A Positive Light on OD/MD Tensions

Team works to create both short- and long-term plan for young patient

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By Stacie L. Setchell, OD, of Virdi Eye Clinic in Davenport, Iowa

I find it interesting that students who intern at my practice always inquire about the future of optometry. I admit there is currently much turmoil between ophthalmologists and optometrists. But I believe a collaboration model is the future for optometry, and I’ve seen it work for the betterment of our patients every day. Don’t get me wrong: I am a firm supporter of progressive optometry. But as a young female optometrist who practices side by side ophthalmologists, and specifically a young female ophthalmologist, I have a vested interest in the professional collaboration between an OD and a MD. Despite the political turmoil, I want to shine a light onto the reality that an OD/MD marriage can be extremely effective when done well. I think we can move into the future together.

A few weeks ago, a 17-year-old female presented to my office with severe keratoconus. Her best corrected visual acuity was greatly reduced to legally blind. I learned that she was no longer attending high school because she did not feel safe navigating a six-floor building. She had only attended school one day in the past three months of living in the area. Her life was limited to verbal conversations with family members around a kitchen table in order to fill her days. She was unable to see a computer, a phone, a TV or even a book. Furthermore, she was an uninsured patient who had tried eyeglasses and RGP lenses in the past with no improvement.

Our corneal ophthalmologist and I each performed examinations on this patient. We then sat down to determine the best treatment modality for her. We quickly realized this was a patient who was going to benefit greatly from both an optometric and ophthalmologic standpoint. As an optometrist, I was able to fit the patient in X-Cel scleral lenses to improve her vision to about 20/40 in both eyes, better vision than she had ever previously experienced. This will allow her to function in a school setting quickly and get her high school diploma. However, given the progressive nature of her corneal disease, I knew the scleral lenses were just a temporary fix. Fortunately, our corneal surgeon has a different skill set to bring to the table, which supports a more long-term plan. She felt this patient may ultimately benefit from a corneal transplant. However, given the recovery required following a transplant and the time needed on the front end to obtain insurance, it was also important to have a short-term plan for her. The tools each of us brought to this patient created a short- and long-term plan for her.

I am aware of many differences between optometrists and ophthalmologists, and there is no doubt many issues ahead will need sorting. However, throughout the duration of treating this patient, it occurs to me that never once were any of the following issues discussed. We didn’t ask who would get paid more for their service, who had more prestige, who was best educated to service this patient or which doctor would ultimately be best equipped to become this patient’s long-term eye care professional. We kept it simple. We brought each of our own skills to the table to get the job done, and I believe her life will be forever changed because of it. I am hopeful that once our differences have been worked out, the OD/MD team will prevail as the future of optometry.