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OD role crucial before, after cataract surgery
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ATLANTA – The optometrist plays a key role in preparing a patient for cataract surgery, advising the surgeon on IOL choice and providing immediate postoperative care, according to Paul Ajamian, OD.
Ajamian, of Omni Eye Services in Atlanta, moderated a special session here at SECO with surgeons Bret Fisher, MD, and Lawrence Woodard, MD. While Fisher and Woodard outlined the latest advances in cataract surgery, Ajamian urged optometrists to set the stage for patients prior to surgery and take responsibility for their care afterwards.
“It all starts with topography,” he said of the preop management. “Many don’t do it in a cataract evaluation. Ideally patients will stay out of their lenses for a week before doing the topography.”
The optometrist’s role is crucial in choosing an IOL, Ajamian said.
“Talk to your patients about monovision, about their goals for distance and near,” he said. “Know the patient’s goals and convey that to the surgeon. These patients want your advice, and they need to be prepared that there may be extra costs.”
The closest surgeon is not always the best, Ajamian continued.
Paul Ajamian
“Patients want your preference,” he said. “You want a surgeon that’s the best they can be, utilizing the latest technology – a surgeon that communicates well and provides a good experience. Some of the best PR our doctors have done is to have been with the patient in the operating room and postop. And you need to work with surgeons that have supported the OD profession.”
Ajamian said optometrists run the risk of losing postoperative care to nurse practitioners and physicians’ assistants.
“Don’t abdicate to someone else,” he said. “All you need is a slit lamp and an eye chart. Management of premium IOLs and laser-assisted cataract surgery does not complicate things much.”
A positive attitude is important day 1 postop, he said, but consult with the surgeon if there is a true problem.
Ajamian cautioned ODs about properly billing for the comanagement arrangement. Be sure to provide the services you bill for, he said.
“There is a system in place to pay doctors for premium lens comanagement for toric and multifocal IOLs,” he said.
Postop care in these cases may include an OCT or topography, which should not be billed separately.
He also said to be aware of your state’s laws regarding consent forms related to comanagement. In some states, the OD, the patient and the surgeon all need to sign it. – by Nancy Hemphill, ELS, FAAO
Disclosure: Ajamian is CE chair for SECO.