BLOG: Comanagement benefits patients, surgeons

Welcome to the maiden entry of our blog on surgical comanagement.

Comanagement of ophthalmic surgery, the shared responsibility and care of a patient during his or her perioperative period by a surgeon and a nonsurgeon provider, has been around in some capacity since the 1980s.

Comanagement of any surgery involves a “transfer of care” from the surgeon to a nonsurgeon —in our case, usually back to the referring optometrist. This system, when effectively implemented, provides patients with both improved access to care and improved care.

Patients who live in rural settings are often hours away from a surgical center. It can be impractical and cost prohibitive for them to return to the surgery center, barring complication, for a 10-minute routine postoperative exam. A regional surgery center may comanage with local ODs to provide access to care that is both cost-effective and efficient.

Outcomes are also enhanced by communication between the involved providers, for example helping to establish refractive targets. In addition, the primary OD may be able to draw on years of history with a particular patient to warn the surgery center about the patient’s personality that may make them a poor fit for a multifocal IOL – conclusions that are difficult to reach when you are only seeing the patient for the first time at the surgical consult.

Comanagement is advantageous to the surgeon, who is able to focus more of his or her time on refining surgical skill and less on seeing routine follow-ups in clinic. It is also advantageous to the optometrist, who can skillfully help his or her patient navigate the perioperative period, make timely referrals, deal with routine postoperative complications and refer back more severe issues. An additional benefit when the primary care OD provides cataract postop care is that they can also readily provide the best optical needs for the patient following surgery and retain him or her in the practice.

Challenges to this model, however, may also be encountered when unexpected complications arise with a surgical outcome of which the primary care optometrist is unaware, and the patient ends up back in their office.

We hope to use this space to describe some interesting surgical cases and how they are managed, clinical care of postoperative complications (both severe and mild), surgical concepts that influence outcomes and preoperative considerations that would be important in making surgical plans. Our hope is that this will lead to greater comfort on the part of the comanaging optometrist when anticipating complicated surgical plans and dealing with the occasional postoperative complication.

We will primarily be looking at cataract and refractive surgery care but will also occasionally delve into glaucoma and corneal surgery. We work for Pacific Cataract and Laser Institute, one of the early pioneering groups in comanaged ophthalmic surgery. Ami is the lead optometrist at our Portland, Ore., office, and I’m a staff optometrist at our Kennewick, Wash., office. We both enjoy serving as a liaison between patients, other ODs and our surgeons.

So, once again, welcome. We hope you check back frequently. We’ll do our best to make the entries worth your while.