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Speakers: Optometry should take a lesson from dentistry
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LAS VEGAS – Optometrists can do a better job of providing preventive care for their patients, just as dentistry does with regular cleanings and x-rays, according to panelists here at Vision Expo West.
Primary Care Optometry News Editorial Board member Marc Bloomenstein, OD; Richard Adler, MD; Paul M. Karpecki, OD; and Jack Schaeffer, OD, spoke at the Ocular Surface Disease and Wellness Symposium, which was co-sponsored by PCON.
Bloomenstein asked how many audience members have an eye exam and a routine physical every year, and there was little response. Schaeffer asked who has seen a dentist in the last 6 months, and a significant number of hands were raised.
“If we make the analogy to dentistry, what do we owe our patients in eye care?” Adler asked. “Twice a year we go to the dentist, open our mouths and get probed, brushed, prodded and x-rayed. What is the equivalent in eye care? Do you think when a patient comes to us we should probe? Scrub? Do routine meibography like dentists get routine x-rays?
“Is there a meaningful relationship between preventive gum care and preventive eye care?” he continued. “Should everyone get the Lipiflow [TearScience]? For all of that work we get done at the dentist, most of us don’t have any issues when we go.”
“Dentistry gets paid for a routine evaluation, and we don’t get paid to do meibography or Lipiflow or TearLab [Osmolarity System],” Karpecki added.
“In some cases, we do have patients with insurance coverage and we have some who will pay cash,” Adler said. “We have to first decide what’s medically in the best interest of the patient. If we decide we should do screening procedures on someone with no symptoms, should we? How did dentistry get these standardized?”
Karpecki said: “Brushing and flossing is the same as warm compresses and lid hygiene. There are a lot of analogies. We need to do a better job.”
Adler noted: “If we’re talking about the spirit of prevention and wellness, why do we have to wait for a complaint? Why are we not getting osmolarity on everyone?”
Karpecki said optometrists should also consider performing meibomian gland expression on all patients.
“We can’t wait for symptoms,” he said.
Adler said he considers meibography his most important test, showing glands that are distorted, dilated or dropped out, indicating meibomian gland dysfunction.
“Can you think of any other test where you can be absolutely certain that they have the disease based on a positive result?” Adler asked.
“You can get noncompliant patients to do something if they see a picture,” Karpecki added. – by Nancy Hemphill, ELS, FAAO
Reference:
Schaeffer J, et al. The dry eye institute: The “why” and the integrated health care model. Presented at: Vision Expo West; Las Vegas; Sept. 13-16, 2017.
Disclosures: Adler reports he is a consultant for Allergan, Lumenis and Topcon. Bloomenstein is on the speakers’ panel for Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, Better Vision Institute, BlephEx, Bruder, Macular Health and TearLab. Karpecki receives consulting fees from AcuFocus, Aerie Pharmaceuticals, Anthem, AMO, Alcon Labs, Allergan, Akorn, Bausch + Lomb/Valeant, BioTissue, Bruder Healthcare, Cambium Pharmaceuticals, Eyemaginations, Essilor, Eyes4Lives, Eye Solutions, Focus Laboratories, iCare USA, Johnson & Johnson Vision Care, OcuSoft, Freedom Meditech, Konan Medical, MacuLogix, Beaver-Visitech, Ocular Therapeutix, Reichert, Shire Pharmaceuticals, Regeneron, RySurg, Science Based Health, SightRisk, TearLab, TearScience, TLC Vision, Topcon and Vmax. He is on the speakers’ bureau for Glaukos and Oculus; has conducted research for Akorn, Allergan, Bausch + Lomb, Eleven Biotherapeutics, Fera Pharmaceuticals, Rigel Pharma and Shire and has an ownership interest in Bruder HealthCare and TearLab. Schaeffer is a consultant for Alcon, Allergan, Bausch + Lomb, CooperVision, Essilor and Vistakon.