While the MDs in our field endure decades of training to sharpen their surgical expertise and medical practice, their need to be high-volume surgeons does not allow them to put in the time to thoroughly know each patient to the same extent as their primary care optometrist.
Take me, for example. No matter what I ask a cataract surgery candidate who’s referred to our practice in our 10-to-15 minute window, I’ll never have the knowledge or trust that their primary care OD worked to establish over the 20+ years of knowing and treating that patient.
As our scope of practice continues to expand, an astute and proactive primary care optometrist, well-versed in the newest medical—as well as surgical— procedures, will play a critical role making early diagnoses and setting the proper sequence of care in motion. This month’s annual surgery issue touches on some of those key procedures.
Advise and Consent
The primary care optometrist’s role in determining the proper path for ocular surgery can be an important one. About a year ago, I experienced this key role firsthand.
I, for one, am a big fan of toric intraocular lenses (IOLs) for several reasons. When placed internally near the nodal point, they correct astigmatic cataract patients better than what we could do with glasses or contact lenses; they are often less expensive than other premium IOL offerings, they don’t move or rotate and there is minimal peripheral distortion in patients with moderate or low levels of astigmatism. When appropriate, I am inclined to discuss their benefits with a patient and speak highly of their potential.
So, when this particular cataract patient came to me, with 1.00D of with-the-rule astigmatism, I initially considered the go-to toric IOL. Just before speaking with the patient, however, I received a call from my colleague, the patient’s primary, emphatically urging me not to use the toric. My colleague had previously tried toric contact lenses and, though an uncommon reaction, this patient was strongly averse to having the cylinder corrected—and of course would have felt the same after cataract surgery. This may have been due to monovision success (or at least familiarity) and the dioptric power the patient preferred.
Either way, this case proved to be a true testament to the value of knowing your patients and conveying valuable information during the referral. A primary’s clinical prowess in knowing everything about the patient from ocular surface status to a potential history of HSV as well as their overall personality makes them a critical player on the patient’s team of eye doctors.
A Guiding Hand
Another exciting area where a more prominent primary care optometrist role can have a positive impact is with minimally invasive glaucoma surgery. There are many new technologies emerging ranging from the original iStent (Glaukos) to the Hydrus (Ivantis) and numerous new procedures like the Xen (Allergan) replacing far more invasive trabeculectomy procedures. With all these options comes the responsibility to not only know and understand the variety of procedures, but to know which one is truly right for each patient’s unique case.
Cleared for Surgery
In addition to staying on top of all the new hot tech and tools on the market, the primary care optometrist must remain sharp in all routine care, especially in evaluating the ocular surface. This may mean looking for and managing early signs of blepharitis prior to sending them off for surgery and otherwise ensuring a healthy and well-functioning ocular surface. It means continuing to express meibomian glands for diagnostic purposes, and administering treatment and hydrating compresses. And, it certainly means treating dry eye and the consequential inflammation prior to surgery.
In my practice, it’s clear that optometry plays a key role in orchestrating the success of patients about to undergo ocular surgical procedures such as LASIK, cataract surgery and even cataract surgery with MIGS. Understanding this critical role and enhancing your knowledge may contribute to the success of these patients’ care more than anything else.