Patient Education With Computer Animations

As ophthalmologists, our main role is surgical; however, we also have a responsibility to educate our patients and counsel them throughout the pre- and postoperative process. Although the typical surgeon relies on himself and his staff to provide patient education, a relatively new alternative, interactive animated software, can clearly and concisely educate patients at the click of a button.

Educating patients is not an easy task; the surgeon must use language that patients can understand. It should undoubtedly be an integral part of the preoperative counseling process, keeping in mind that ophthalmic anatomic, physiologic, and surgical terms are complex and as such often overwhelm the patient. Time is another challenge in patient education because these conversations are often lengthy and may also become too routine in their delivery. Customizing each conversation to the patient's needs and education level is important.

We know that patients with poor health literacy usually have poor compliance and therefore greater risk of disease progression.^1-3 Education initiatives must be direct and informative. During the conversation, patients may be uncomfortable asking the surgeon for clarification or prompting additional questions. This may mean that the surgeon mistakenly thinks the patient understands the material, when in reality he is still confused. If the patient clearly grasps information on his condition, the surgical concept, and the therapy, he will be able to better manage postoperative results.

ANIMATED PATIENT EDUCATION
For these reasons, I prefer to use interactive patient education software to augment the educational process. In one study,⁴ Lin et al showed that using videos to educate the patient preoperatively increased postoperative patient satisfaction better than conventional methods.

The animation and narration of ophthalmic topics in the 3D-Eye Office suite (Eyemaginations, Inc., Towson, Maryland; Figure 1) offer an enhancement to your current communication with patients. I use this system as a complementary tool for patient education; it is integrated into the office setting and may be displayed via an external monitor or personal computer in areas such as the reception area, exam room, or optical dispensary. I have found that this system creates awareness of the procedures, products, and services we offer patients. Topics include ophthalmic anatomy, physiology, pathology, surgery, and surgical complications.

In a typical use of the software, I create a playlist of videos for the patient to watch while his eyes are dilating. Once the videos are complete, I return to the room and follow up with the patient, elaborating on the videos and asking if he has any additional questions.

Recently, my colleagues and I conducted the Interactive Computer Aided Patient Education (ICAPE) study to evaluate the educational quality of the 3D-Eye Office. A total of 144 people were divided into four groups: patients undergoing cataract surgery (n=20), physicians and registered nurses from the department of ophthalmology (n=18), physicians and registered nurses from other departments (n=18), and people undergoing a modern medicine course (n=88). Each group was shown video animations of varying length and content, including cataract, LASIK, diabetic retinopathy, retinal pathology, age-related macular degeneration, and glaucoma. Participants were asked to fill out a comprehensive questionnaire on their experience.

When added together and expressed as a percentage, the average approval rating of the 3D-Eye Office video animations was 92.7%. Among medical professionals only, the approval rating was slightly lower (88.9%); however, questionnaire results in the group of patients undergoing cataract surgery indicated that the videos increased understanding of the condition, the surgical procedure, and associated risks and complications.

The caveat in the cataract patients group is that the video did not adequately ease patients' apprehension. This is why each surgeon must remember to use computer animated software as a complementary means of patient education.

INFORMED CONSENT
Another function of the 3D-Eye Office suite is informed consent. Although the software is not designed as an informed consent tool, it provides enough information to allow its use in a supplementary fashion. Using the animations in this fashion may increase the quality of the informed consent process; however, a randomized, clinical trial is needed to confirm this notion.

Patient education is a mandatory element of the counseling process. By integrating animated and interactive videos into one's practice, communication between surgeon and patient is not only enhanced but also made more appropriate. In a busy clinic, it is easy to set the playlist to facilitate initial education. Once the video sequence is over, the surgeon may return to the room and continue with more individualized counseling, including providing further education and answering any remaining questions.

Carl Glittenberg, MD, practices with the Department of Ophthalmology, Rudolf Foundation Clinic, and at the Ludwig Boltzmann Institute for Retinology and Biomicroscopic Laser Surgery, both in Vienna, Austria. Dr. Glittenberg states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +43 1 71165 4638; fax: +43 1 71165 4609; e-mail: carl.glittenberg@wienkav.at.

1. Juzych MS, Randhawa S, Shukairy A, Kaushal P, Gupa A, Shalauta N. Functional health literacy in patients with glaucoma in urban settings. Arch Ophthalmol. 2008;126(5):718-724.
2. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional healthy literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med. 1998;158(2):166-172.
3. Muir KW, Santiago-Turla C, Stinnett SS, Herndon LW, Allingham RR, Challa P, et al. Health literacy and adherence to glaucoma therapy. Am J Ophthalmol. 2006;142(2):223-226.
4. Lin PC, Lin LC, Lin JJ. Comparing the effectiveness of different educational programs for patients with total knee arthroplasty. Orthop Nurs. 1997;16(5):43-49.