CORNEA 46 EWAP SEPTEMBER 2022 lens patient. “This is not the case for patients with dry eye or ocular surface disease,” she said. “Patients should be seen ideally a month or so after fitting to ascertain that they are doing well and that there aren’t any problems with wear and care of the lenses and use of any concomitant medications.” Dr. Jacobs noted that she has seen a number of patients who misunderstood instructions and were using multipurpose solution to fill their lenses, creating a toxic epitheliopathy that took many months to recover from. After the 1-month check, the patient should be seen after about 3–4 months, then after 6 months, she said, noting that she typically arranges to see the patient the same day as the optometrist if the patient lives far away. If all is well, she will see the patient yearly after that. In many cases, Dr. Jacobs likes to set up a schedule so the optometrist is seeing the patient annually and she is as well, with visits spaced 6 months apart. Dr. Mian said it requires good communication, as with any comanagement situation. He said it’s important to ensure that the doctors you’re partnering with recognize the extent of the medical problems the patient has. Whether it’s dry eye, autoimmune disease, ectasia, LSCD, or neurotrophic issues, these need to be clearly communicated, and there needs to be follow-up communication both ways so the patients’ needs are met. One thing that has changed in the last 5–10 years, Dr. Mian said, is that this has become its own specialty in optometry, so there are residency programs where optometrists learn to do specialty fits. “Someone who has gone through an extensive training program for these lenses would be a good person to partner with because they’re better trained to help patients,” he said. EWAP Editors’ note: Dr. Jacobs is Associate Professor of Ophthalmology, Harvard Medical School, Boston, Massachusetts, and has interests with Dompe and TECLens. Dr. Mian is Professor of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, and disclosed no relevant financial interests. Optometrists share - from page 34 the same way because if we’re not using the same language, patients will pick up on the smallest inconsistencies, and that can be very unnerving for them.” Dr. Cunningham noted the importance of education in the process. “We spend a lot of time educating our community ophthalmologists and optometrists,” he said, adding that this can be anything from monthly emails to live and virtual continuing educational events. The most important thing is education on both sides, he said. The ophthalmologists and optometrists have to be able to get together, and there needs to be an open line of communication all the time. “It’s having very candid conversations about what the concerns are and realizing that, above all, it’s the patients’ needs and safety that will dictate the relationship,” he said. While comanagement is often most set up for LASIK and cataract surgery, Dr. Cunningham noted that his practice also does a number of other procedures, and he mentioned the success of comanagement for corneal crosslinking. Dr. Cunningham also noted the importance of constantly reevaluating the system to ensure that the comanagement model is still providing better service than a sole practice. We need to make sure as clinicians and physicians that we’re providing the best possible care for patients, he said. “In the beginning, we thought we had a template that could increase the level of care for patients in our system if it was done properly. It was what we foresaw would be the new model, and now it makes more sense because of the crush of the healthcare system,” he said. EWAP Editors’ note: Dr. Cunningham works at Dell Laser Consultants, Austin, Texas. Dr. Ibach works at Vance Thompson Vision, Sioux Falls, South Dakota. Neither disclosed relevant financial interests.
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