Four out of five cataract diagnoses are made by an optometrist, making ODs the gatekeepers to cataract referrals and to intraocular lens (IOL) technology, according to the Optometry Times. And ophthalmologists rely on ODs not only for referrals, but for follow-up care and patient education as well.
Co-management of postoperative patients has been “hotly debated for several decades,” notes the American Academy of Ophthalmology (AAO). Common concerns include ethical issues, resentment over who benefits financially, and gaps in patient education leading to disappointment with IOL outcomes. However, co-management has come a long way. Here’s how it can benefit everyone, along with tips to help the arrangement go smoothly.
Benefits to ODs, MDs, patients
A joint position paper from the AAO and American Society of Cataract and Refractive Surgery (ASCRS) updated last September finds postoperative, co-managed care an “appropriate” course of action—a complete reversal from the previous AAO/ASCRS guidance, according to Christopher J. Quinn, O.D., American Optometric Association vice president.
“This is a very positive acknowledgement of what has become standard practice,” Dr. Quinn says. “It’s a reflection of the many years of successful patient care and good work that our members provide.”
Co-management has potential benefits for all parties involved. Aging Baby Boomers could create “significant new opportunities” for optometrists, according to the Optometry Times. “A practice treating just five new cataract patients per month could generate additional revenue of $86,610 per year—not including ancillary revenue sources.”
ODs also benefit from a co-management arrangement because it can save them time and boost their productivity. One Los Angeles surgeon who co-manages cataract surgery patients told Ophthalmology Management that without the ability to send patients to optometrists for follow-up care beyond day one and week one post-op checkups, he would likely do around 30 percent fewer cataract surgeries. “Rather than seeing an increased use of optometrists as an economic threat, ODs just may be a golden ticket to raising productivity,” states the article.
And finally, when done right, co-management benefits patients for reasons of convenience and continuity of care. “Patients usually prefer to continue care with their optometrist because of their established relationship and the convenience of being seen at the optometrist’s office, which is usually closer and offers more flexible scheduling,” reports the Review of Optometry.
Educate patients pre- and post-op
The importance of thorough patient education in co-management arrangements cannot be overstated. “Despite the good prognosis, cataract patients may still feel apprehensive when we mention the presence of cataracts and the possible surgical intervention,” write a group of ODs in the Review of Optometry. The authors state that as the patient’s primary eye care provider, the OD is responsible for educating patients about cataracts and treatment options.
Josh Johnston, OD, agrees: “It’s our job to educate patients about cataracts and stay abreast on current treatment options. Patients now have the ability to have laser cataract surgery and choose IOLs that reduce or eliminate the need for glasses after surgery,” he told the Optometry Times.
While ODs may take the lead on patient education, it is just as important for MDs to participate, too—particularly when it comes to explaining the limitations of IOLs (artifacts while driving at night, poor acuity at some distances, etc.) (See: “IOL: Multifocal Lens – Overview”)
Patients who choose premium lenses are very demanding, said Dr. Johnston. Many have had LASIK and assume that cataract surgery will essentially be the same, with the same outcome, he told the Optometry Times. “These patients expect distance, intermediate, and near vision, and spectacle independence.”
Showing patients high-quality videos is an effective way to help them understand all their lens options. (See: “IOL: Premium Lens – Overview”) And some patients may benefit from being fitted with multifocal contact lenses as a trial before surgery.
Open lines of communication between ODs and MDs and patients is a major factor in successful co-management. When done correctly, co-management can help both optometrists and ophthalmologists build their practices.
“It helps you strengthen your clinical skills, build the trust of your patients, and establish strong working relationships with other eye care professionals close to your practice,” writes Patricia Fulmer, O.D., on NewGradOptometry.com. “Through working together, the patient benefits and is sure to receive the best care available…which should always be our ultimate goal.”