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Laser centers are giving ODs the tools they need to comanage PRK patients
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BETHESDA, Md.—Optometrists who have committed to the laser vision correction market by signing on with a laser center can expect to enroll in educational programs specific to comanaging the photorefractive keratectomy (PRK) patient.
Referred to as credentialing, these educational programs may vary in cost from one laser center to another, but the common thread is specific instruction for the pre- and postoperative care of PRK patients. In addition to credentialing, many laser centers offer both ODs and MDs continuing education courses on related topics such as corneal topography, the use of steroids and laser in situ keratomileusis (LASIK).
Laser center officials from across the country told Primary Care Optometry News that their credentialing programs have two goals:
- to help optometrists and ophthalmologists implement and maintain a high standard of care for PRK patients and
- to help clinicians be as comfortable as possible with their first PRK patient.
--- Gary F. Jonas
"People who think optometrists will just refer patients for laser vision correction without being properly trained do not really understand the profession," said Gary F. Jonas, chief executive officer of 20/20 Laser Centers Inc., located here. "We view doctor education as a critical component."
Optometrists and ophthalmologists who pay a network development fee to 20/20 Laser Centers do not pay to attend the credentialing program, Jonas said. Offered in Canada prior to excimer laser approval in this country, this 2-day program allowed doctors to observe PRK being performed, attend lectures, examine postoperative patients and talk with surgeons.
A similar credentialing course is now offered in the United States, said Jonas, in addition to continuing education courses. "Continuing education is a central part of our program," he said. "We have a mentoring program where a doctor who had the training and still has questions can work in concert with an experienced refractive surgeon for additional consultation."
Credentialing not an afterthought
Another company, Global Vision Inc., knew the type of credentialing program it wanted to have in place even before the Food and Drug Administration approved the excimer laser for vision correction.
"Our plan from the start was to have a credentialing program for our doctors, before we even knew what the FDA had imposed upon ophthalmologists for credentialing," said Joann B. Rushing, vice president of marketing and public relations. "Our program is focused towards the optometrist because we use a comanagement model, but we strongly suggest that our ophthalmologists participate as well."
Global Vision's first credentialing session, held in Jacksonville, Fla., attracted nearly 60 doctors, all of whom had positive responses to the program, Rushing said. She believes their program will become a "seal of approval" because it focuses on pre- and postoperative management and because Louis J. Catania, OD, vice president of professional services and optometric director, leads the instruction.
Catania also put together a guide specific to pre-procedure patient evaluation and postoperative evaluation and management. "All of the ODs and MDs who have received this guide feel it is going to be the piece that gets them comfortably into the new technology," Rushing said.
Optometrists who invest in Global Vision, called associates, do not pay a fee to take the credentialing program or the continuing education courses. Doctors who sign on to use a center, but make no financial investment, pay a course fee. "The charge increases in proportion to the lack of tie to the network," Rushing said.
Course covers physics to postop care
--- David C. Eldridge, OD.
Practitioners who complete the training program offered by TLC The Laser Center Inc., Tulsa, Okla., will take "probably the most intense course of any in the field," said David C. Eldridge, OD, advisory board chair.
The first course offered in Canada prior to FDA approval of the excimer, TLC's university-affiliated, 16-hour, 21/2-day program is a thorough hands-on experience for doctors, Eldridge said. "We start with the basic physics and principles of lasers, and go all the way through tissue interaction with lasers to PRK, LASIK and postoperative viewing."
Doctors have the opportunity to view patients postoperatively at 1 day, 2 days, 1 week, 1 month and 6 months, Eldridge said. "We also bring in patients who are 3 and 4 years out from their procedure, as well as post-RK patients who have undergone laser procedures."
Upon passing a test at the completion of the course, attendees receive a certificate and notebook filled with the latest research on laser vision correction.
Eldridge estimates that TLC has trained more than 1,500 doctors through the programs in Canada. Physicians who will perform laser procedures at TLC sites will undergo additional training, including a 40-hour program of didactic wet-lab and preceptorship with doctors experienced in PRK and LASIK.
Centers maintain high standards
--- Jack W. Melton, OD.
In addition to helping optometrists effectively evaluate and manage the PRK patient, credentialing programs allow laser centers to uphold their own standard of care, said Jack W. Melton, OD, president of Laser Eye Institutes of America in Edmond, Okla. There is no fee to the LExES Panel of Doctors for taking the Laser Eye Institute's course, Melton said, because as panel members the credentialing and continuing education courses are part of the package.
"Credentialing is a very important part of the process because we want to maintain the highest standard of care for the patients," Melton said. "You will find that optometrists and ophthalmologists who are involved in these centers are the type of people who want to live up to that standard of care."
The credentialing program--12 hours of education--is where ODs learn patient selection and postoperative care issues, Melton said. This education takes place before the center opens and the first patient is seen. In addition, surgeons who perform PRK undergo a separate credentialing process under the direction of the medical director at each laser site.
A good analogy of the philosophy behind credentialing programs, he said, can be found in a hospital that wants to make sure its doctors are providing high standards of care to patients and requires its medical staff to be highly trained. "Our system does not provide for anyone to provide services there who is not credentialed," Melton said.
PRK credentialing programs are available at:
Global Vision Inc.
Jacksonville, Fla.
904-355-5111
TLC The Laser Center CE Foundation
Tulsa, Okla.
918-491-6162
Laser Eye Institutes of America
Edmond, Okla.
405-330-2360
20/20 Laser Centers Inc.
Bethesda, Md.
301-571-2020