O.D. Scene

THE ENTERTAINING SIDE OF OPTOMETRY

O.D. Scene creator, writer and editor Jack Schaeffer, O.D.

The development of optometry-owned referral centers have taken a place in the history of the development of the Integrated Healthcare Model (formally known as the medical model). Trailblazers began this movement, and now these referral centers have moved in to the main stream with many in traditional ophthalmology practices.

I’ve interviewed some of the key O.D. referral center directors, or founders, which you’ll hear from this and next month. These doctors not only have made a difference in our practices, they are also on the lecture circuit helping educate their fellow O.D.s on all aspects of the optometry practice of the future. This month, I speak with Derek Cunningham, O.D., F.A.A.O., and Walt Whitley, O.D., M.B.A., F.A.A.O.

Among the slew of topics discussed is cataract surgery comanagement — something crucial to the future of the Integrated Healthcare Model. The optometrist’s understanding and involvement in the comanagement process is imperative to the well-being of these patients.

Finally, for those of you who have been grappling with winter, take a tour of the Hawaiian Island of Kauai, courtesy of “Travel, Food & Wine” columnist Kirk Smick, O.D. Until next time, aloha!

Key Optometric Leaders Weigh in...

Derek Cunningham, O.D., F.A.A.O., Austin, Texas, and and Walt Whitley, O.D., M.B.A., F.A.A.O., Norfolk, Va.

Q: Can you briefly describe your practice?

DC: I practice at Dell Laser Consultants in Austin, Texas. It is a surgical referral and research practice. I see pre- and post-op patients, as well as research patients (both surgical and pharmaceutical).

WW: I am the director of optometric services at Virginia Eye Consultants in Norfolk, Va., where my practice encompasses consultative eye care, clinical research, practice development, optometric education and the supervision of an extensive referral network.

Q: What do you see as your role in a referral center to enhance the optometric profession?

DC: We have chosen a practice modality that exclusively relies on strong and skilled private practice optometrists. We aid in education, practice management resources and practice growth. The stronger the practices are that refer to us, the stronger we become.

WW: My role within our practice is to represent the optometric community and look out for optometry’s best interests within our practice, community and within our state. Currently, I serve as a trustee on the VOA Board, as the VOA Legislative Chair and a Co-Chair on several VOA Education Committees. Our practice firmly understands the optometric comanagement model and is continuously looking for ways to partner and integrate our practice with the O.D. community. Mutual trust and communication are vital to any relationship, and a referral center is no different. Referral centers should provide consistent support and sponsorship of the local and state optometric associations.

The Whitley family “monkeying around” for Halloween.

Q: How do you see the referral center concept expanding the scope of optometric practice?

DC: Centers like ours do not do any vision care, routine care or long-term pathology management. We take great responsibility in ensuring our referring doctors are efficient and comfortable in treating all pathologies.

WW: Within the referral center, the emphasis is on providing problem-focused care through consultations, medical treatments and ocular surgery. Our role is to be an extension of the optometric practice, address the patient’s/referring doctor’s specific needs and return the patient after the care is rendered. We work closely with our referral network and encourage our referring doctors to practice at the highest level of our profession, well within their comfort level or practice modality. We provide education on innovative technologies, as well as on advances in the diagnosis, treatment and management of ocular disease.

Q: Cataract surgery comanagement is at the forefront of practice today. How do you feel optometry should expand this?

DC: Optometrists are fully capable of being very skilled perioperative surgical specialists. I think it is important that they are involved in their patients’ surgical care because of their familiarity with the patient and increased surgical demand on ophthalmology. There are multiple educational opportunities at every major eyecare meeting for optometrists to become more familiar with perioperative care.

WW: With the aging demographic and the increased need for cataract surgery, optometry will play a critical role in caring for these patients. If current trends hold, there will not be enough surgeons to meet the demand for cataract surgery, and optometry will need to answer this call. Our patients come to us for their vision and medical eyecare needs, and they want us to be involved in their care. Patients look to us to not only educate them on the procedure and their IOL options, but also to care for them throughout the process perisurgically.

Q: What is your opinion on Kentucky’s expansion with laser privileges?

DC: If it provides more patient access to care, I am a huge fan of it.

WW: Oklahoma took the lead with other states, such as Kentucky, West Virginia and Louisiana to follow.

