Individualizing Optometry Care to all Patient Populations

Bryce St. Clair, OD, MPH 

There are so many ways in optometric practice that we customize treatment options to the patient’s age, disease severity, and ocular characteristics.  Similarly, we also need to individualize care by adapting to our patients’ cultural and socioeconomic realities.  The experience of providing care to immigrant and refugee communities in Houston, TX, Columbus, OH, and now in Baltimore, MD, has taught me some lessons that I try to bring into my practice to better serve and foster connections with all my patients:

Make all patients feel welcome. Adherence to our medical recommendations is built on trust. In every doctor-patient interaction, there are small things we can do to build connection and trust:  Remembering that a patient just became a grandparent and asking about their new grandchild; wishing a Muslim patient “Ramadan Mubarak” during the month of fasting; or asking a question about an immigrant’s favorite food from their country of origin. One small thing we have done in our practice is to utilize the “sticky note” feature of our electronic health record (EHR) system to note the phonetic spelling of unfamiliar names. That way, my staff and I have a better chance of pronouncing patients’ names correctly when we see them.   

Be patient with those who are new to the U.S.  The U.S. healthcare system is enormously complex. It can be challenging for anyone to navigate—but it is especially so for patients who come here from other countries.  Many aren’t aware that even though they have an insurance card, they may still need to pay for their visit.  Co-pays, deductibles and formularies are not familiar concepts in many places outside the U.S., and this can be further complicated if English is not your primary language. For lower income patients, these features of American health care can be huge barriers, but even for well-to-do patients, they can create misunderstandings.

Offer solutions at a range of price points.  When I tell a patient they need cataract surgery, I let them know that the basic procedure, which is mostly covered by insurance, includes a single-distance lens.  They also have the option to spend upwards of $5,000 per eye or more to reduce their dependence on glasses with toric or multifocal features.  Similarly, when I see a patient wearing an older monthly-replacement contact lens, I explain that I can renew their current prescription, or—if they’re interested in more convenient, comfortable, and healthier alternatives—I can introduce them to newer options available at a range of price points, which our optical shop can review with them in more detail. I like to lay everything on the table from conservative to very aggressive treatment, and from low cost to high cost so that we can figure out the best choice together.

Serve the underserved. The sad reality is that many patients who need eye care never even cross the thresholds of our practices. The uninsured or underinsured, the unhoused, recent immigrants—all these groups typically lack access to basic vision and ocular health care. I encourage colleagues to investigate whether your community has a Federally Qualified Healthcare Center (FHQC) or a community health center (CHC) that provides vision or eye health services. Depending on your level of interest and time commitment, you can volunteer regularly, refer uninsured patients there, donate equipment or make a financial contribution. Vision screening fairs hosted by churches, state optometric associations, or other community groups also provide an opportunity to reach underserved populations. The need is great.  For example, 19% of Latinos in the U.S. have undiagnosed and uncorrected refractive error.¹  However, I always encourage people at screening events to get a full exam as soon as they can, because a simple screening can’t tell us enough about their risk for conditions like glaucoma or diabetic retinopathy.

Most optometrists have a desire to help people—it’s why we entered a health care profession.  By showing all our patients that we have a vested interest in connection, we can provide more patient-centered eye care to better meet all our patients’ needs.

For more information:

References:

1. Varma R, Ying-Lai M, Klein R, Azen SP; Los Angeles Latino Eye Study Group. Prevalence and risk indicators of visual impairment and blindness in Latinos: The Los Angeles Latino Eye Study. Ophthalmology 2004;111(6):1132040

Bryce St. Clair, OD, MPH, is an Assistant Professor of Ophthalmology at the Johns Hopkins School of Medicine Wilmer Eye Institute in Baltimore, MD. He worked with CASA and the Maryland Optometric Association to establish a single point of service for immigrants and refugees in the Baltimore community to receive essential eye care.  Dr. St. Clair is a multi-lingual optometrist who is interested in equalizing health disparities in the United States.

Disclosure: Dr. St. Clair has received honoraria for speaking on behalf of Tarsus, Dompe, and Alcon pharmaceuticals.

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