Healio
Healio
Issue: May/June 2011
May 01, 2011
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Improvement of patients' vision from the 'cradle to the grave'

Issue: May/June 2011

Daniel S. Durrie, MD, Jason E. Stahl, MD, Erin Stahl, MD, and Durrie Vision.

Although offering patients the best possible post-surgical outcomes is the goal of all premium practices, the physicians at Durrie Vision in Overland Park, KS, take that mission one step further — by offering premium refractive correction to patients of all ages.

Durrie Vision became a strictly refractive surgery practice in 1991 and provides patients ranging from the pediatric age group to the more “typical” elderly cataract patient individually tailored treatment based on a series of advanced tests. Being outside the scope of insurance/Medicare has been a great advantage to providing such services, according to Daniel S. Durrie, MD.

“If I want to order a retinal OCT on everyone to make sure their retinas are normal, I get to do that,” Dr. Durrie said. “That’s something that shows the advantages of not being in the ‘system,’ so to speak.” Images by Kenny Johnson Photography.

Jason E. Stahl, MD, shown performing a refractive lens exchange.
Various waiting areas are provided throughout the practice for patients, who are personally escorted through each stop along their exam route. Additionally, a viewing room featuring a high-definition television screen is available for patients’ family members so they can observe their loved one’s laser procedure.
Jason E. Stahl, MD, performs all of Durrie Vision’s premium IOL procedures and specializes in treating patients who have undergone previous refractive surgery.

From left: Drs. Jason Stahl, Daniel S. Durrie and Erin Stahl. Each physician specializes in treating a different age group but shares the same goal: providing premium care. “Our goal, as a family and as a Durrie Vision team, is to be able to treat everybody who needs a refractive error treated,” Dr. Erin Stahl said.
“We’re a refractive surgery practice, not just a LASIK practice,” Dr. Jason Stahl said. “So when we evaluate a patient we want to determine, first of all, whether the eye is healthy and then … what’s going to be the best procedure for their vision not only today, but long-term.”
A large portion of Dr. Stahl’s IOL practice includes performing lens exchanges on patients who underwent laser vision correction with Dr. Durrie 10 to 20 years previously. “We’ve taken the approach of really going after the pathology of the aging lens,” Dr. Stahl said.

Patients who have already successfully undergone procedures like RK, PRK and LASIK and want to maintain their good uncorrected vision have high expectations, according to Dr. Stahl. Therefore, having tools available such as the ORange Wavefront Aberrometer (WaveTec) and an excimer laser for fine-tuning adjustments is really a requirement for premium outcomes, he said.
Dr. Erin Stahl, Dr. Durrie’s daughter, is a pediatric ophthalmologist who has completed her refractive surgery and corneal fellowship with Durrie Vision and will apply the refractive technologies available to adults to her practice at Children’s Mercy Hospital. “Many of the pediatric doctors just don’t know about these technologies and aren’t comfortable using them, and that’s where I come in,” Dr. Stahl said.
One of the biggest misconceptions about pediatric refractive correction is that it’s about getting children out of their glasses, be it to play sports or be accepted by their peers, according to Dr. Stahl. In reality, the focus for refractive correction in pediatrics is on two groups: children with anisometropic amblyopia and those with developmental disabilities. Though many children with amblyopia do well with patching and glasses, some require more extensive treatment like refractive lens exchange. Children with developmental disabilities often have sensory and tactile issues preventing them from wearing glasses — thus compounding their disabilities because they are functionally blind. In both instances, the goal of early intervention is not to provide uncorrected vision, but rather to provide improved vision so the patient can go on to function better in life.

Although not all refractive surgeons will be comfortable performing pediatric refractive surgery, it is important to know “there’s a population of children who can benefit from these technologies,” and to refer them on to surgeons who do specialize in such treatment, Dr. Stahl said.
In an effort to educate patients regarding both their current and future eye health, Dr. Durrie developed a comprehensive eye exam called the Advanced Ocular Analysis. This series of in-depth tests encompasses all aspects of the eye and is recommended to the practice’s patients every 2 to 5 years.
Dr. Durrie’s area of focus falls between that of Drs. Erin and Jason Stahl with regard to age, covering the teenage to early-middle-aged bracket and the area of laser vision correction. Regardless of the type of procedure being performed, however, the goal remains the same: “I want to make sure everybody who has refractive surgery in my practice — whether it’s a laser procedure or a premium IOL — is the best candidate,” Dr. Durrie said.

The Advanced Ocular Analysis is built around both the practice’s EHR system and its method for capturing test images. “As the patient moves through different testing equipment, all that information is building within their patient record,” Dr. Durrie said. “By the time they see the doctor, this information is centralized so we can go through a logical process to make sure their eyes are as healthy as possible.”
Surgical coordinator, Shari Clark, administers antibiotic drops in a patient’s eyes prior to a sub-Bowman’s keratomileusis procedure with Dr. Durrie.
Technician Kris Daughtry performs one of the many tests included in the Advanced Ocular Analysis. Although the tests would be quite costly if billed under insurance, Durrie Vision charges a $150 refractive workup fee, which is later applied to the patient’s surgical procedure.

Thorough patient education is critical to the premium practice, according to Dr. Jason Stahl. “We spend a lot of time with patients preoperatively understanding their visual needs. Then we talk about what the different lens technologies can do for us, the ranges they can give us, and that nothing’s perfect,” Dr. Stahl said. “We really pick and choose what’s going to be best for them.”
In one of the inviting, comfortably appointed patient waiting areas, articles highlighting the practice’s many years of service and achievements are on seen on display, demonstrating the Durrie Vision motto, “Three decades of vision correction.”
Thorough preoperative testing, coupled with the practice’s use of EHR, provides Durrie Vision’s physicians with a detailed look at each patient’s past, present and future eye health, according to Dr. Durrie. “The fact that I have this documentation on everyone means I don’t miss anything, but I also think it’s just better quality of care,” he said. “We spend at least 20 minutes face-to-face with each patient, and we review all this [information] ourselves.”

An example of one of the “non-typical” premium IOL patients the practice sees quite frequently. This patient, in his 30s, received a phakic IOL one day previously.
Although some practices market the services they offer, Durrie Vision takes a different approach. According to Dr. Durrie, “We don’t market a procedure or a technology, because we don’t know what the patient needs until we see them.”