O.D. Scene

THE ENTERTAINING SIDE OF OPTOMETRY

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

Last month, I introduced you to some of the key O.D. referral center directors. These guys discussed how their centers operate in addition to their influence on the profession as a whole.

Here, in part two of this two-part series, I speak with three individuals who founded some of the first and most successful referral centers. They are Paul C. Ajamian, O.D., F.A.A.O., Douglas K. Devries, O.D., and Christopher J. Quinn, O.D., F.A.A.O.

In addition to their duties as doctors in referral centers, these gentlemen are leaders in the optometric community and spend much of their time educating fellow optometrists. Dr. Ajamian was recently inducted into the National Optometry Hall of Fame (way to go, Paul!), Dr. Devries is an associate clinical professor at the Pacific University College of Optometry, and Dr. Quinn currently serves as a member of the board of the AOA.

Next month, we speak with new speakers of the profession, and resident world traveler/epicurean, Kirk Smick, O.D. F.A.A.O., of the “Travel, Food & Wine” section, discusses a recent visit to Hong Kong.

Enjoy this month’s column, and I look forward to visiting with you next month!

Key Optometric Leaders Weigh in...

Paul C. Ajamian, O.D., F.A.A.O., Atlanta, Douglas K. Devries, O.D., Sparks, Nev., and Christopher J. Quinn, O.D., F.A.A.O., Iselin, N.J.

Q: Can you briefly describe your practice?

PA: I practice at Omni Eye Services, which is a comanagement center. We are located in Atlanta, with three main offices and an ASC. Our patients are 1/3 glaucoma, retina and cataract/anterior segment. We were the first practice in Atlanta to do surgery with the LenSx laser, and we do a number of premium lenses and complicated cataract cases along with DSAEK, retinal injections for AMD and the iStent for open angle glaucoma.

DD: I practice at Eye Care Associates of Nevada, which is a referral practice I co-founded in 1992 with Paul Hiss, M.D., in Reno, Nevada. It has rapidly expanded state-wide to both Northern and Southern Nevada. On a daily basis, we see pre-surgical patients as well advanced anterior segment and advanced glaucoma patients. We also fly several times a month to rural Nevada towns and cities to provide cataract surgery to patients of optometric practices in those areas. I spend the vast majority of my clinic hours treating advanced ocular surface disease.

CQ: I, too, practice at Omni Eye Services. Our main office is in Iselin, N.J., but we have four additional locations in Northern N.J. and N.Y.C. As a referral center, we see patients who have complex disease.

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

PA: To continue to promote the fact that O.D.s should keep everything they can in-house by embracing every aspect of eye care and committing to life-long learning to provide that care.

DD: First and foremost, to be there for patient care at all times. Next, of course, is to assist and support the optometric community in education and legislation.

CQ: My philosophy is that the referral center’s primary purpose is to enhance the optometric profession. We do that through educational support for fellow O.D.s, students and residents. We return referred patients back to the referring doctor’s practice and provide substantial political support for the optometric profession.

The Quinn family hitting the slopes.

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

PA: In the early days, the leaders of the referral centers throughout the country played a critical role in optometric education and legislative initiatives.

DD: Referral centers should always be acting and educating in the best interest of the local optometric community and be willing to educate through training.

CQ: True referral centers want to expand optometric scope so that the complex care we provide is concentrated here. We represent the top of the pyramid, which needs a strong base of community O.D.s for support. Our goal is to always work to expand the base by strengthening the practices of our referring doctors. The more care they provide, the more successful they become and the better for our practice.

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

PA: The surgeon should see the patient for surgery — period. It is our responsibility to deliver the pre-op counseling and post-op care. If you are not on Medicare, get on it. If you don’t have time to see post-op patients or think it’s not worth it, rethink that. Patients will only trust and refer others to you if they see you as their primary source for information and care.

DD: The opportunity is that the trust and the relationship is between the optometrist and the patient. Patients nowadays must be educated in IOL choices. This education should take place at the referring doctor’s exam. The referring optometrist should be preforming pre-surgical workups, including ocular surface evaluations, prior to referral.

