Jessilin Quint, OD, MS, MBA, FAAO, is a combination of a scientist, policy strategist and practitioner. She has an MS in molecular biology and an MBA in health care administration. Since she graduated from Indiana University School of Optometry in 2014, she has moved to central Maine, where she co-owns a private practice with three locations, 50 employees and seven full-time optometrists.
Even though the practice is a full-scope primary care practice, the majority of her population is over the age of 50. “By having an aging patient population, we have to be prepared to treat more ocular pathology,” she says. Often, that means that she or one of the other practice doctors is making a glaucoma diagnosis.
“Because optometry is a primary care profession, we often have the opportunity to see glaucoma before the patients realize they have it,” she says. The good news is that, for most optometrists, this falls squarely within their capabilities. “There are a lot of treatment modalities that fall within most states’ scope of practice,” she says. Even those ODs who may not be comfortable actively co-managing glaucoma patients can often find other ODs who are confident in managing that condition.
Patients trust their primary eye care providers, she says. She has already built that relationship with many of her patients, so if she suspects glaucoma, she can continue to work with that patient to educate, diagnose, manage and treat those patients in their own community.
“It’s important to have all the tools available to me,” she says. “Compliance is already an issue for many of these patients, so if we add in that they have to drive hours several times a year to see an ophthalmologist, it could affect their compliance. And the result could be that the disease is going to progress more quickly and potentially result in permanent vision loss,” she says.
She makes sure that she spends the time with patients to ensure that not only do they understand the importance of using the medication as she has directed but also that they are using the most appropriate glaucoma medication for their needs.
“I’m a big fan of branded medications, especially in glaucoma. For glaucoma medication to be effective in slowing disease progression, it needs to be consistent, reliable and used appropriately,” she says. “There is too much variability in generics, and I don’t want to risk that inconsistency.”
She appreciates knowing precisely what the efficacy and mechanism of action is for each medication. She also thinks about how the preservatives and ingredients in the medication will impact the ocular surface.
“Many generic glaucoma medications cause significant ocular surface issues, which often lead to eye discomfort and blurry vision. Those ocular surface disease symptoms can affect a patient’s quality of life and contribute to poor compliance,” she says.
She often reaches first for Lumigan, with its once-in-the-evening dosing. “A proven prostaglandin, it effectively lowers the intraocular pressure (IOP) without destroying the ocular surface.” She says that patient compliance is higher with a simpler regimen, too. This first-line medication helps patients get on the best path for managing the disease and the IOP. It’s effective, consistent and well tolerated by patients, she says.
She reinforces the importance of compliance at every visit. “Patients need to understand that once that vision is gone, it’s gone. We have to take the time to educate patients,” she says. In addition, she follows these patients carefully, adhering to standards of care that have them returning every three to four months. “We are helping to halt progression of the disease, so it’s very important to have these checkpoints.”
If she detects progression of visual field loss or thinning of the nerve fiber layers, then she may move beyond the foundational therapy to a combination agent like Combigan.
REINFORCING THE MESSAGE
Dr. Quint counts on her staff to be able to reinforce her message to patients, and she says that she appreciates how well Allergan helps her staff do that. “Allergan offers optometric staff training for prior authorization programs like PARx Solutions and Cover My Meds. It also provides educational materials, samples and assistance programs for patients who are struggling to pay for their medications. These programs have allowed my team to focus on patient care and making sure our patients are getting the best medications for their condition,” she says.
Even beyond optometric offices, Allergan supports the profession, not only through its extensive research and development into products but also in the way the company supports state and national optometric associations. Dr. Quint says that “Allergan is a great partner, working to better the profession as it delivers products that help us care for our patients.”