Opinion
Video
Improving Patient Adherence in Diabetic Macular Edema Eye Care
Joseph M. Coney, MD, FACS, reviews best practices for improving adherence to treatment among patients with diabetic macular edema through comprehensive education on the disease and available therapies.
Joseph M. Coney, MD, FACS: I think the most important thing for adherence is really understanding the patient’s journey. When I’m with a patient for the first time, I like to get background information about the patient. I tend to incorporate some of the social determinants of health, such as where they live, what they do for a living, and how much they know about their disease. We also try to manage expectations at the same time. I let them know this is not a 1-visit-and-done situation; it’s not a 1-shot-and-done scenario. We will still need to follow them, even when they’re stable. They would need to have some type of follow-up just to make sure that if this…comes back, we can maintain good vision. I think managing expectations is really important.
I think the communication…between the doctor and the patient is something that we haven’t really talked about over the years. We know that it’s important, but I think in our clinic, we get so busy that it’s overlooked. We really have to understand that it’s not about what we say to the patient; it’s about what they perceive from us. If they don’t think that we have addressed their needs and concerns in a certain way and helped them feel comfortable, because there’s a lot of anxiety that goes on and when we’re speaking over them, they may not adhere to their therapy. Once these issues are met and the patient understands that we have their best needs and wants at heart and want them to succeed, I think they are more likely to keep those appointments.
One of the most important ways that we could help adherence in our patients is that oftentimes when patients come in, they’re told they’re losing vision, they have swelling in the eye, they have diabetic retinopathy, and they think they’re really going to lose their vision. It may be a very stressful time for both the patient and their family during this time. I think it’s really important that although we may share in their losses in these exams, which may not be the most gratifying experience, it’s also important that we stress other gains in their life. We have the ability to show them our ancillary tests. OCT [optical coherence tomography], which is a scan of the back of the eye, is 1 of the most powerful tools we have. We can show them when the swelling was and when it has resolved; we can show them their photographs. I [say things] like “This is bleeding, this is dead tissue” when it comes to the fluorescein angiogram; “This is what abnormal blood vessels look like.” I use these words because I want them to understand it’s a sight-threatening problem. But after 6 months or a year, when I repeat that fluorescein angiogram and I obtain a new photograph, and we compare the photograph to their baseline photograph, they can see the hemorrhages have gone away, the abnormal blood vessels are no longer present, and the swelling is reduced. I think it’s a powerful statement to them about why they need to stay on therapy and, more importantly, why they need to continue with their follow-ups. I think it’s really important for us to share those photographs, put them side-by-side, and help them understand their own journey.
This transcript is AI generated and reviewed by an AJMC® editor.
