to sig- nificantly reduce those costs without compromising quality," said David Litoff, MD, ICON Eyecare, Denver. "This type of research should help our policy makers generate smarter health care initiatives and better healthcare programs." To help cut back on patients seeking ocular help at the ED when it is not necessary, better education on how to access care would be helpful, Dr. Aizuss said. "It is surpris- ing that research has demonstrated Uniform epithelium removal in only 5 - 7 seconds Corneal Xlinking, PRK Advanced Surface Ablation Improved clinical outcomes of CXL and PRK with Amoils Epithelial Scrubber Minimize total procedure time Avoid alcohol damage to surrounding tissue No need for subsequent scraping T. 800.461.1200 www.innovativexcimer.com order online www.innovativexcimer.com AMOILS EPITHELIAL SCRUBBER www.innovativexcimer.com AMOILS

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