Dry Eye Awareness Month: Building a strong optometry-ophthalmology comanagement model

Building a collaborative care model

In recognition of Dry Eye Awareness Month, Shareen M. Greenbaum, MD, and Amanda Amberg, OD, both of Hollywood Eye Institute in Hollywood, Florida, discussed how their co-management model improves outcomes for patients with dry eye disease. Amberg explained that optometrists typically serve as the primary eye care providers and gatekeepers for dry eye, performing initial evaluations and identifying conditions appropriate for long-term management. Cases involving findings that require surgical intervention, such as conjunctival chalasis, signal the right time to transition to collaborative care. Greenbaum noted that the two physicians intentionally align their schedules so they can consult with each other in real time when a patient needs input from both specialties.

Improving surgical outcomes through dry eye management

Both physicians emphasized that untreated ocular surface disease is a common, often overlooked cause of patient dissatisfaction after cataract surgery, even when visual acuity outcomes are excellent. Greenbaum said her approach to surgical timing has evolved significantly since early in her career, when she prioritized rapid scheduling over addressing underlying ocular surface disease. She now takes a more patient approach, often delaying surgery by several months to allow Amberg to optimize the ocular surface and ensure accurate preoperative measurements. Amberg cited identifying cataracts earlier and avoiding delays in referring patients for surgery as key opportunities for optometrists to improve outcomes.

Diagnostic and treatment approach

Amberg described a diagnostic protocol that begins with noninvasive tear break-up time testing, lipid layer evaluation, and corneal staining photography before any treatment is selected. Treatment options offered at Hollywood Eye Institute include intense pulsed light therapy, radiofrequency treatment, dynamic muscle stimulation, thermal pulsation and manual expression, serum tears, punctal plugs as an adjunctive therapy, and amniotic membrane grafts for more severe keratitis. The practice also offers BlephEx for demodex and blepharitis-related conditions, which are common among South Florida patients. Surgical interventions, including treatment of conjunctival chalasis or removal of pterygia affecting biometry, fall under Greenbaum's role when ocular findings require it.

Advice for the optometry and ophthalmology community

Both physicians stressed that trust, communication, and the absence of competition between providers are central to a successful co-management relationship. Amberg encouraged optometrists to broach the topic of dry eye with patients even if they are not comfortable treating it themselves, noting that patients often arrive at surgical consultations unaware they have ocular surface disease. Greenbaum added that every member of a surgical practice should be engaged in identifying and treating ocular surface disease prior to any ocular or eyelid procedure, given its impact on patient satisfaction and surgical outcomes.