This is Standard of Care in My Practice
By Gary Kirman, OD
Drs. Drue Bahajak, Gary Kirman, and Stephen Baer (left to right) from Kirman Eye in Hummelstown, Pennsylvania pose with their AdaptDx Pro headsets, the second-generation dark adaptometer developed by MacuLogix®.
In 2014, we bought the AdaptDx® tabletop dark adaptometer. Using dark adaptation we were able to uncover existing disease that wasn’t yet clinically present, and having a definitive diagnosis encouraged our patients to begin implementing lifestyle changes and taking vitamins in the hopes of preserving their vision. We were on the right track, but this was only the beginning. Over the past seven years, we’ve collected data on thousands of patient encounters and have used this data to make incremental adjustments to our protocol. Today, we’ve fully embraced the AMD Excellence Program®, which our practice helped develop.
From Good to Great
The AdaptDx was a good fit for our practice right from the beginning. But because we have three optometrists simultaneously seeing patients, working with only one device had its limitations. We struggled with an ethical dilemma because we were unable to deliver the same care for every patient. We felt stuck because, without more space, we couldn’t add more tabletop dark adaptometers, especially since these required a dark room. Fortunately, the portable AdaptDx Pro® headset was introduced. Not only were we the first practice to get an AdaptDx Pro, we were the first to have three of them—one for each doctor on duty.
Numbers Tell the Story
Now that we’re not all lining up to use the same tabletop device, we’ve doubled the amount of testing we perform and have significantly improved our capture rate. Just as you would expect since AMD is three to four times more prevalent than glaucoma, we are now finding and treating more AMD in our practice compared to glaucoma. In 2019, our doctors treated 2.2 times more AMD than glaucoma. When we look at the six-month data after we implemented the AdaptDx Pro, we found 3.3 times more AMD compared to glaucoma, which is much more reflective of the prevalence of these diseases.
The number of AMD patients captured using dark adaptation wasn’t only correlated with how many tests we were able to perform. It was also impacted by the age limit we set. Initially, we tested patients age 60 and older, but we were curious to learn whether starting at 55 would make a difference. It did. After a year, we found that there was another 7% of patients that had abnormal dark adaptation at age 55. We’re currently looking at what additional percent we may find between patients age 50 and age 55.
Numbers Change Lives
We’ve performed nearly 4,000 dark adaptation tests in seven years. But this is so much more than data. These are people who count on me. I can’t even fathom the impact that this has had on my patients’ lives. We’re not just spinning dials; our goal is to extend quality of life by preserving patients’ vision for as long as we possibly can. I can’t express in words, or in numbers, the profound degree to which dark adaptation has contributed to my ability to achieve this goal.
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About the Author
Dr. Kirman earned a B.S. in Biology at Lafayette College and received his doctorate from the Pennsylvania College of Optometry. In 1986, Dr. Gary Kirman joined his father as a partner at Kirman Eye in Hummelstown, PA. He is an active member of the Central Pennsylvania Optometric Society and was awarded “Optometrist of the Year” from the Central Pennsylvania Optometric Society. He was also the first optometrist to receive the “Young Optometrist of the Year” award from the Pennsylvania Optometric Association. Dr. Kirman was a member of two mission teams that provided eye care to the people of Dominica and Belize.