Five pillars of a strong OD/MD partnership

The relationship between optometrists and ophthalmologists has the power to be one of the most impactful collaborations in health care. We are positioned as the patient’s primary eye care provider—the first contact, the long-term relationship, the trusted guide. The ophthalmologist is the colleague we turn to when a patient’s needs extend beyond what our individual scope of practice allows us to provide, depending on where we practice. When that handoff is seamless, patients thrive. When it breaks down, they fall through the cracks.

When that handoff is seamless, patients thrive. When it breaks down, they fall through the cracks.

I recently sat down with 2 colleagues who have thought deeply about this: Kevin J. Kovach, MD, a board-certified comprehensive ophthalmologist and founder of Kovach Eye Institute in Chicago with over 30 years of clinical and surgical experience; and Giannie Castellanos, a Florida-based OD with a specialty in pediatric care and myopia management, and founder of The Chiasm, a network dedicated to connecting ODs and ophthalmologists for better patient outcomes.

What emerged from those conversations are 5 pillars that every OD can act on today to build referral relationships that truly protect their patients.

Pillar 1: The right referral starts with the right partner

Most of us learned to refer by proximity or convenience—whoever was nearby, whoever someone in the office had heard of. Castellanos challenges that entirely.

“When you graduate or move to a new city, it’s so important to meet ophthalmologists in your area,” she said. “Not only through local societies and networking events, but [also by] going into their office. Look at the equipment. Is the front desk overwhelmed? Do they understand [different] insurances? And then, actually ask the doctor: Can I shadow you for an hour?”

Shadowing changes everything. It shows you how the practice operates when no one is performing for a guest. Kovach agrees and recommends something that sounds almost radical in its simplicity: Interview the ophthalmologist before you ever send a patient.

“I would interview the doctor that I work with, just like I interview the ophthalmologists that work for us,” he said. “The optometrist should interview the ophthalmologist—and ideally observe some cases—so they understand how the surgeon performs care.”

What should you look for? Quality of results, patient experience, and alignment on communication expectations. The ophthalmologist should be able to clearly explain to you what happens to your patient from the moment they arrive until they are returned to you.

Action steps

• Visit the ophthalmologist’s office before you refer your patient.
• Ask directly: What is your communication protocol after a procedure?
• Talk to colleagues. Personal referrals from trusted ODs carry the most weight.

Pillar 2: Build a communication system—not just a relationship

The handshake is not enough. You need a system.

Kovach’s practice has invested in exactly this: a team of liaisons and patient education coordinators whose job is to communicate back to referring ODs. Every doctor he works with has his personal phone number. But knowing that he may be in the operating room, his team fills the gap.

“If an ophthalmologist isn’t giving you their phone number, their email, or their staff’s information, communication cannot happen, and patient care will be compromised,” he said.

His practice uses a Health Insurance Portability and Accountability Act (HIPAA)-compliant built-in portal system, allowing any registered provider to securely link up and receive timely updates on their patients. Within 24 hours of a procedure or consultation, that information goes back to the referring OD.

In terms of patient records, Castellanos said that she ideally would like all information in one HIPAA-compliant database that both ODs and MDs can reference. Her referral coordinator contacts her every time a patient doesn’t schedule or doesn’t show, and asks whether she would like to co-manage. That is the kind of active, intentional communication that makes a relationship feel like a real partnership.

The takeaway: Do not assume communication will happen naturally. Establish the system before the first referral goes out.

Action steps

• Ask every ophthalmology partner: How and when will I hear from you after my patient is seen?
• Designate a point person in your office to manage referral communication—not just the doctor.
• Explore HIPAA-compliant portal options. Fax machines and unencrypted texts are not HIPAA compliant.

Pillar 3: Make your referrals detailed and thorough

Here is an uncomfortable truth: A fax that says “blurred vision” is not a referral. It is an incomplete referral—light on context and short on clinical value.

“We don’t want to reinvent the wheel,” Kovach said. “If it’s cataracts, we need to know: [Is the patient] frustrated, optically uncorrectable, symptomatic? Are they ready for surgery or [are they] just being introduced to the concept? The more details we have, the better the encounter will be.”

The same applies to complex cases. For a keratoconus suspect, Kovach wants to know whether the concern stems from significant astigmatism changes, topography shifts, or autokeratometry findings—because that detail affects the consultation, the diagnosis, and ultimately the insurance approval.