Each state has different needs, and it is important for our state associations/membership to decide what is important to them to advance the profession — whether it is expanded scope with lasers, injections, glaucoma and/or oral medications.

In our state, the priority is the non-covered services legislation, which we are introducing in Virginia and prohibits contracts from requiring discounts, setting fees, requiring extra services and procedures when they are not covered by the visioncare plan.

The first step to [decide what is important to each state is to] establish and ensure both members and nonmembers of each state association understand that optometry is a legislated profession and get involved.

The Whitley family enjoys a vacation.

The Cunningham family acting silly.

Q: You see many externs and residents; how do you advise them to purchase or join a private practice?

DC: Private practice optometry constitutes the vast majority of our patient referrals. This exposes externs and residents to how well the comanagement model works. We also stress what procedures can be done and pathologies managed in private practice to reinforce the pathology education that students receive.

Due to our large referral network, we also typically serve as a job placement service for new graduates and private practices. If students consider opening new practices, we assist them in purchasing equipment through our vendors. We also will assist in marketing for new practices. We help establish these practices as primary care doctors who have good relationships with surgeons and refer them to our surgical patients for disease treatment and routine care.

WW: It’s important to practice in an area where you really want to live. Wherever you go, there are usually opportunities. If not, make lemonade, and find a way to make it happen. In the meantime, it’s important to prepare and differentiate yourself from your peers, and find a competitive advantage, such as developing a specialty or niche like contact lenses or dry eye that will get you that dream position. When you develop that niche, don’t just say you have an interest, show your potential employer how your niche/specialty can help promote and grow the practice.

Q: Do you think participating in a residency is important?

DC: It is one of our strong recommendations if students have a keen interest in pathology.

WW: Although residencies aren’t for everyone, I have always been an advocate for pursuing one and started one in our practice. For those who want to specialize in certain aspects of optometry or want to advance their clinical skills in a short period of time, a residency will only benefit them throughout their career.

Q: Where do you get your CE credits?

DC: I like to attend all the national meetings. The education and professional relations are exceptional.

WW: Although I attend many meetings each year, I get most of my CE credits at our local society and state association meetings. It’s important to get involved within our state associations and support our profession.

Q: What is your favorite optometric meeting and why?

DC: The meetings that take place in exotic locations have always been an incredible blend of academics and leisure.

WW: I have lots of favorite meetings. However, I always enjoy going to Optometry’s Meeting. From shaping the future of the profession in the House of Delegates to the CE programs to the networking, there is so much to do, and it’s always a great time.

Dr Whitley with wife, Lindsay.

Q: Where was your favorite lecture and why?

DC: In a horse barn in Calgary, Alberta. A perfect mix of cowboy and optometry.

WW: My favorite lecture was in Turks and Caicos for Tropical CE. We had an awesome group of attendees, and the beaches were amazing.

Q: According to ASCO, almost 65% of the student body in optometry schools is female. What is your advice for this powerful demographic post-graduation?

DC: I think that understanding that traditional eye care is dramatically changing and the speed at which they must adapt will be critical. For our female colleagues, we have some outstanding role models that show all of us that women can rise to the pinnacle of the profession and still be ideal mothers (Drs. Jill Autry and Kelly Nichols, for example). We can all enjoy success in both family life and in our professional careers. The more flexible their practices are and the quicker they can adapt will provide endless opportunities.

WW: That’s awesome! Optometry is a great profession, and it’s important to get involved within the profession.

Q: Who are the members of your family, and what do you like to do for fun?

DC: I have three children — H-Bomb (age 7), BrieBrie (age 5), Abidoo (age 2) — and a very tolerant wife, Jennifer.

Family is everything to me, so every free second goes there. We are a very physical bunch, so we’re always outside and looking for thrills or anything that will beat us up a little. Can’t really get through a day without a couple body slams or head locks.

WW: My wife, Lindsay, has the hardest job between the two of us. She stays home with our four year-old identical twins, Beckam and Brock, and our youngest, Brady, who is 2.

My wife and I enjoy traveling, dinner dates and going to the gym to balance our eating-out hobby. I enjoy spending time with my family doing our normal weekend activities, such as sports, waterparks, playing Wii or just hanging out.

Dr. Cunningham and his son act out the video game characters, the Mario Brothers.

Q: Who is your optometry mentor, and why?

DC: Endless very selfless people I look up to every day. I am constantly surprised by the help I get from established educators in optometry.

