BLOG: Four ways to make allies, not adversaries, of your comanaging doctors

ByElizabeth Yeu, MD, FACS

1. Don’t assume

We cannot assume that perioperative care is automatically understood by all referring optometrists. Those who are in vision care-focused practices may not have had an opportunity to care for postoperative patients much at all. That means surgeons need to be proactive in setting expectations and demonstrating what to look for after surgery. For example, I demonstrate how to check the inferior angle for any retained lens fragments, normal vs. concerning levels of corneal edema, and the upper limits of acceptable postop IOP for both glaucomatous patients and those with healthy optic nerves.

2. Educate on the latest technology

We also can’t assume that the community optometrists are as aware of developments in advanced-technology IOLs as we are. It is important for us to hold educational opportunities for local referral sources regularly about the changes we’ve seen in optics (which have advanced considerably in the past 5 years), including low-add multifocals, presbyopia-correcting IOLs with toricity and extended depth of focus (EDOF) lenses. I have found that it is particularly important to show referring ODs what an EDOF lens looks like in the eye and how it differs from a multifocal IOL. The two can look very similar even though the optics focus light quite differently.

3. Understand how definitive a recommendation the referring doctor has made

Some primary care eye doctors tell their patients broadly that there are new options for IOLs but leave most of the discussion to the surgeon and surgery center staff. Others make a very definitive recommendation. When that is the case, it is important to let the referring doctor know of any deviation from the recommendation. If an OD has recommended a multifocal IOL, for example, but I decide that implanting a monofocal or pseudoaccommodating IOL is a more appropriate option, I will personally call the doctor so he/she isn’t caught by surprise.

4. Send the patient back

Make sure that you explain to patients that if they need bifocals or reading glasses after surgery, they will return to the referring doctor for those. That said, it’s equally important to make sure you and the referring doctor are aligned on the patient’s goals after surgery. For example, if the patient is 20/25 in each eye and 20/20 binocularly, she may be quite happy to have met her goal of not needing to wear glasses much. If the optometrist then prescribes spectacles to correct the remaining 0.25 D of myopia, it unnecessarily undermines the surgeon’s results and can turn that happy patient into an unhappy spectacle wearer again.

Disclosure: Yeu reports she is a consultant/adviser for Alcon, Allergan, ArcScan, Bausch + Lomb/Valeant, Bio-Tissue, BVI, i-Optics, J&J Vision, Lensar, Kala Pharmaceuticals, Novartis, Ocular Science, Ocular Therapeutix, Ocusoft, Omeros, Science Based Health, Shire, SightLife Surgical, Sun, TearLab, TearScience, Veracity and Zeiss; does research for Alcon, Allergan, Bausch + Lomb, Bio-Tissue, i-Optics, Kala and Topcon; and has an ownership interest in ArcScan, Modernizing Medicine, Ocular Science, SightLife Surgical and Strathspey Crown.