Continuous Improvement

In medicine, like other important fields of work, we must keep looking for ways to improve our performance. We need to constantly evaluate and upgrade our tools and techniques to find better solutions to the challenges we are helping our patients face. If we simply stay in our comfort zone and do the the same thing every day without looking for improvements, we will stagnate and miss opportunities to get better results for our patients. 

With that spirit in mind we have looked for better injection tools to treat wet Age Related Macular Degeneration (ARMD). Since we started injections of anti Vascular Endothelial Growth Factor (anti-VEGF) drugs to stop the severe loss of vision that comes with untreated wet ARMD, we have changed the syringes multiple times and changed the needles at least 3 times. Each time they get smaller and less irritating than the ones before. When we started injections in the eye, we used to use a very small needle that was 30 gauge (remember wire gauge numbers that are higher are actually smaller). The most recent change is the most significant one where the needle is now down to 33 gauge and that is half the size of the original 30 gauge needle. It also has much less “dead space” in the hub of the needle where some residual drug is trapped and does not get into the patient. There is a loss of about 50% of the drug in this “dead space”. What a waste! The new needle has a much smaller hub and more of the drug is delivered to the patient thereby lasting longer and getting better results with less waste.

From left to right: 25ga – 27ga – 30ga – 32ga – 33ga needles

Other improvements have been the development of very high resolution diagnostic equipment that allows us to follow a problem accurately and with excellent repeatability.  This enables us to  really see if the treatment we are using is working. We currently use the best top of the line Heidelberg Engineering system to take pictures and do angiograms in order to find a problem and see how our treatment is working. A unique feature of this system is the ability to put the scan lines exactly on the same spot in the eye where a problem was originally detected and take additional readings that we can directly compare to past readings.  This feature allows us to more accurately determine if there are changes or if the treatment needs to be altered.

A screen shot of the image processing software showing images from two different days. Bottom left dark image shows little change in the two exams above.

A more simple improvement has been changes we have made to our clinic schedule. We have instituted “injection days” where the patients that only need an injection come in and get that done very efficiently and quickly and are on their way with the little or no wait time, no pain, and usually no dilation of the eyes.  We have improved the way we numb the eye and prepare it for treatment, making this injection schedule very effective, convenient and safe as the chance of infection is very small. The biggest bonus is that the patient is comfortable throughout the procedure.  Injections in the eye should not hurt.  Treating ARMD is not a “cure” but is an incredibly successful treatment if done on a routine schedule.   We explain to our patients that their treatment schedule should not be broken if we want to maintain the great results that this treatment can get, and we help them stay on that schedule by making the treatments quick and painless. 

The moral of the story is that seeking continuous improvement makes us better at our work and is in the best interest of the patient. Keep improving, and we do! Sincerely Dr V.

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