Optometrists and ophthalmologists often work as a combined care team for patients seeking vision correction through refractive and lens based surgeries. This type of collaborative care is commonly referred to as “co-management”.
Family optometrists (ODs) bring a wealth of knowledge with respect to the patient’s ocular history, personality, preferences, visual demands, and of course, his or her contact lens and glasses prescription updates over the years. Surgeons (MDs) bring years of medical training, expertise in lens and treatment selection, incredible hand-eye coordination and dexterity while maintaining excellent communication and care for the patient undergoing a procedure. Both providers should have extensive knowledge of surgical candidacy guidelines, treatment day flow and expectations, post operative care proficiency, and complication management, should any arise. Open and thorough communication, teamwork, and a relationship built on trust is critical to provide our patients with the best possible outcomes.
When the care team is able to work together in a collaborative way, we level up together for our patients. Let’s dive into SharpeVision’s three surgeons’ powerful insights on collaborative surgical care:
How do internal and external ODs help provide vitality to your practice?
“Eye care comprises such a large spectrum of patient care from birth (screening for strabismus, cataracts, refractive error) to childhood, myopia mitigation, and onward through adulthood. It is a delight to collaborate with our optometric colleagues so that the patient experience is cohesive throughout their lives. This keeps each specialist doing what he or she does best, while communicating and educating each other. I have learned so much about new dry eye therapies, contact lens advances, myopia mitigation, and other issues from our optometric colleagues. I love to demonstrate and educate our optometric colleagues about the nuances of refractive surgery. Our in-house optometrists serve as a wonderful bridge to our optometric community. It’s a complete win-win for everyone.”
What can make or break the shared care experience?
“Communication – 100%! We have that as one of our five core values: “excellence in communication.” The implementation of the Sophrona software allows our optometric colleagues to have a window directly into our scheduling software, so that they can know at any given time exactly where a patient stands in the process. We also want our optometric colleagues to have direct access to our in-house optometrists and surgeons at any time to text/call. We all do better when we communicate optimally.”
What are the main barriers to vision correction surgeries, and how can an optometrist help a patient overcome these barriers?
“The main barriers to vision correction surgeries for most patients are cost, fear, and procrastination. The first step is determining which of these 3 (or something else) is keeping your patients from the benefits of refractive surgery, then addressing that issue specifically. If the issue is cost, speaking about the long term cost savings of refractive surgery vs contact lenses can be helpful. Also, introducing the patient to financing options can help. If the issue is fear, identifying specifically what the patient is afraid of helps immensely, as what the patient is afraid of is often a misunderstanding or a risk they see as high, which is in fact, extremely low or non-existent. Identifying and addressing their specific fear(s) is all many patients need to move forward. If the issue is procrastination, encourage the patient to get the benefits of refractive surgery now. Waiting only increases the hassle and cost of contacts and glasses. If they see the value of refractive surgery, encourage them to grab that value now. Why wait?”
How can ODs and MDs work in sync to best prepare the patient for the surgical experience?
“OD and MD partnerships work best when both are on the same page and say the same things to patients. Having pre-agreed upon information helps reinforce our message. Conflicting information can confuse patients and breeds uncertainty. Quoting the same statistics (regarding results, enhancement rates, complication rates, etc.) helps solidify that info in the patient’s mind and provides reassurance that the MDs and ODs know what they are talking about. We should avoid conflicting info by coming to an agreement on all information being presented to patients and staying consistent to that messaging.
What are your top tips for ODs in the community looking to get more comfortable with collaborative care?
“Collaborative care should be a rewarding and enjoyable process for the patient, optometrist, and surgeon.
- Pick your surgeon’s brain! There’s a wealth of experience and knowledge that your surgeon is dying to share with you, to help ensure team alignment and help cultivate your skill set and exposure.”
- Don’t feel alone or overwhelmed. Your surgeon is here to help with any question, post-op complexity, or unique patient expectation or outcome.
- Share your experiences with your peers. Other OD colleagues may have some sage advice and valuable insight regarding their experience with other surgeons or practices.
- Keep it legal and ethical. Federal laws dictate what is and what isn’t considered legal or ethical, and it’s probably best to not collaborate with surgical practices that are not following the rules. A federal lawsuit is not in anyone’s best interest, and could completely bankrupt your practice.”
What insights can you provide MDs looking to grow their network of referring or collaborating optometrists?
“The key attributes that have served me best in my career collaborating with ODs are approachability, availability, and gratefulness. Engaging in conversations and educational opportunities with optometrists helps bridge the gap between our specialties. Make every effort to remove barriers to patient referrals from optometric practices in a timely and efficient manner, and have transparent communications and scheduling options. And above all, recognize the ODs have options with their patients, and emphasize how grateful you are to have the OD’s support, trust, and collaboration.”
In the last decade, premium offerings such as Multifocal IOLs, MIGS, EVO ICL and ocular aesthetics have gained a lot of traction. What is your take on this expanding scope, and how will this affect the direction of the interplay between the fields of ophthalmology and optometry in the future?
“There have been more advancements- in every aspect of eye care- over the last decade than ever before. So there’s more to learn and know now than ever! This makes our specialty exciting, vibrant, and inclusive. It also clearly underscores the importance of ophthalmic experts, optometrists, and eye surgeon working together for the greater good of patient care. Excellent outcomes and exceptional customer service are only achieved through the collaboration of all providers!”
What is your most memorable collaborative care experience to date?
“We have had seven members (so far) of a wonderful family come down from Fairbanks Alaska with seven children, five of whom we have treated. We collaboratively cared for them with their optometrist to create an amazing experience for these patients. They are such a wonderful family, all very outdoorsy and active, and all had a great result. This was such a joy to experience. I am privileged and honored to be chosen as their surgeon.”
“I started my career as a refractive surgeon in the Army, at Carl R. Darnall Army Medical Center, Fort Hood, TX. All our refractive surgery patients were taken care of in an MD-OD collaboration, with a refractive optometrist doing all the initial evaluations and post-op appointments, and the surgeon meeting all patients for a pre-op counseling session and the eventual surgery. I loved this set up, as it played to each specialist’s strengths. Our optometrist was a master refractor and provided us with the most precise pre-op measurements for surgical planning. As a surgeon, I loved that I could focus on surgical planning and the surgery itself, which are the parts of my job I enjoy the most. And since we had such a tight relationship, our optometrist was very comfortable approaching the surgeon with any questions or concerns regarding a patient’s post operative care. I truly believe that patients get the best experience when each member of the patient care team gets to do what they love and what they do best.”
“My most memorable experience was collaborating with a low vision specialty optometrist in the care of a 38 year old with Retinitis Pigmentosa. She had been told by 11 different MDs and ODs that there was no hope for her declining vision, even with her age and lens clarity. Her optometrist took the time to consider all options and referred her to me for a cataract evaluation. After a thorough medical and visual history and full evaluation, I agreed that cataract surgery would be beneficial for her mild PSC cataracts. Within 48 hours post op, she was in tears of joy, as she could see clearer immediately and actually achieved 20/20 vision.”
Thank you, doctors!
If you would like your optometrist to provide collaborative care for your surgical procedure, we welcome the opportunity to connect with them! Our co-management interest form can be found here: https://forms.gle/W9kuxo85SLFKGWiB9