Working in a specialty surgery setting to co-manage refractive surgery patients is a great way to find success as a new grad. More optometrists should consider surgical co-management as a way to diversify their skill set and/or grow their practice. It’s crucial that we become well-versed in every aspect of our patient’s eyecare.
After all, refractive surgery is an increasingly popular alternative to glasses & contact lenses. With the growing amount of patients who are interested in refractive surgery, all optometrists must be ready to discuss and manage pre-operative & post-operative care for these patients. Here are five reasons why you should co-manage patients in a surgery setting.
Reason #1: You'll build a partnership with a trusted surgeon
Each surgeon possesses their own method of serving their patients. Co-managing surgical patients or even working in a specialty surgery setting has the potential to enlighten a new grad on how a clinician may foster a positive working relationship with their patients.
You’ll learn firsthand that trust is the foundation to establishing a symbiotic professional relationship. The surgeon is an extension of you. As a new graduate, the pinnacle to success is constantly learning, and working in a specialty-surgery setting provides learning opportunities in spades. You will undoubtedly acquire a plethora of information that you can successfully apply throughout your career as an OD.
When the surgeon performs LASIK, PRK, or even refractive lens exchange, you’ll be within close proximity to absorb the intricate details involved in ophthalmic surgery and disease. With the ability to customize treatments using both lens and laser-based options, optometrists and patients can build a cohesive treatment plan which the surgeon can subsequently execute.
Reason #2: You’ll learn proper pre-operative & post-operative management of refractive and cataract surgery
While co-managing at a surgical specialty practice, you’ll observe key areas of the anterior & posterior segments. The first step to managing complications is to find ways to avoid them altogether or, at the very least, to decrease their likelihood. This starts with astute observations during your pre-operative exam.
For example, dense cataracts can often result in a delayed return of acuity. This happens due to corneal edema from the heightened levels of phaco-energy used during the procedure. Increased levels of corneal edema are much more common in patients with Fuch's Dystrophy as well.
Additionally, pseudoexfoliation can result in an increased risk of glaucoma, dislocated lens material, and IOL dislocation due to loose zonules. Issues in the epiretinal membrane can result in increased risks of cystoid macular edema so prescribing an NSAID before & after cataract surgery can prevent cystoid macular edema. You’ll get to learn these aspects of care, and more, by working in a surgical sub-specialty environment.
Assessment of the eye’s overall status pre-operatively can help you to anticipate when the patient will recover their maximal visual acuity. Moreover, while working at a specialty practice, an OD can learn how to manage any anterior and posterior segment complications which may arise.
Reason #3: The combined knowledge between the surgeon and optometrist makes for the best possible refractive outcome
When a cataract surgery patient enters our office, we must be able to explain, build, and execute a plan for them in a clear and concise manner. When a patient undergoes cataract surgery, they have four options.
- The first option is to have both eyes corrected for distance while still requiring reading glasses. This scenario is still the most common refractive preference for patients undergoing cataract surgery today.
- The second option is to have monovision (in which one lens corrects for distance and one lens corrects near vision), which is my absolute favorite because patients seem to accommodate really well. This option works best when a patient has already experienced and adapted to monovision with contact lenses.
- The third option is a multifocal lens that is corrected for both eyes (distance and near). The downside for patients with regards to multifocal lenses is that they can result in glare/halos at night and loss in contrast.
- The fourth option is bilateral myopia for reading for jewelers or patients who perform a ton of near work. This scenario is typically the best surgical outcome for life-long myopic patients who are happy with their uncorrected near vision and habitually remove their glasses for reading/near work.
All of these options are presented to the patient who will then make a decision based on financial considerations, lifestyle, and preferences. With the refractive knowledge of the optometrist and the surgical power of the ophthalmologist, the potential is there to build a fantastic plan for the patient.
Reason #4: You'll get to work to serve patients while co-managing
Every specialty surgery setting co-manages with hundreds of optometrists within the area. When working in a subspecialty setting you are able to network with optometrists throughout your area (they’re constantly referring patients to your practice). When a patient visits us, they are referred to us by our amazing optometrist partners. We have over 300 referring optometrists at Dougherty Laser Vision.
We then take a proactive role in building relationships with our key eyecare provider network and co-managing the patient together. While doing so, one of the positive consequences is that you simultaneously build a strong network and relationship with these doctors.
Reason #5: You will learn the new refractive surgery options to be better equipped to educate and inform patients
There are new refractive surgery options that are constantly on the horizon. Working within a surgical subspecialty you have the privilege of being at the epicenter. For example, although Toric ICL has been used all over the world for many years, it has only just recently gained FDA approval in the US. We are finally able to perform Toric ICL in the US and now we can offer patients who are greatly nearsighted with astigmatism this incredible option here in the US. Also, Alcon just released the AcrySof IQ Trifocal Panoptix IOL, which delivers a combination of distance, intermediate, and near.
In conclusion, co-managing patients for refractive & cataract surgery is very rewarding. As the patient’s primary care optometrist, we can guide them through the complex decision and care for them through the process with our extensive knowledge. Learning co-management can increase your ability to take great care of these patients and benefit your career in the future. Refractive surgery is the future, whether you agree or disagree. As optometrists & new graduates, we need to be better equipped to learn the co-management side of optometry & better serve our patients.