Eyeworld

72 | EYEWORLD | DECEMBER 2023 G UCOMA LESSONS LEARNED by Liz Hillman Editorial Co-Director About the physicians Yen Cheng "Joey" Hsia, MD Diablo Eye Associates Walnut Creek, California Deborah Ristvedt, DO Vance Thompson Vision Alexandria, Minnesota Dr. Hsia said when he has comanaged glaucoma with optometrists, they were certified by the California State Board of Optometry to diagnose and treat primary open angle glau- coma for patients 18 and older. He said that comanagement within the same practice often consists of optometrists following POAG sus- pects with or without ocular hypertension and mild POAG that's clinically stable, monitoring for progression and treating with medical ther- apy as indicated. He said that ophthalmologists are "consulted if progression is detected and/or non-medical treatment is warranted." Dr. Hsia said comanagement can also be appropriate after angle-based MIGS for patients with POAG. "For this specific postoperative group, optometrists generally see the patients after postoperative month 2 when the risk of compli- cations diminish and the intraocular pressure is more stabilized," Dr. Hsia said. Dr. Ristvedt said she and her colleagues have worked to educate the optometric com- munity on the various surgical treatments for glaucoma and how they could be involved in comanagement either before surgery is needed or afterward. "What we've done is educated our opto- metric community about angle-based surgery as well as more minimally invasive glaucoma procedures, like subconjunctival procedures, so they're well versed in the multiple technologies we use, the why behind it, and how to manage complications if there is a hyphema or pressure Comanaging glaucoma patients with optometrists continued on page 74 W hen Deborah Ristvedt, DO, fol- lowed in her grandfather's and father's footsteps, becoming a comprehensive ophthalmologist, she said the 45-year-old practice was seeing a lot of primary eyecare at the time she joined. "My grandfather and dad had built up a strong relationship with so many people for so many years," she said. "What I found was that I didn't have the ability to see as many surgical consultations or surgical cases as our commu- nity was growing because of those established relationships." This was until the practice underwent a major shift away from comprehensive eyecare toward a focus on being a surgical practice. This transition, Dr. Ristvedt said, was in part made possible thanks to relationships that she and her colleagues began to establish with optometrists to comanage primary eyecare, such as patients with stable glaucoma. "The biggest thing is not having a fixed mindset. We're continuing to evolve as ophthal- mologists, as optometrists, and really being able to push ourselves into new algorithms and new ways of thinking as our demand for eyecare en- hances. I think that has been a beautiful journey in my life, to use the skills that I've learned and be in the operating room more for patients who need that. This system works, and it's nice to be able to utilize our skillset at the optimal level," Dr. Ristvedt said. Yen Cheng "Joey" Hsia, MD, told EyeWorld that one of the pros of comanagement is that it allows the ophthalmologist to decompress their schedule to accommodate new patient consults and patients with more severe diseases. He also said that optometrists often have more chair time with patients to go over medications to im- prove compliance and/or provide more compre- hensive eyecare, including refractive needs. Getting optometrists involved with medical glaucoma and post-surgical management has changed over the years, Dr. Ristvedt said. "Many optometrists now have technology, like OCT and visual field testing, that allows for more standardization in detecting change or progression," Dr. Ristvedt said. "There is no way we can keep up with the level of care, the detail of care, if we don't work together." —Deborah Ristvedt, DO

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