co-management
Treating Patients with Cataracts
Follow these three keys for creating a winning co-management plan.
KENNETH A. YOUNG, O.D.

In today's practice environment, it's common for optometry and ophthalmology to provide primary and tertiary care in concert with each other; one of the most common opportunities is that of the cataract patient. But what are the keys to building successful opportunities for co-management?

Talk it over

The first key lies in open communication. This not only involves the optometrist and the ophthalmologist, but the patient as well. In our office, we take the time to prepare the patient on what to expect pre- and postoperatively. We typically see our patients three times after surgery: the 24-hour visit, at one week and at three weeks. We inform patients beforehand that they'll be taking medicated eye drops for several weeks following surgery and that it's imperative that they follow the directions in using their medication. We also inform them they may experience side effects (e.g., blurry vision, shimmering lights and photophobia) for a few days after surgery. We also explain that several weeks after their surgery, we'll prescribe new spectacles for them because their prescription will have changed. We do everything we can to prepare patients and to ease any apprehensions they may have.

The surgeon and his staff help prepare the patient for what to expect during surgery. Our patients meet with the surgeon before surgery so the surgeon can explain the procedure to them and answer any questions they may have. He also takes that opportunity to obtain any additional information that he may need, such as A/B scans. The O.D. and the surgeon should reassure the patient and his family members.

Keep it on the level

Open lines of communication must also exist between the optometrist and the ophthalmologist -- this is the second key. They must share mutually in each other's best interests. The ophthalmologist must know that the optometrist is adequately trained, competent and willing to diagnose, treat or refer postoperative complications. Recent statistics indicate an increase in postoperative complications following phacoemulsification. Therefore, should the co-managing optometrist suspect any problems, he should immediately consult with the surgeon.

Likewise, if the surgeon encounters difficulties during surgery, he should contact the optometrist to let him know what to expect on the first postoperative visit. An example of this may be increased stromal edema that may result from the heat build up generated by the phaco tip when encountering a hard nuclear cataract. If the optometrist knows this before the first day post-op visit, he's better able to explain to the patient the postoperative results on that first day. By communicating with each other, a mutual trust develops between the two practitioners, and thus more opportunities to work together may also develop.

It's all about the patient

The last key is to do what's in the patient's best interest. The health and well being of the patient should always come first. Should the surgeon feel that he needs to see the patient postoperatively due to some surgical complication or some postoperative risk, then the optometrist should wait willingly until the surgeon feels comfortable in transferring the patient's care. The patient should also know that he always has a choice in who provides his postoperative care.

Count the benefits

All in all, it's a win-win situation for everyone involved. The surgeon gets to do what he is best trained and suited for and the optometrist, likewise. But most importantly, the patient has been assured and has received the best possible care available.

DR. YOUNG IS IN PRIVATE PRACTICE. HE'S A MEMBER OF THE AMERICAN OPTOMETRIC ASSOCIATION AND IS AN ADJUNCT FACULTY MEMBER AT THE SOUTHERN COLLEGE OF OPTOMETRY. HE'S WORKED AS A CLINICAL INVESTIGATOR FOR THE FDA AND FOR MANY DIFFERENT CONTACT LENS, SOLUTION AND PHARMACEUTICAL MANUFACTURERS.