WW: Doug Devries, O.D., has been my mentor and close friend throughout my career. He has helped me every step of the way and taught me through his example on how to be a better optometrist, leader, educator and friend.

Q: If you could have dinner with anyone, living or deceased, who would it be and why?

DC: My daughter BrieBrie. Everything I want to know is in her head.

WW: I’d like to have dinner with Abraham Lincoln. He was a remarkable leader who led our country through one of its most difficult times. I’ve always been fascinated with the Civil War.

Q: What is your favorite book, movie, band and adult beverage?

DC: Book: “A Brief History of Time”; Movie: Dumb and Dumber; Band: Waylon Jennings; Adult beverage of choice: Never found one I didn’t like.

WW: Book: “Banker to the Poor”; Movie: Pretty much anything with Will Ferrell; Band: U2; Adult beverage of choice: I’m an IPA guy.

Q: What do you see as expanded scope?

DC: This is a question for each state to decide. Whatever level they choose, I hope the majority of doctors will practice to the fullest scope possible.

WW: It’s all about what is in the best interest of our patients and profession. With the lack of supply in providers and the increased demand for medical eye care, optometry needs to be able to provide patients with the appropriate care in a timely manner wherever the patient is located. Each state will have to determine those needs.

Q: What is your prediction for the future of the optometric profession?

DC: I think the eyecare market will grow overall, as ophthalmology will need to focus more on surgeries due to increased demand. This is already leaving a void in many areas of eye care from ocular surface disease treatment to glaucoma management.

In terms of pharmaceutical dominance, we have seen very impressive increases in the availability of several drugs for specific indications. I think this will continue for ocular surface disease drugs that are heavily underutilized at this time.

Finally, I think the profession will diversify further into medical care and begin to experiment with the cosmetic and aesthetic side of eye care.

WW: It’s a great time to be an optometrist, and the future is bright. We need to continue to practice to the full scope of our education and further establish optometry as THE primary eyecare provider.

With the changing demographic of our patients, the increase in chronic ocular/systemic disease and the future eyecare workforce (more O.D.s than O.M.D.s), optometry will play a critical role in healthcare delivery.

We need to be proactive not just in the treatment and management of disease, but in the prevention and early detection of ocular conditions as well. We must become clinically integrated with our colleagues in the medical community to address public health needs while growing the profession.

Travel, Food & Wine

Kauai: The Garden Isle

Kirk L. Smick, O.D., F.A.A.O., Morrow, Ga.

When I think of Hawaii, I typically think of the islands of Oahu and Maui. Oahu is home to Honolulu and the famous Waikiki Beach. Maui represents sophistication with its stunning golf courses, fabulous restaurants and art galleries. Having been to both, in addition to the big island of Hawaii, my wife and I decided to visit the Hawaiian island of Kauai.

Overview

The almost six million-year-old island is only 553 square miles and 30 miles in diameter. It is arguably the most beautiful of the major Hawaiian islands, as it is the least built upon and boasts dramatic contours and lush mountains. In fact, it is known as the Garden Isle because 98% of its land is undeveloped rainforests and mountain ranges.

Something else to keep in mind: Kauai is an island in microcosm. The North side is always cool and damp, while the South side has the nicest beaches and most sun.

Where to stay/eat

Kauai has two spectacular resorts: the Grand Hyatt Kauai and the St. Regis Princeville Resort. I highly recommend dining at both, as they each offer an array of culinary experiences.

As for dining outside your hotel, I suggest Kintaro Japanese Restaurant, which has excellent sushi, and Duke’s, which is perfect for lunch, as it’s located on the gorgeous Kalapaki Beach.

Kauai’s speciality is shaved ice, which consists of ice cream, syrup, cream on top and ice crystals. The best one I had was at the Hee Fat General Store.

What to see

The island is most noted for Mount Waialeale, which is situated in its center. The annual rainfall there averages 450 inches, although in 1982 it measured 666 inches, which is a world record.

Another must-see is Waimea Canyon State Park (pictured above). It is more than 3,000 feet deep and composed of several shades of brown, green and red. On the day we visited, the sun was shining so brightly that it seemed we could see forever into the distance.

Something else to consider: the dozen or so art galleries in buildings along Hanapepe Road.

So, for your next winter getaway, consider Kauai, the Garden Isle.