CQ: Optometry must continue to embrace surgical comanagement, as it is efficient and offers great patient outcomes. With surgical comanagement, we marry the excellent surgical care provided by our surgeons with the personalized, local and convenient care provided by the patient’s primary care O.D. Patients love it, our surgeons love it, and our referring doctors love it.

Dr. Devries getting ready to fly his plane.

Dr. Ajamian and wife, Susan, on a trip to N.Y.C.

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

PA: My hat is off to their amazing effort. I would love to be able to do YAGs and SLTs in my state and when the time is right, I will be.

DD: They did a great job of organizing and training doctors and presenting it to their legislators.

CQ: It is great for our healthcare system, as millions of patients have improved access to needed care. The aging of the population will also increase demand for these services. Hopefully, more states will grant this authority to O.D.s in the coming years so patients can easily access this important care.

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

PA: I would like everyone to be in private practice, but that’s not realistic. That said, it doesn’t matter to me where my externs and residents go, as long as they enter a practice where they can control how they practice, with the equipment they need to properly diagnose and the time they need to do a proper job of patient management.

DD: This is a tough task with the debt students are accumulating in getting their degrees these days. What I tell them is to aspire to join or start a group private practice, which I think is the future for optometry. But whatever type of practice they enter, they should strive to practice at the highest level they have been educated and look for that opportunity to join a group practice.

CQ: I advise students and residents to choose a path that allows them to take advantage of their training, provide excellent care and experience the personal satisfaction of professional practice. Private practice provides all these elements. That said, the dominance of private practice as a mode of practice for every healthcare profession is waning. I emphasize successful patient care, independence and integrity in practice no matter where they decide to practice.

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

PA: My residency changed my life. It gave me the confidence to know what and what not to refer and how to deal with conditions I didn’t see in school. But practice experience, if it is the right environment, is a residency. The ABO recognizes three years of practice as equivalent to a residency, which I am in total agreement with.

DD: Yes. It enables young doctors-in-training to gain confidence from treating a large number of patients and seeing the results.

CQ: I believe residency education is critical to producing competent and confident practitioners. With the expanded scope of practice for our profession in the past 30 years, the ability to gain extra clinical experience during residency offers a great advantage. As scope continues to expand, I expect it will become mandatory training in the future.

Q: Where do you get your CE credits?

PA: All over. I love meetings. They keep me in touch with new developments, and they are how I keep in touch with a great network of friends.

DD: Optometry’s Meeting, SECO, Vision Expo East and West and the GWCO.

CQ: All over. State meetings, regional meetings, AOA, online. There are so many ways to get great education today.

Q: What is your favorite optometric meeting and why?

PA: I am partial to SECO, as I serve as CE chairman and have been a volunteer for more than 30 years.

DD: It’s tough to narrow to one, as they all have slightly different goals. That said, I enjoy all the meetings mentioned for CE.

CQ: Optometry’s Meeting is by far the best, and the name says it all. Great CE, great interaction with colleagues, great student interactions and a great exhibit hall. But, most importantly, it is the only meeting where the business of the profession takes place. The important debate and decisions that decide the future of optometry occur only at Optometry’s Meeting.

THe Quinns celebrating daughter Kelly’s college graduation.

Q: Where was your favorite lecture and why?

PA: Last year, I had the honor of moderating a SECO special session lecture by Harry Quigley, M.D. It was the best glaucoma lecture I ever heard. This year, Terry Kim, M.D., from Duke, also amazed all of us with his lecture style, knowledge of corneal disease and great sense of humor.

DD: Panel lectures at large meetings are always the most fun.

CQ: I enjoy the OGS meeting each year because it provides cutting edge education on one of my special interests, glaucoma.

Dr. Devries and son, Kyle, skiing Lake Tahoe.

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?

PA: Be leaders, and get involved with the profession, as all O.D.s should. With this increasing demographic, we will need women who become state and national leaders and speakers and authors to represent women in the profession.

DD: Like-minded graduates should form a group that would facilitate both a family and a private practice.

