Education doesn’t stop in the classroom — nor should it. Retina patients often come in confused at best and scared at worst. Vision is something that is easy to take for granted, but when patients are facing diminished sight or even possible blindness — at this moment, more than ever, they need reassurance and facts they can relate to. You can be the best retina specialist in the world, but if a patient walks out of the presurgical or pretreatment appointment lost and scared, the days before the actual medical intervention may be anxiety ridden. Patients have access to an internet they can search on their own, which can both provide helpful information and create confusion and worry. Here we look at patient education methods, both new and old, and how they resonate with today’s patients, whose technology literacy runs the gamut from flip phone to savvy.

The Choice Is Yours for Video

For educational video, retina specialists have several choices at a range of prices. Ivan Alzuro, producer for Richmond Corporate Video in Richmond, Virginia, says motion graphics or animation can often actually be more effective than a person in front of the camera. “It can help you visualize in a very different way and we’ve found it is the preferred method for many viewers,” he says, reminding that it can be less scary to see a medical procedure in animation than on a live human. Matthew Speicher, MD, a retina specialist at The Retina Care Center, in Baltimore, Maryland, learned the live human video lesson from the waiting room. “We actually had (those) videos going in the past and we had the feedback that some patients didn’t want to see it,” he says. “Many don’t want the visual.” A way to avoid this is to put it on your website and let a patient know it’s there — but leave the choice to view it up to them.

Financial Commitment

Alzuro also reminds not to skimp on the narrator if you choose to produce a video. “Many people just want to save $100 by having someone in their office do it,” he says. “It’s not just as simple as having a pleasant voice. For the impact on your business, why wouldn’t you want a professional? I can’t tell you how many demos I am sent that are just terrific. The supply is out there. The difference is usually huge in the quality.”

But what will this cost you? Alzuro says in the central Virginia area, for example, that each minute of motion graphics is usually at least $500 and each minute of animation is usually at least $1,000. If you choose to just go the route of a person in front of the camera, he says you can expect that a video shoot in his area to be anywhere between $1,800 to $4,000, based on his recent research. “Just remember that this is going to represent your business,” he says. “You want it to be a positive and not diminish what you’re trying to do.”

John W. Kitchens, MD, retina specialist at Retina Associates of Kentucky in Lexington, Kentucky, found success with his “Eye to Eye” video series. Divided into several parts, including general aspects of the retina, pathologic conditions of the retina, and his own educational background, he has found the series has been a major boost in education and also allows current and potential patients to get a sense of his personality and relatability. “This was an investment but it definitely stayed in the four figures,” he says. “You need to think about the long haul with this. The response has been tremendously positive.”

Rahul N. Khurana, MD, a retina specialist at Northern California Retina Vitreous Associates in San Jose, California, has also found video to be an important asset to his work. “From videos on the American Academy of Ophthalmology website to those on our website, video allows the viewer to have a strong understanding of what they’re dealing with,” he says. “For so many patients, they’re confused, and this is something they can view more than once that allows them to be walked through procedures.”

Stewart O’Keefe, MD, a retina specialist at Retina Institute of Virginia in Richmond, Virginia, uses schematic videos embedded in the electronic medical record. For example, in a laser procedure, these videos might be 30- to 60-second visualizations of the eye and a cross-section of what the laser might do, he says. Because many patients have greatly diminished vision, he has 2 large monitors in every room to display the videos.

Video Isn’t Your Only Option

Video isn’t the only way to effectively educate patients. It shouldn’t necessarily take the place of a simple model if you feel it feeds your presentation. Dr. O’Keefe, for one, says his eye model that is about the size of a small basketball can often be superior to video for patient education, in that he can open it up to show patients the retina, the vessels, and an optic nerve to truly visualize the problem, along with explaining the work to be embarked on. Or for a scleral buckling procedure, he shows patients the silicone bands used in the procedure.

Of course, the best educational resource may be simple literature on your website. For Dr. Speicher, his practice’s website goes further than many in terms of laying out a variety of treatments. By having a page devoted to each treatment listed, only some of which have an accompanying video, it allows the patient to have an at-the-ready read and an easy way to show their loved ones what’s going on when all they want to do is help. “I’ve found a simple approach be a significant help,” says Dr. Speicher. “I spend the time with them and take them through, explaining what the procedure will mean. I find this easy-access material calms many of my patients and it makes sense to them. Having them rely too much on a video could be isolating.”

Although some might think age is a major factor in what kind of presentation a patient would respond to, Dr. Kitchens hasn’t found it to be so. “By now, the smart phone has made so many people technologically savvy,” he says. “Rather than to the age, be in tune to what they want by listening and seeing what they respond to. For some, regardless of age, it may be the take-with-them pamphlet.”

Still, no matter what, don’t be so quick to let your patient just search the internet on their own. Dr. Khurana wrote an article for JAMA Ophthalmology looking at this very issue,¹ in response to a study of diabetes patients in which the authors revealed that many searches led patients to information that was less than accurate or appropriate for patients, he says.² “It’s easy to assume that medical searches have been vetted and have credible sources, but some are unregulated,” Dr. Khurana says. “It’s a Wild, Wild West of information. As physicians, it’s our responsibility to lead patients in the right direction.”

Khurana directs his patients to places such as the American Academy of Ophthalmology’s EyeSmart (www.aao.org/eyesmart-search ) as an example of credible sources of information. He also describes common conditions on the Northern California Retina Vitreous Associates website.

A Little Experimentation

Remember that finding the right patient education recipe for a practice may come through experimentation — it could be a combination of video and pamphlets, or maybe you find that a website is the best for your communication skills and your patients’ needs. Also, a questionnaire could make the difference in terms of finding out what works best for your patients. But, whichever communication tools you use, make sure they are equal to a low enough reading level for the most amount of patients to understand.

“It takes time to find out what works, but we feel good that our patients are being reassured,” Dr. Speicher says. “I want my patient to be relaxed so we can help them. That’s the point — isn’t it?”

References

1. Khurana RN. Online Information for Diabetic Retinopathy—Often a Missed Opportunity for Patient Education. JAMA Ophthalmol. 2019;137(11):1246.
2. Kloosterboer A, Yannuzzi NA, Patel NA, Kuriyan AE, Sridhar J. Assessment of the quality, content, and readability of freely available online information for patients regarding diabetic retinopathy. JAMA Ophthalmol. August 22, 2019. [Epub ahead of print]