Castellanos frames it beautifully as the “lightning pass”—sending the patient with everything the specialist needs to get them seen and treated quickly. Visual fields for a neurology patient. International Classification of Diseases, Tenth Revision (ICD-10) codes (a missing code can derail a prior authorization). Relevant scans. A brief, clear clinical summary.

But the preparation doesn’t stop with the paperwork. Educating the patient before they leave your chair is equally critical. A patient who knows why they are being referred, what to expect, and which questions to ask will have a better experience—and won’t walk in saying, “I don’t know. My other doctor told me to come here.”

Action steps

• Create a referral template with the following required fields: chief complaint, clinical findings, relevant test results, ICD-10 code, and urgency level.
• Brief the patient before they leave: why they are going, what the ophthalmologist will do, and that they should return for follow-up.
• Send supporting data through your electronic health record (EHR) or a secure portal—not via text, fax, or other non-HIPAA compliant communication systems.

Pillar 4: Track every referral and close the loop

If you are not tracking your referrals, you are not managing your patients’ care—you are just hoping. Castellanos is direct about this gap in our profession.

“We don’t realize the impact it has on the profession,” she said. “It’s so easy to refer the patient out without a tracking mechanism that’s going to make sure that patient does that full loop back. And because we’re not tracking them, they end up leaving. Where do they go? I don’t know.”

Some insurance plans may require referral logs—and for good reason. Tracking protects you clinically and legally, and it protects your patient from becoming invisible in the system.

What does tracking look like in practice? It can be as simple as a HIPAA-compliant spreadsheet managed by a staff member dedicated to referral follow-up. Better yet, a built-in workflow in your EHR. The point is intentionality; someone in your office owns the follow-up.

Track the referral when it goes out. Follow up if the appointment is not confirmed. Follow up again when the patient is seen. And follow up to ensure they return to your care.

Action steps

• Assign a staff member to own the referral log—someone who tracks from referral to return.
• Create a standard follow-up protocol: Day 7 if no appointment is confirmed. Day of consult check-in. Postprocedure return.
• Ask your EHR vendor which referral tracking features exist that you may not be using.

Pillar 5: Make the relationship a two-way street

The healthiest OD–MD relationships are not transactional; they are reciprocal. And reciprocity requires intentional effort from both sides.

Too often, optometrists feel the referral relationship only runs in one direction. You send patients; they see them; your patients don’t always come back. Castellanos describes a rare but powerful model: the ophthalmologist who keeps your business cards at the front desk and sends patients back for glasses, contacts, treatment for dry eye, and routine care.

“Ophthalmologists sometimes see 40 to 50 patients a day,” she said. “I am sure some of these patients need glasses, contacts, or dry eye care. Go out of your way to send one patient a week [to the optometrists that refer patients to you]. That is the practice you want to work with.”

Kovach echoes this from the ophthalmologist’s side: We all win only when we all win together. The goal is the patient’s highest level of care, and that requires both providers to feel like valued partners.

That means ODs must also show up as partners. Castellanos notes something many of us have felt but rarely say out loud: Optometrists sometimes meet an ophthalmologist at a networking event, assume there’s a relationship, and never do the legwork to confirm it. A handshake is not a referral relationship. A relationship is built by consistency, follow-through, and a genuine willingness to make the other doctor’s job easier.

A handshake is not a referral relationship. A relationship is built by consistency, follow-through, and a genuine willingness to make the other doctor’s job easier.

Action steps

• Ask your ophthalmology partner directly: Will you place our business cards at your front desk and refer nonsurgical patients to us?
• Send a note to the ophthalmologist confirming that you have taken over the care of a post-op patient who has returned to you.
• Consider consistency a long-term strategy: Show up at the same events, follow up with every patient, and remain visible.
• Remember: It is not who knows you. It is who remembers you.

Putting it all into practice

Our patients trust us with their vision. That trust does not pause when we refer them out; it transfers. When we send a patient to an ophthalmologist, we are extending our relationship, our credibility, and our care to that partner. That is not something to do casually.

The good news is that the solutions are not complicated. They are practical, actionable, and available to every OD regardless of practice size or setting. Build your ophthalmology partnerships with purpose and intention. Build systems. Send complete referrals. Track every patient. Invest in the relationship as generously as you hope your partner will.

Start today. One conversation, one improved system, one stronger partnership—that is how we raise the standard of care for every patient who trusts us with their vision.