AOA 2024: Refreshing knowledge on laser procedures

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Spencer Johnson, OD, FAAO, overviews his talk that gives the best practices for pre- and post-operative management for laser procedures like YAG capsulotomy, peripheral iridotomy, and selective laser trabeculoplasty.

With more states approving scope of practice expansion bills across the nation, Spencer Johnson, OD, FAAO, gave a refresher on the best practices to conduct a series of laser procedures, including pre- and post-operative care and choosing the best candidates. He shared these tips in his lecture at AOA's Optometry's Meeting in Nashville, Tennessee.

Video transcript

Editor's note: This transcript has been lightly edited for clarity.

Spencer Johnson, OD, FAAO:

Hi. My name is Spencer Johnson. I am a faculty member at the Rocky Mountain University College of Optometry. The course that I'm presenting is about 3 of the most common laser procedures that optometrists do, so YAG capsulotomy, peripheral iridotomy, and selective laser trabeculoplasty. So we go over when they're indicated, who are good candidates for those, tips and best practices to minimize risks and maximize outcomes. So this talk is also designed to help optometrists who comanage these procedures as well, so you'll know better who to refer for these, how to take care of them after, how to set appropriate expectations.
You know, I see a little bit of hesitancy, those who are just starting or just wanting to start doing these procedures. Maybe they're in a state that just passed legislation so they can, and really try to build their confidence with these, that you could do this. You really have the skills that you've been developing over the years as an optometrist, you're just applying them to a new procedure. I just think the understanding and the communication is really important. So that our colleagues in ophthalmology know what we're able to do, what we're capable of doing, how we want to manage our patients. And in those cases that need comanagement, how we want to do that. Just keep those lines of communication open and I think as we do that, our patients are better served.

I really think the key, like almost any procedure, is just patient selection, knowing who is a good candidate for these, who's going to have a good outcome, preparing the patients, and then just good follow-up after to making sure you're helping them have as good an outcome if they can.

The nice thing about these procedures are they're all based on slit lamp technology, which optometrists, of course, we learned from our first semester practically in optometry school. So the transition is not usually very tough. The skills that we need we have and even the knowledge of who's a good candidate and so forth, we've we've already been that from comanagement. So the transition usually is pretty easy for most providers. Really, like anything, just get in and do it. You'll find a lot of times it's the fear of the unknown, and you get in there, you're like, "Okay, yeah, this is straightforward." Of course, there's some cases that are more difficult than others. And that's just where experience comes in that you can know that, okay, yes, this was the more difficult case, but they're not all like this, and you just move on and continue to progress with your skills. Like all procedures, expectations are important. So for example, like a YAG capsulotomy, it's not going to fix all the issues potentially with their vision. And so you just set the expectations very realistically and say, "It's possible that this could improve your vision, but you may not notice a significant difference. In any case, this will help us better evaluate the health of the back of your eye." So it's really about setting expectations. Again, these are all procedures that optometrists have the skills to do. They have the knowledge to perform these. And so if you're at a state that could do them, you know, go ahead and dig in and you'll better serve your patients if you can do these. And if you're in a state that still comanages, hopefully this course will help you better take care of the patients that you do have.

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