CQ: Students, both male and female, make a tremendous investment both financially and through hard work in their education for the privilege of practicing optometry. My advice is to stay engaged with your colleagues, which is key to continued success after graduation. Joining the AOA and your state affiliate is the best way to stay connected and to be successful.

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

PA: My wife, Susan, is an R.N., health coach and avid gardener. She started lecturing recently, and I enjoy being her trial audience. Occasionally, I dig holes for her plants, and I only complain about it every third hole. My daughter, Natalie, is a summa cum laude graduate of Valdosta State University and entering the Occupational Therapy program at Medical University of South Carolina. Needless to say, I am extremely proud of her!

DD: My oldest son, Scott, is entering his final year of physical therapy school, and my youngest son, Kyle, is a manger for the sports apparel company Under Armour. I enjoy flying airplanes, skiing, scuba diving, riding motorcycles, shooting pistols and rifles.

CQ: My wife, Susan, and I enjoy travelling, golfing, skiing and sailing. Our daughter, Kelly, just graduated medical school and is a dermatology resident. Our son, Billy, is a Naval Officer finishing flight school to become a Navy pilot. We enjoy spending any time we can with our kids.

Q: Who is your optometry mentor and why?

PA: Paul Shulman was an amazing optometrist who I only heard lecture twice, but taught me that ocular disease was not just the bailiwick of ophthalmologists. He inspired me to become a lecturer.

DD: My mentor was Bill Kanellos, O.D., who guided my involvement in optometry from the very beginning.

CQ: Educationally, Dr. Larry Gray was a great inspiration on what optometry could achieve as an integrated partner with medicine. My team of attending doctors during residency at the Baltimore VA, including Drs. Rick Sharp, Gary Oliver and Peter Lalle, were an incredible influence on me in terms of how to practice medical optometry at a very high level.

Dr. Ajamian, a life-long Patriot’s fan, celebrating this year’s Super Bowl win.

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

PA: I have lunch or dinner planned soon with Irwin Suchoff, O.D. I met him recently, and we hit it off immediately. He is an icon in binocular vision and C.O.V.D., and because I almost specialized in this area out of school, I have always admired him from afar.

DD: Jesus. Who wouldn’t want to talk to Jesus?

CQ: Tough call. Maybe Isaac Newton. After all, the guy basically invented modern physics and calculus.

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

PA: Book: “Why Bad Things Happen to Good People;” Movie: The Theory of Everything; Band: Jethro Tull; Adult beverage of choice: A good Kentucky Bourbon, neat.

DD: Book: “Atlas Shrugged;” Movie: Something About Mary; Band: Jimmy Buffet; Adult beverage of choice: Grey Goose Dirty Martini.

CQ: Book: Recently, “Unbroken;” Movie: Top Gun; Band: Bruce Springsteen; Adult beverage of choice: Grey Goose Martini, dry, cold with a twist.

Q: What do you see as expanded scope?

PA: It is defined by what each state wants to do and can implement realistically.

DD: A uniform scope of practice in all states “as taught” should be our goal.

CQ: I do not see any reasonable restriction on the potential scope of the practice of optometry. I don’t consider the type of doctoral degree you earn an obstacle from developing competence in anything within eye care. Of course, scope of practice must always reflect our training.

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

PA: If each optometrist practices full scope, including glaucoma and anterior segment and cataract comanagement, the future is bright, and we will solidify our hard-earned place in the healthcare community as true primary care eye physicians.

DD: I feel the profession will gain market share if we can continue to embrace the medical side of eye care. At the same time, we can never lose the refractive roots of our profession. We must adapt to all modalities of optometric practice, as well as becoming more involved in the proactive side of ocular health and not just the reactive side of medical eye care. We really need to take a page from the dental profession.

CQ: I believe the future is incredibly bright but it will take work to remain successful. If we embrace comprehensive care, I believe optometry will continue to take market share from ophthalmology. We must recognize that while refractive care is critically important, limiting practice to only routine exams will not be a model for future success. Optometrists will continue to make strides in the pharmaceutical and surgical care market.