Eyeworld

74 | EYEWORLD | DECEMBER 2023 G UCOMA Contact Hsia: Joey.Hsia@ucsf.edu Ristvedt: deborah.ristvedt@ vancethompsonvision.com Relevant disclosures Hsia: None Ristvedt: Allergan, Glaukos, RxSight, Sight Sciences intraocular pressure range, frequency of glauco- ma imaging, and the patient's individual needs." One area where communication is import- ant is how to manage patient feelings when they are referred from the ophthalmologist to the optometrist or vice versa. To avoid the patient feeling abandoned, Dr. Hsia said to alternate or stagger care of the patient between these providers. He also said it can help to introduce patients to the comanagement ap- proach early in their treatment course. Dr. Hsia said in a comanagement relation- ship, both parties need to agree on a general management philosophy, clearly defined roles, and what constitutes an emergency. "Whatever role the optometrist plays, it should fall within the scope of practice for that state. In states with greater overlap in scope of practice, such as those that allow optometrists to perform SLT, there should be agreement on who is doing a given procedure and timing within the agreed upon management philos- ophy," he said, adding later that optometrists should attend glaucoma-related continuing education courses on current practice patterns. Dr. Ristvedt thinks that comanagement between ophthalmologists and optometrists will continue to be especially important. "There is no way we can keep up with the level of care, the detail of care, if we don't work together," she said. "I'm thankful that in our community, we have wonderful relationships built with trust and time and encouraging one another to be at our best. I'm at my best when I'm learning new technology or surgery and I'm pushing the bar in our thought process when it comes to some of these disease processes like glaucoma. That's where the passion for inter- ventional glaucoma has come from because I've seen the beauty and the power in it. I think I've also seen the beauty and power in learning. Optometrists are hungry to know more, and when you build that trust and that relationship with your fellow optometrists, it does enhance patient care. Patients will tell me on a weekly basis how much they trust both their primary eye doctor and their surgeon. It is a beautiful system when you can have that communica- tion, support, and understanding that you're all working together for the ultimate goal of giving better care than you've ever given before." spike. That is the key when it comes to mini- mally invasive glaucoma surgery and coman- agement, especially with cataract surgery," Dr. Ristvedt said. "Even with standalone cases, I would consider SLT a form of MIGS because a lot of optometrists are sending patients before putting them on drops and seeing it as first line. With standalone glaucoma, it depends on what we're doing and comfort level. There are certain optometrists who might not be as comfortable managing complications, so that's a key, too." Dr. Ristvedt said it's important to educate optometrists about the evidence behind SLT as a first-line therapy, especially due to the quality of life and ocular toxicity issues that come from putting patients on more and more glaucoma drops. She said she's found that once her opto- metric colleagues understand the why behind her recommendations, they'll come on board with the mindset. "Across the board, I think optometrists can manage or comanage a lot of these glaucoma procedures that we do," Dr. Ristvedt said. One challenge that ophthalmologists might have in beginning a comanagement relationship with optometrists is the worry that if they were to refer patients, they won't get them back. "I think that's always been a fear that I'm going to refer a patient who I've developed this relationship with and I'm not going to get that patient back. That's where our whole educa- tional series on glaucoma, cornea, cataracts is so crucial. We do work as a team and we need to be able to communicate by phone, in person, by letters what is happening with this patient so we can all be on the same page. Education goes back to understanding the reason why we do something, understanding our thought process, and being able to communicate what that plan is so that they are involved in the treatment plan. … The doctor-doctor relationship is so crucial in effective communication." Dr. Hsia also said that communication is key for successful ophthalmologist-optometrist comanagement. "My preferred method of communication is to be available in person to allow the optom- etrists to consult me in real time on issues that may be outside of their scope of practice," Dr. Hsia said. "I also include management guide- lines in the patient's chart, outlining target continued from page 72

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