I direct my therapy based on what I learned in the DED evaluation and the patient’s load of inflammation.
Pre-surgically, Xiidra (lifitegrast, Shire) is my choice of prescription medication because patients have improvement in as little as two weeks. I favor FreshKote drops (Focus Laboratories) as an over-the-counter eye drop which patients can conveniently purchase in the practice. For those with meibomian gland dysfunction, I will perform LipiFlow (Johnson & Johnson Vision) thermal pulsation to help clear obstruction prior to surgery.
For patients with allergies, inferior corneal staining due to exposure, and low levels of inflammation, I like to use absorbable punctum plugs, such as Comfortear Lacrisolve 180 (Paragon BioTeck). They are ideal for use around surgery and are widely underutilized. Alternatively, I may employ the manufacturer’s long-term Comfortear Punctum Plugs; they are easy to insert and fit most punctum sizes.
It is easy to get overwhelmed by the vast array of OSD treatments, so it is important to take a stepwise approach. For presurgical patients, decide what needs immediate attention and what can wait, based on the testing. Treat the highest need first.
As mentioned earlier, the most important aspect to achieving success with this comprehensive strategy is education. By explaining a patient’s condition and informing them of how it is treated, you help them understand the importance of the therapy you prescribe.
ODs taking charge
The need for comprehensive, full-scope optometric care is clear. Many aspects of patient care could benefit from better relationships between primary-care providers and optometrists. To help bridge this gap, ODs should consider working directly with primary-care providers. Family physicians often refer directly to ophthalmologists, bypassing optometrists. We need to educate primary-care doctors about to our role in caring for patients.
When optometrists take charge of the care, we create solid partnerships with our patients. I know my patients will continue their care with me following referral to my fellow ophthalmologists because of the time and effort I spend educating them up front prior to the referral.
It has been well discussed that the eye care industry is facing an increase in the number of patients needing surgical care. At the same time, the number of U.S. ophthalmologists isn’t expected to increase, and they are retiring faster than they are being trained.8 I talk to patients about local surgeons who are performing micro-invasive glaucoma surgery (MIGS), small-lenticule extraction, dropless procedures, laser cataract surgery, or about those who are using the latest intraocular lens (IOL) technology.
Because I take charge and help my patients choose a surgeon, I build trust by sharing my expertise. Perhaps ODs do not always consider taking charge in that way, but we can. I attend MD meetings, get to know the doctors, and forge relationships. I find out if they are responsive and how they communicate (Can I text or call them? Do they read my letters?), and I learn what works.
Optometrists are poised to leverage our key role in patients’ overall eye health. By employing all tools and treatments available and enhancing our relationships with surgeons and primary-care providers, we will ensure the highest standard of care for our patients.
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