Eyeworld

EW FEATURE 52 Preparing for changes in ophthalmology • December 2017 Dr. Trattler said while integrated optometrists do not yet play a role in managing patients with the sole issue of dry eye at the Center for Excellence in Eye Care, they do help manage patients with dry eye in and around cataract and refractive surgery. Dr. Sheppard said working with optometrists, who perform all roles in his practice except for surgery, allows him and his colleagues to reserve their skills for more complex cases. "I can't churn out dozens of well patient exams and postoper- ative visits all day long," he said. "Instead, the level of pathology that all our doctors see is significantly higher than it would be otherwise." If a clinician wants his or her practice to get busier with the same number of hours in the day, Dr. Holland said one has to practice smartly, more efficiently, and one way to do that is by working with optometrists. On the dry eye front, Dr. McDonald said taking on these patients can snowball into a wealth of other patients. "They might come to you for dry eye but when you make them happy, you get their cataract, you get their spouse's cataract, you get their daughter's LASIK. There's a big halo effect here, even though you're starting by treating their dry eye," she said. EW References 1. Farrand KF, et al. Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. Am J Ophthal- mol. 2017;182:90–98. 2. 2016 Dry Eye Products Report: A Global Market Analysis for 2015 to 2012. Market Scope. December 2016. Editors' note: Dr. Loh has financial interests with Allergan (Dublin, Ire- land), Box Medical Solutions, Johnson & Johnson Vision (Santa Ana, Califor- nia), Shire (Lexington, Massachusetts), and Sun Pharmaceuticals (Mumbai, India). Dr. McDonald has financial interests with BlephEx and TearLab. Dr. Sheppard has financial interests with TearLab. Dr. Trattler has finan- cial interests with Allergan, BlephEx, Johnson & Johnson Vision, Shire, and Sun Pharmaceuticals. Drs. Holland and Lindstrom have no financial interests related to their comments. Contact information Holland: eholland@holprovision.com Lindstrom: rllindstrom@mneye.com Loh: jenniferlohmd@gmail.com McDonald: margueritemcdmd@aol.com Sheppard: docshep@hotmail.com Trattler: wtrattler@gmail.com well-managed patients who need routine follow-up. Many dry eye pa- tients can be delegated to optometry for treatment and follow-up as well. Dr. Holland said Cincinnati Eye Institute has two optometrists devoted to its dry eye clinic, which it established 5 years ago. "I usually see the dry eye patients only once. I see them on the initial consultation, lay out the treatment plan, and I rarely have to see those patients back again," Dr. Holland said. The continued management of these patients is performed by the optometrists. "It's made my practice more efficient. These patients have a chronic eye problem, they have loss of vision, loss of quality of life, they're suffer- ing, so we shouldn't ignore them. I think we deliver higher quality care and more efficient care to my other patients by setting up a dry eye clin- ic within my practice." Dr. McDonald has technicians in her practice perform dry eye diagnostic testing, but for certain dry eye therapies, such as LipiFlow (TearScience, Morrisville, North Carolina), a thermal pulsation treatment, and BlephEx (Franklin, Tennessee), an eyelid cleaning and exfoliating treatment, she finds her patient conversion rate is higher if she tells them she'll be performing the treatment. However, she doesn't find they take too much time out of her day. In addition to dry eye, several MDs who employ or work closely with optometrists collaborate in oth- er aspects of patient care manage- ment. Dr. Holland said optometrists at Cincinnati Eye Institute perform preop workups and postop follow-up with cataract patients, monitor stable cornea transplant patients, and manage other chronic disease patients, such as medically or surgi- cally stable glaucoma patients. "I think if we look at the projected numbers of patients that we're going to have to manage … there were approximately 4 million cataract surgeries done in 2017, and by 2021–22 that number is going to increase to about 7 million," Dr. Holland said. "We're going to have less practicing ophthalmologists due to retirement, so we are going to be overwhelmed with age-related diseases, such as cataract, glaucoma, dry eye, and macular degeneration. We have to figure out how to take care of these patients more efficient- ly. Like other areas of medicine, we're leaning on physician extend- ers, and in ophthalmology the best choice for a physician extender is an optometrist." Efficient continued from page 50 Dr. Loh demonstrates using BlephEx and Meibox (Box Medical Solutions), a slit lamp mounted meibographer, on her resident. Source: Jennifer Loh, MD

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