Eyeworld

70 | EYEWORLD | JUNE 2022 R EFRACTIVE by Ellen Stodola Editorial Co-Director About the doctors Derek Cunningham, OD Dell Laser Consultants Austin, Texas Mitch Ibach, OD, FAAO Vance Thompson Vision Sioux Falls, South Dakota C omanagement can be an important part of an ophthalmology practice, facilitating collaboration between optometrists and ophthalmologists in the community and giving patients the best possible care. In the April 2022 issue of EyeWorld, "Comanagement in refractive cataract surgery" highlighted how this might work in a practice and tools to aid in its success. Here, EyeWorld asked two optometrists to discuss their experiences in practices that have a comanagement approach. They shared recom- mendations for practices interested in expand- ing their comanagement network. Mitch Ibach, OD Vance Thompson Vision Mitch Ibach, OD, discussed his experience at Vance Thompson Vision, where he said about 90% of the patients they see in cataract, glau- coma, and cornea are referred from a primary optometrist or ophthalmologist in the communi- ty. "Refractive surgery is a little less, but it's still 60–70% of those who come to us for refractive surgery," he said. Dr. Ibach stressed why cultivating and managing a large optometric referral network is the lifeblood of the practice. "That's what we're built on, so we work hard to be excellent at communication, making sure that they know what's new, and making sure that they're getting their patients back." Educational events help in this process. These events allow for teamwork "but also teach the referring network what's new in our practice and how we're handling some outcomes and how we're trying to give patients a fantastic experience," he said. Education is also important for staff in the practice. "Once a year, we run an 8- to 10-week staff training where those who want to advance and get certifications can do virtual or live edu- cation with some of our doctors," he said. "Our staff is so important in preliminary education for our patients and delighting them in their experience." Dr. Ibach said the practice also does educa- tion for physicians, which include half- or full- day symposia aimed at optometry and focusing on cataract, refractive, glaucoma, and cornea subspecialties. These are very well attended, he added. The practice uses other platforms, like social media, to facilitate education, as well as dinner events. "Offering that education has created a nice bridge of keeping relationships that have been the lifeblood of the practice," Dr. Ibach said. When considering comanagement, Dr. Ibach said there are advantages as well as things to look out for. "I think there are a lot of advan- tages, and the number one is that it facilitates continuity of care that the patient has with their long-term optometrist or ophthalmologist," he said. There are many years of trust built into those relationships, and in a 15-minute cataract evaluation, you just can't get all of that history. "Having a good relationship with the referring doctor coming in and knowing some of those things can be beneficial," he said. Additionally, in the postoperative period, it allows the patient to get back to their optom- etrist if they need glasses or continued care. It allows our surgical partners to do more surgery, Dr. Ibach said. "In our practice, that's been key, trying to allow our surgeons to do as much surgery as they can or want to do, and that's been helped by having a comanagement model for our patients," he said. "Ultimately, it allows everyone to do what they want to do." Dr. Ibach said that it may be challenging when first starting out to build the relationships and the trust. "Comanagement is definitely a two-way street," he said, adding that he some- times hears concerns from optometrist col- leagues that they're worried that they will not get their patients back if they refer them out. "As an optometrist, we have to communicate that on the front end that I want to see a patient back and lead in the postoperative care." For a surgeon who's starting to do coman- agement, it's a lot easier if you have the policy of "we're going to try to get as many patients back as we can," Dr. Ibach said. It's hard to pick and choose which you want to keep from cat- aract surgery. For refractive surgery, it's a little different, Dr. Ibach added, because patients have the goal of being less dependent on glasses Optometrists share how their practices are using comanagement

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