Optometry societies, schools provide education in comanagement

Perioperative surgical care is an important part of today’s curriculum.

J. Christopher Freeman

by J. Christopher Freeman, OD, FAAO

With optometrists serving as primary eye care providers it is important for us to be knowledgeable in the perioperative care of eye surgery.

Many options for postgraduate optometric surgical comanagement education are available at the annual meetings of the American Academy of Optometry, American Optometric Association and local, state and regional associations.

Specialty society

The Optometric Council on Refractive Technology (OCRT) even hosts an annual all-day symposium with advanced courses in refractive technology and surgery. OCRT invites optometry students and residents to attend the annual symposium at no cost.

“As optometrists, it is important to be involved in all aspects of our patients’ visual needs,” OCRT President and Primary Care Optometry News Editorial Board member, Marc Bloomenstein, OD, told PCON. “The OCRT was established as a resource for optometry regarding refractive technology. With more than 250 members from around the world, we continue to provide a pulse on all that is new within the refractive surgical arena.”

Comanagement in the schools

Many private and corporate surgical centers also provide optometric education on vision correction surgery for local doctors. But what about new graduates? What is their training like coming out of school?

Southern College of Optometry President Richard Phillips, OD, is working to make sure they are ready for practice. “When I became president of Southern College of Optometry in 2007, I noted that the laser and comanagement curriculum was not as extensive as I felt necessary, specifically in refractive surgery education. We now have lasers on campus and are presenting this information to our students during the third year both didactically and clinically, as well as during fourth-year clinical rotations.”

The optometry schools in the United States are committed to offering comprehensive education, including courses in vision correction surgery.

For example, according to President Clifford Scott, OD, MPH, the New England College of Optometry teaches a formal course that includes optometric pre- and postsurgical care.

The college’s academic dean, Barry Fisch, OD, explained, “The course covers current trends in keratorefractive surgery, surgical patient selection, postoperative care for cataract and refractive surgery, and new technology such as premium IOLs and corneal collagen cross-linking.”

Another example of formal surgical comanagement training is the semester-long course in ophthalmic lasers at the University of Missouri-St. Louis College of Optometry. According to Eric Polk, OD, adjunct assistant professor and instructor of the course, the first half of the class is dedicated to refractive surgery procedures such as laser vision correction, discussing surgical options, complications, wavefront aberrometry and corneal topography. The second half covers therapeutic laser use such as phototherapeutic keratectomy, glaucoma, retina, iris and lens capsule laser procedures.

Other examples of colleges offering surgical comanagement education in their curriculum with specific coursework covering refractive and ocular surgery include Southern College of Optometry and Pacific University College of Optometry.

Southern teaches a semester-long, three-credit-hour course, “Ophthalmic lasers and perioperative management,” for third-year students in which they learn about managing patients undergoing ocular surgery, including postoperative complications.

Lewis Reich, OD, PhD, vice president for academic affairs, describes this course as extensively covering refractive surgery principles and techniques. It even offers a hands-on workshop that includes epithelial débridement of porcine eyes with excimer laser ablation, as well as Nd-YAG capsulotomy and argon peripheral iridotomy treatment on model eyes.

Pacific offers a semester-long refractive surgery elective course for third-year students taught by Beth Kinoshita, OD, and Matt Lampa, OD. According to Dawne Griffith, OD, clinical director for TLC Laser Eye Centers in Portland, adjunct assistant clinical professor at the college and a guest lecturer for this course, “The students are introduced to the history of refractive surgery from Fyodorov to femtosecond laser and monofocal IOLs to accommodating IOLs.”

The course includes a basic discussion of optics and lasers as well as important clinical components such as patient selection and complication management. In addition to discussing laser vision correction and the optometrist’s role in patient management, Dr. Griffith said this elective course encompasses cataract and IOL surgery including presbyopic premium IOLs, as well as therapeutic surgeries such as penetrating keratoplasty, deep anterior lamellar keratoplasty and Descemet’s stripping endothelial keratoplasty.

Practicing ODs provide instruction

At most schools, optometrists who practice in surgical settings serve as adjunct faculty to teach these courses and share real-world experience and clinical pearls.

According to Thomas Freddo, OD, PhD, director of the School of Optometry at the University of Waterloo, the school brings in optometric staff from TLC Laser Eye Centers to teach the didactic coursework in refractive surgery while assigning its own faculty to the laser center to provide postoperative care and supervise students in managing cases.

Many optometry schools, such as the Oklahoma College of Optometry at Northeastern State University, Pacific University College of Optometry and the University of Houston College of Optometry provide for clinical externship experience with supervised clinical care of ocular surgery patients.

In addition to formal courses, guest lecturers are brought in to discuss refractive surgery. Many optometry schools and colleges will cover ocular surgery in the context of treatment and management of ocular disease courses or contact lens courses where a student learns risks, benefits, limitations and alternatives to surgery, contacts and spectacles.

Hands-on patient care

The limitation of any didactic course work is that full understanding of clinical applications comes from combining that didactic work with hands-on patient care and real-world experience. Many schools will offer as part of their clinical externship program the opportunity to participate in clinical care in refractive or ocular surgery care. Several schools have externship sites with private practices or corporate laser centers for more in-depth training, including routine and complex case management, preoperative counseling and candidate selection, and advanced diagnostic testing such as corneal tomography and wavefront aberrometry. Some externship programs allow for refractive surgery clinical observations and visitation as well as involvement with other subspecialties such as retina or glaucoma, while others offer extensive patient care experience in a refractive surgery center with an optometrist or ophthalmologist.

The many examples of schools and colleges of optometry teaching future optometrists are too numerous to mention, but all programs have had to evolve through the years to train optometrists to be ready to practice in the “real world” of eye care. As refractive surgery has grown and become a mainstay in eye care, new optometrists are entering the workforce ready to see those patients.

• J. Christopher Freeman, OD, FAAO, is clinical director at TLC Laser Eye Centers, Oklahoma City. He is an adjunct assistant professor of optometry at the Oklahoma College of Optometry and co-director of an Association of Schools and Colleges of Optometry-accredited optometric residency in refractive and ocular surgery. He has supervised optometry students and residents previously at Johns Hopkins University School of Medicine, Baltimore, and Dell Laser Consultants, Austin, Texas. Dr. Freeman may be reached at Chris.Freeman@tlcvision.com.