The results of the Optometric Management “Readers’ Survey” are in, and most of our respondents have expressed great interest in expanding into medical eye care.

This interest makes sense — an article published by the American Optometric Association earlier this year indicated that demand for medical eye care services is expected to balloon due to the aging population (article viewable at bit.ly/AOAmedicaleyecare ). And, some optometrists have found the move into medical eye care personally rewarding.

Justin Bazan, OD, owner of Park Slope Eye, in Brooklyn, N.Y., says when he first started out, he was in a retail setting as a “detect and refer doctor” — and found it disheartening. He says he had minimal opportunity to build relationships with patients with this approach. So, upon opening his own practice, he says the first thing he did was expand medical services to better reflect his training as an OD.

Below, ODs who successfully expanded their practices provide their main tips on how other optometrists can do the same.

Have a passion for the medical service

Michael Cymbor, OD, FAAO, managing partner of Nittany Eye Associates, with locations in Pennsylvania, says it’s important to consider expanding into areas you already have a passion for.

“For me, I was a general optometrist who really loved glaucoma and managed it as far as I was able — but for the most part, the furthest I could go without an external referral was drops,” he says. Adding glaucoma services to his practice allowed him to pursue this interest and better serve his patients, Dr. Cymbor explains.

Think of “natural fits”

Sometimes, an expansion into a medical service is simply the natural progression of a practice. As an example, Jeffrey Sonsino, OD, FAAO, founder and chief medical officer at Eyeris, in Nashville, says that his expanding into dry eye management was the result of becoming known for complex contact lens care. He was getting regular referrals for complicated cases and fitting specialty lenses — something he says required a dry eye disease (DED) center.

Amanda S. Legge, OD, partner at Wyomissing Optometric Center, with locations in Pennsylvania, says her practice’s move into retina care was “the perfect space” to expand into “because retina specialists are overwhelmed, largely because there are treatments that need repeat therapy every few weeks.”

“If optometry manages age-related macular degeneration well, wet conversion can be diagnosed while a patient is asymptomatic,” she says. “This gives patients better outcomes and, frankly, makes the retina specialist’s job easier because early diagnosis of wet conversion results in better visual acuity and less injections overall with the treat-and-extend anti-VEGF protocol.”

Consider hiring an associate

If your budget permits, hiring an associate can bring in a lot of expertise, especially if it’s in an area you haven’t had as much time to devote to, notes Dr. Sonsino.

Dr. Sonsino says, when expanding into DED care, he brought in an associate who had a special interest in dry eye disease to ensure his patients would be treated with the same “level of excellence” they had come to expect from his practice. “We sent her to train with some of the most successful dry eye practices and practitioners in the United States,” he says. “Now, we team up [on] patients. I fit the lenses, and she manages the dry eye disease. Together, we have better outcomes.”

Dr. Cymbor’s clinic brought in an ophthalmologist who was fellowship-trained in glaucoma, “which allows us to keep patients in-house who require selective laser trabeculoplasty or minimally-invasive glaucoma surgery. It’s been one of the most rewarding aspects of my practice to date,” he says.

Invest in the right equipment

Carefully consider the needs of the patients you will be seeing, and purchase equipment accordingly. For instance, for her retina patients Dr. Legge says anyone looking to expand into retina needs high-quality OCT and photography. She says she also employs a device that helps her detect macular degeneration a lot earlier, “which is important for patients to know, so they can make lifestyle changes to hopefully prevent the need for retina specialist intervention in the future,” she says.

Determine scheduling needs

Clinics will want to plan out their schedules to make sure there is enough time and personnel available for specialty services, notes Dr. Cymbor. For example, to make the schedule for his glaucoma specialty clinic work, he says he uses block scheduling, seeing glaucoma patients exclusively on Wednesdays from noon to 4 p.m.

During that time, “we do close down testing for other services,” he explains. “We know that we’ll need several testing rooms just for glaucoma. With 12 different optometrists in the practice, most covering general optometry, we simply can’t all run tests at the same time. Instead, a block schedule works to stagger testing space.”

Find a supplier you trust

A clinic without the right supplies won’t last very long, so having a relationship with a good supplier is invaluable, says Dr. Sonsino. For his DED clinic, he “worked with suppliers who had our best interest in mind,” he says.

Don’t “poach” referrals

“The challenge for anyone [expanding their medical services] is reaching new patients — because no OD wants to lose a patient they are already managing,” says Dr. Cymbor. “It’s easy to offer these services for patients you’re already seeing but as far as becoming a referral center, that’s the bigger hurdle.”

Dr. Cymbor says that they’ve treated this situation cautiously, always being clear that they are there to provide a service — not take over an existing OD’s general optometric care.

“We get the message out [to referring doctors] that we’re getting patients back to their primary OD as soon as possible,” he says.

Fulfilment in expansion

No matter what expansion in medical eye care you might be considering, Dr. Cymbor says that it can be a personally fulfilling endeavor.

“...[Expanding my medical services] personally provides me with a great sense of purpose,” he sums up. “It is a rewarding feeling when we can manage a difficult condition. You hear a lot about burnout in this field, but I would argue that expansion is truly the cure for burnout.” OM