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Digital karma: Making the right choices as a premium surgeon

The decision-making process is aided by subjective, objective and lifestyle analysis.

We all know what karma refers to — in Hinduism and Buddhism, it is “the sum of a person’s actions in this and previous states of existence, viewed as deciding their fate in future existences.” Karma is like a destiny or fate, following as effect from cause. I view “digital karma” as the modern-day version of fate in this digital era.

Unbelievably, I truly believe the fate that happened to me recently is a cause and effect of doing the right thing for my patients as much as possible and giving them the right choices as a premium surgeon. Just 2 weeks ago, I was awakened midweek at 3 a.m. to a bang at my home, happened to look at my video surveillance system and saw three armed men standing outside my bedroom window. Of course, I tried not to panic and was able to call 911, and within 2 minutes, 10 police officers convened at my home and thwarted the inevitable. Maybe all those right choices I made for my patients finally paid off with digital karma.

When facilitating the decision process for patients about to undergo premium cataract surgery, both the surgeon and patient face many choices and/or obstacles in selecting the best option. Below I discuss my strategy in making the right choice as a premium surgeon in terms of subjective, objective and lifestyle analysis.

Subjective analysis

This process starts the moment the patient checks into the office: Staff gets a sense of the patient’s disposition and personality immediately, and this intel gets passed onto the main cataract workup technician, who eventually really gets to know the patient and his/her concerns. Testing technicians can even add their 2 cents in the process and eventually all of this personality and expectations intel is forwarded to the premium surgeon before the exam process through the “red notes” (aka, digital Post-it Notes) section of the electronic medical record, not part of the medical chart. As a premium surgeon, I review this intel and delve deeply into the modified Dell questionnaire that we have patients fill out that same day. The main advantage of this questionnaire is that patients tell you if they really want to be out of glasses and, if so, for what specific activities. It also tells you how many hours they spend on their laptop and smartphone, and it makes them self-grade their own personality from easygoing to perfectionist. I avoid premium IOLs in the latter class, especially when they circle with a black pen around the word “perfectionist” to the point where it tears the paper. This analysis definitely defines patient personality and expectations.

Objective analysis

This is the detailed process of thorough diagnostic testing in terms of quantifying the quality of the patient’s vision using objective scatter index measurements with the HD Analyzer (Visiometrics), iTrace (Tracey Technologies) and/or OPD3 (Marco Ophthalmic) to measure angle kappa and alpha for multifocal IOL decision-making, corneal topography with devices such as Pentacam HR (Oculus) and Cassini (i-Optics), and corneal epithelial mapping with devices such as Cirrus HD-OCT (Carl Zeiss Meditec) and ArcScan to determine if a patient can have a laser vision correction enhancement post-premium IOL if needed, and tear film analysis with osmolarity (TearLab) and MMP-9 (Quidel) measurements and dynamic meibomian gland imaging with devices such as LipiView (Johnson & Johnson Vision) to determine ocular surface quality preoperatively. OCT of the macula to rule out macular pathology such as epiretinal membrane is important as well.

Lifestyle analysis

This analysis is somewhat linked to my subjective analysis section in which the patient questionnaire helps set the mode for what visual outcome the patient desires postoperatively. Additionally, I gather intel from the referring optometrist, ophthalmologist and/or primary care physician who typically knows their patient’s lifestyle needs the best to aid in the IOL decision process. Simply listening to the patient in the exam lane and spending less time looking at the EMR computer usually lead to good rapport and confidence in you as the surgeon, with the patient more willing to be open and honest in their realistic expectations with premium cataract surgery.

Regardless of the approach, consistency in the analysis process in making the right choices for our patients as premium surgeons is critical to a successful outcome and happy patients. Digital karma has an odd way of working, but I feel mine came at the most opportune time and avoided an armed robbery conflict. I have since upgraded the security at my home and will be ready if they dare tempt digital karma a second time.

Disclosure: Jackson reports he is a consultant for Marco Ophthalmic, Carl Zeiss Meditec, Visiometrics, Oculus, Johnson & Johnson and i-Optics.

