For Susan Kegarise, OD, accessibility to parents and children has been a priority in this new kind of back-to-school season. At Donelson EyeCare in Nashville and Cool Springs EyeCare in Franklin, Tennessee, the practices owned by Dr. Kegarise and her husband, Jeffrey Kegarise, OD, the doctors and their staff work tirelessly to serve as many patients as safely possible. “When a parent calls, we don’t want to say, ‘Our first appointment is in four weeks,’” she says. “We look at our accessibility per doctor with a goal of no more than two days out for an exam.” Another practice adopted by the clinic is to book by capacity, not exam type. This has been shown to greatly reduce unnecessary waits and delays for patients.
“We use very high-trained technicians and equipment so the doctor can do what they do best, which is make professional assessments and prescribe solutions. You want to maximize patient-doctor time,” she says. “We may not be spending an hour with each patient, but we’re spending quality time.”
Another way the ODs at Donelson EyeCare and Cool Springs EyeCare have found to best serve their patients is exam effectiveness. “The parents fill out a vision development questionnaire, which is graded before the doctor even goes in,” she says. The questions range from homework to handwriting, and Dr. Kegarise acknowledges the importance of doctor’s understanding all about a child’s learning progress during these unprecedented times, which include the virtual demand of home learning.
DEMANDS OF HOME LEARNING
“In a typical classroom, [the students] are looking at the board and back to the desk—it’s a different demand on the visual system,” she says. “Now, with virtual classroom learning there is increased stress on the focusing and convergence system muscles which are more active at near. They have to work harder, and be able to sustain their effort for longer periods of time.
In addition to the comprehensive exam elements, the doctor discusses the questionnaire results and conducts up-close binocular testing. The practice also uses advanced technology, including RightEye, an eye tracking technology to identify and graph visual tracking impairments. “It’s so important for reading,” says Dr. Kegarise. “We can show the results to the parent and talk about why the child has headaches or doesn’t want to be on the computer. We can do so much more when we’re face to face with the child.” Since both Dr. Kegarise and her husband have deeply held beliefs in the benefits of vision therapy, they are also able to recommend when the patient needs to be referred to a developmental specialist eye doctor
HAVE PARENTS PRESENT
Parents can learn a lot from sitting in on the child’s eye exam—not only about their child’s vision but even their own. With an increase in patients showing symptoms of dry eye, headaches, blurred vision and eye fatigue, there is also an increase in parents reporting the child struggling to do their work.
“Dry eyes can be a problematic short term issue and a potential long-term problem because the children aren’t blinking as much. That creates a lot of dryness on the front of the eye,” she says. “We’re seeing issues with their oil glands; we have seen 14-year-olds and their meibomian glands are like a 40-year-old and we think, ‘Hmm, when these 14-year-olds actually become 40-year-olds, we’re going to have serious dry eye problems.’ We’re seeing those issues so much earlier due to the demand of digital devices.”
Many patients are also asking questions about the benefits blue light-filtering eyeglasses “High-energy blue light causes fatigue and reduces quality of sleep, and that adds to visual fatigue,” says Dr. Kegarise. These discussions with the doctor are critical, not just for the patients, but for the parent’s own edification. “We prescribe a lot of anti-fatigue lenses and recommend warmer-hue lighting, for example. We talk to the parents about all of this because it can help everyone in the household.” Another suggested practice is the 20/20/20 rule; looking up from the device screen every 20 minutes at something at least 20 feet away for 20 seconds. She acknowledges that while it’s easy to remember, it’s hard to monitor. That is where parents can help by reminding their children during studying.
Dr. Kegarise reflects on how the advice she and her doctors give to their patients changes with the new challenges that arise as technology advances. “The profession changes as life changes. There’s more to consider. ”In the past we concentrated on detecting refractive error, like nearsighted, farsighted and astigmatism. Now, the discussions include refractive issues, plus much more emphasis on near eye muscle demand, proper blinking, long term eye health and slowing the development and progression of nearsightedness.
While Dr. Kegarise doesn’t see patients herself currently, she is very involved, holding regular meetings with doctors and staff to keep everyone up to date on best practices. As the teaching deliveries change with this fall’s back-to-school season, it requires her and the doctors and staff to incorporate more digital device use and lifestyle counseling into their discussion.
Hear From the Doctors
Dr. Susan Kegarise and Dr. Jeffrey Kegarise are not just practice owners but published authors, as well. Their book One Patient at a Time covers patient and doctor culture, their method of taking care of patients, training and general business management knowledge. They also have a podcast called As I See It which is available on Amazon and iTunes. You can contact Dr. Susan at [email protected] or go to their website TheK2Way.com for more information.