BLOG: Glaucoma patients benefit from collaborative care
Key takeaways:
- Primary care optometrists play a critical role in screening for and diagnosing glaucoma, leading to earlier diagnosis.
- The optometrist, surgeon, patient and family members are all part of the collaboration.
Simple math demands that ophthalmologists and optometrists work together in caring for glaucoma patients. We have a growing population of patients with glaucoma, with a stable number of MD glaucoma specialists to manage them.
Most surgeons I know would rather be in the operating room, so a collaborative approach in which optometrists manage glaucoma patients over time, including pre- and postoperative care, just makes sense. From my perspective, providing glaucoma care also enriches the practice of optometry. The medical optometric model enhances our position as physicians in the medical community.
There is no question that primary care optometrists play a critical role in screening for and diagnosing glaucoma. This has been facilitated by growing access to diagnostic tools such as OCT that can provide objective, quantifiable data for earlier diagnosis. That’s a win for patients: Earlier diagnosis means we can start medical therapy and refer for laser or surgical interventions earlier, with the goal of delaying or preventing functional vision loss.
Effective collaborative care of glaucoma patients is all about relationships and communication. It’s really important that both the optometrist and the surgeon understand each other’s treatment philosophies and preferences. A great way for ODs to get to know the surgeons they refer to better is to spend a day shadowing the surgeon in the operating room. That can be a great opportunity to chat one-on-one and see how the doctor interacts with patients. By building a closer connection, you’ll feel more comfortable reaching out to each other in the future about an urgent need, a complex case or a suspected complication.
In our surgically oriented practice, the surgeon and I share similar philosophies on glaucoma care, but that doesn’t mean we always agree. Sometimes one of us would choose to be a little bit more (or less) aggressive, and it is important that we are able to discuss our differences of opinion. We try to put our egos aside and be open to the idea that maybe our partnering doctor has read some studies that we haven’t or has had clinical experiences that drive them to consider a different option. Two heads are better than one in this way. Multiple viewpoints are beneficial because medicine isn’t like baking a cake: There is no recipe that will yield a perfect outcome every time. I believe this ability to function as part of a team is what makes our practice successful, and it’s one that can be adapted to any practice setting.
The patient and their family members are part of the collaboration as well. Having multiple people involved reinforces the idea that glaucoma management is a long-term process. Glaucoma, like many diseases, isn’t “cured” but rather monitored and, hopefully, well controlled. There are many ways to manage it, both topically and surgically, and openly discussing all risks and benefits is an important part of the decision-making process.
Finally, in a truly collaborative partnership, the patient should be sent back to their referring optometrist for ongoing care. Based on the nature of the referral relationship, this may include the postoperative follow-up, continuing medical management of glaucoma and/or vision correction needs. There is room for all of us to participate, to the benefit of our patients.
For more information:
Nicholas J. Bruns, OD, FAAO, practices at Summit Eye Care of Wisconsin, an OD-MD surgical practice in Milwaukee. He can be reached at nbruns@summiteyecareclinic.com.
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