Adapting to Change
The art of glaucoma care is evolving incredibly rapidly. Visual field technologies now include objective testing using pattern visual evoked potential. Imaging techniques have a higher resolution than ever before and today feature ganglion cell analyses and optical coherence tomography angiography. Filtration surgery appears to be transitioning to more advanced stenting techniques, as evidenced by the Xen45 (Allergan) and the InnFocus MicroShunt (InnFocus). New tube shunt plate designs are in development as well. At the same time, the role of microinvasive glaucoma surgery as an alternative to filtration surgery is growing, with microstents enhancing supraciliary aqueous outflow on the horizon.
In response to these developments, clinicians must continually adapt how they practice. Change can be difficult and must be implemented on multiple levels. Strong leadership teams must fully understand the potential benefits and challenges of each new technology. These individuals learn not only from industry training but also from peers across the country. This information is a starting point for implementation. Depending on the extent to which adopting a new technology or technique will affect clinical practice, a stepwise or pilot study approach may be needed. Certain clinicians on a team may be more flexible and amenable to change than others, so the former are more likely to lead the charge.
Proper staff training is critical to these efforts. Without the staff’s buy-in and involvement, the road to implementation will be a bumpy ride at best and a failure at worst. Adopting new surgical procedures also requires the careful selection and education of patients. At the outset, it is probably best for these cases to be grouped at the beginning or end of the surgical schedule. Surgeons must perform an adequate number of cases to master the learning curve of any new procedure while carefully avoiding putting the first patients at undue risk. Quality surgical outcomes early on will win over both patients and the clinical team.
Successfully integrating promising new technologies into clinical practice demands a strategic approach that reflects the personality and dynamics of the practice and its members. As with most operational changes, the quality of leadership generally determines how smoothly and successfully the organization adapts. n
Steven D. Vold, MD
Chief Medical Editor