Currently, the practice of medicine occurs in a volatile and unpredictable environment. Medicare cuts always seem to be around the corner, and ophthalmologists are constantly trying to find ways to cut overhead and increase production to keep pace with declining reimbursement.
In addition, a rift has opened up between ophthalmology and optometry during the past decade. Ophthalmologists generally feel that optometric expansion into medical and now surgical practices is politically motivated. Nonetheless, according to the American Optometric Association, optometrists provide approximately 70% of primary eye care services in the United States. Due to improvements in the quality of optometric education and state legislation allowing them to treat glaucoma medically, optometrists manage a large percentage of glaucoma patients. These practitioners are investing in technology (spectral domain optical coherence tomography, frequency doubling perimetry, etc.) that permits the earlier diagnosis of glaucoma, and they are becoming more comfortable looking at the optic nerve. Although many ophthalmologists would argue that the management of a disease that can ultimately lead to blindness should be left to them, the reality is that most patients with glaucoma are asymptomatic and present to an optometrist's office for a routine examination. These practitioners serve as the gatekeepers and, based on their comfort level, will treat or refer patients.
As the US population ages, the incidence of glaucoma is expected to increase by 50% by the year 2020.1 The proportion of the US population older than 65 years is projected to increase from 35 million to 71 million by the year 2030.2 It is therefore critical that ophthalmologists and optometrists forge a relationship that will best serve patients. If you are an ophthalmologist ready to make the effort, here is some advice.
ONE-ON-ONE MEETINGS
One of the best ways to develop a relationship is to arrange for one-on-one meetings with optometrists in your area. These interactions can take place over lunch or dinner. They allow for open communication on what your practice can offer to their patients. Ultimately, optometrists want to ensure that their patients receive the highest-quality and most efficient care possible. Remember, their reputation is on the line when they make a referral, so they want their patients to have a positive experience. Being available for curbside telephone consultations or after-hours/weekend emergencies shows that you are willing to go the extra mile to earn optometrists' trust.
OPEN COMMUNICATION
Keeping the optometrist abreast of his or her patient's condition is important. Referring patients back to that practitioner for their primary eye care needs demonstrates that you are not interested in stealing them but in providing the specialized care required. I prefer to perform my own testing for consistency, but I always include a report with copies of the diagnostic tests for the referring optometrist to keep in his or her records. The same should be true when the patient follows up with his or her optometrist. The key is effective communication between the glaucoma specialist and referring optometrist.
In my colleagues' and my multispecialty practice, one person is dedicated to developing relationships with the optometrists in our region. We also have three optometrists in our practice who help facilitate this process. Because our practice has multiple optical shops, local optometrists were reluctant to refer patients to us for fear of losing them completely. We make it very clear during our initial meeting that we will not dispense glasses and contact lenses to referred patients and that the referring optometrist will continue to serve as the patient's primary eye care provider.
EDUCATIONAL FORUMS
Providing educational conferences, either in your office or at a local restaurant, is a great way to integrate your practice into the optometric community. Our practice provides quarterly continuing medical education (CME) meetings in our office's conference room, and we rotate topics based on attendees' feedback. The event is catered. It requires significant resources and planning because of the regulations governing CME. One of the benefits of our CME conferences, however, other than brand recognition, is a chance to showcase our state-ofthe- art facility and surgery center.
Personally demonstrating to optometrists what their patients might experience during their consultations can be of great value. On-site educational meetings are an excellent opportunity to highlight advanced technology (electronic health records, diagnostic testing, the latest surgical innovations) that your practice offers. Preceptorships, both clinical and surgical, are another avenue to developing relationships with referring doctors. The experiences allow these practitioners to learn your approach to managing patients' disease.
Educational newsletters sent directly to optometric practices that contain information on recent studies or advances in the field can be useful. Ultimately, being proactive about optometrists' education and showing a genuine interest in working with them to best serve their patients will help cultivate a long-term relationship.
CONCLUSION
As the US population ages, will the large number of patients suffering from glaucoma receive adequate care? In areas not readily accessible to ophthalmologists, where optometrists serve as primary eye care givers, it is critical that these two types of eye care specialists work together for the good of patients. There is no better time than the present to foster this valuable relationship.
Kevin P. Pikey, DO, is an assistant professor of ophthalmology and codirector of the Glaucoma Service at the University of Missouri-Kansas City School of Medicine and Eye Foundation of Kansas City. He is in practice as a glaucoma specialist with Sabates Eye Centers in Kansas City, Missouri. Dr. Pikey may be reached at (913) 261-2020; pikeyk@sabateseye.com.
- Eye Disease Prevalence Research Group. Prevalence of open-angle glaucoma among adults in the United States. Arch Ophthalmol. 2004;122:532-538.
- CDC. Public health and aging: trends in aging—United States and worldwide. MMWR Weekly. 2003;52:101-106.