We all know what karma refers to — in Hinduism and Buddhism, it is “the sum of a person’s actions in this and previous states of existence, viewed as deciding their fate in future existences.” Karma is like a destiny or fate, following as effect from cause. I view “digital karma” as the modern-day version of fate in this digital era.

Unbelievably, I truly believe the fate that happened to me recently is a cause and effect of doing the right thing for my patients as much as possible and giving them the right choices as a premium surgeon. Just 2 weeks ago, I was awakened midweek at 3 a.m. to a bang at my home, happened to look at my video surveillance system and saw three armed men standing outside my bedroom window. Of course, I tried not to panic and was able to call 911, and within 2 minutes, 10 police officers convened at my home and thwarted the inevitable. Maybe all those right choices I made for my patients finally paid off with digital karma.

When facilitating the decision process for patients about to undergo premium cataract surgery, both the surgeon and patient face many choices and/or obstacles in selecting the best option. Below I discuss my strategy in making the right choice as a premium surgeon in terms of subjective, objective and lifestyle analysis.

Subjective analysis

This process starts the moment the patient checks into the office: Staff gets a sense of the patient’s disposition and personality immediately, and this intel gets passed onto the main cataract workup technician, who eventually really gets to know the patient and his/her concerns. Testing technicians can even add their 2 cents in the process and eventually all of this personality and expectations intel is forwarded to the premium surgeon before the exam process through the “red notes” (aka, digital Post-it Notes) section of the electronic medical record, not part of the medical chart. As a premium surgeon, I review this intel and delve deeply into the modified Dell questionnaire that we have patients fill out that same day. The main advantage of this questionnaire is that patients tell you if they really want to be out of glasses and, if so, for what specific activities. It also tells you how many hours they spend on their laptop and smartphone, and it makes them self-grade their own personality from easygoing to perfectionist. I avoid premium IOLs in the latter class, especially when they circle with a black pen around the word “perfectionist” to the point where it tears the paper. This analysis definitely defines patient personality and expectations.

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Objective analysis

This is the detailed process of thorough diagnostic testing in terms of quantifying the quality of the patient’s vision using objective scatter index measurements with the HD Analyzer (Visiometrics), iTrace (Tracey Technologies) and/or OPD3 (Marco Ophthalmic) to measure angle kappa and alpha for multifocal IOL decision-making, corneal topography with devices such as Pentacam HR (Oculus) and Cassini (i-Optics), and corneal epithelial mapping with devices such as Cirrus HD-OCT (Carl Zeiss Meditec) and ArcScan to determine if a patient can have a laser vision correction enhancement post-premium IOL if needed, and tear film analysis with osmolarity (TearLab) and MMP-9 (Quidel) measurements and dynamic meibomian gland imaging with devices such as LipiView (Johnson & Johnson Vision) to determine ocular surface quality preoperatively. OCT of the macula to rule out macular pathology such as epiretinal membrane is important as well.

Lifestyle analysis

This analysis is somewhat linked to my subjective analysis section in which the patient questionnaire helps set the mode for what visual outcome the patient desires postoperatively. Additionally, I gather intel from the referring optometrist, ophthalmologist and/or primary care physician who typically knows their patient’s lifestyle needs the best to aid in the IOL decision process. Simply listening to the patient in the exam lane and spending less time looking at the EMR computer usually lead to good rapport and confidence in you as the surgeon, with the patient more willing to be open and honest in their realistic expectations with premium cataract surgery.

Regardless of the approach, consistency in the analysis process in making the right choices for our patients as premium surgeons is critical to a successful outcome and happy patients. Digital karma has an odd way of working, but I feel mine came at the most opportune time and avoided an armed robbery conflict. I have since upgraded the security at my home and will be ready if they dare tempt digital karma a second time.

Disclosure: Jackson reports he is a consultant for Marco Ophthalmic, Carl Zeiss Meditec, Visiometrics, Oculus, Johnson & Johnson and i-Optics.