Something interesting has been happening over the last few years: ODs are increasingly using their hands, not just their heads, when caring for their patients. And I don’t mean twirling dials on a phoropter or moving a slit lamp joystick around. I’m talking about things like performing SLT for glaucoma, YAG capsulotomy for post-cataract patients, intralesional steroid injections for chalazia and more—procedures that most people, ODs included, had long considered exclusive to ophthalmology.
These are in-office procedures done without the need for an operating room’s full complement of technical and human resources. Still, in describing these interventions, you might be inclined to use “the S-word”—surgery. That’s a loaded term that riles up those who feel optometrists should stick to making glasses, so we at Review try to limit its use to avoid the baggage that comes with it. Strictly speaking, these procedures do meet the definition, as surgery derives from the Greek for “hand work.” Consulting a dictionary may be an overused way of making a point, but I do find that historical precedent interesting. (Another fun-with-etymology fact for those of us who attend a lot of conferences: symposium means “drinking party” in Greek.)
No one expects optometrists to do ILM peels or scleral buckles, but relatively low-risk, high-reward procedures like capsulotomies satisfy an unmet need for patients who can’t easily access ophthalmological care. It’s the same argument that served optometry well through the TPA wars. And it comes with the same responsibilities: a willingness to study, train and master the tasks expected of you before use. These procedures can’t be learned from an article or two; by definition, a hands-on procedure needs to be practiced under the tutelage of a mentor.
Diagnosis and referral will always remain staples of an OD’s clinical responsibilities. But since hands-on procedures are one of the biggest growth areas in optometric education, we’ve devoted this issue’s Corneal Disease Report to things an optometrist can do in-office to intervene for patients beyond basic identification and comanagement. In these pages, you’ll learn about epithelial debridement and stromal puncture for corneal erosion, EDTA chelation for band keratopathy, amniotic membrane application for wound healing, and how to perform foreign body removal.
You may notice that, this time, we did let the S-word slip in a few times. If you’d like, go ahead and take a minute to celebrate. Possibly at the next symposium.Two new columns debut this month. Paul Karpecki, OD, our workaholic Chief Clinical Editor, offers personal reflections on trends in practice in an op-ed column called “Through My Eyes.” Paul has seen it all, and we look forward to his perspective. Also, Bisant Labib, OD, of PCO highlights the real-world relevance of fundamental principles of care in “The Essentials.” Both are sure to be insightful. Enjoy!