Getting your practice involved in the post-surgical pathway

Jade Coats, OD, FAAO, described a meaningful evolution in the role of optometrists within the refractive and cataract surgery care pathway, with particular emphasis on the preoperative phase as the foundation for postoperative success. Historically, many optometrists were more involved in postoperative care, but the speaker notes a positive shift: optometrists are now being empowered with better tools, diagnostics, and clinical confidence to participate earlier in the patient journey. This includes measuring key parameters and identifying preoperative risk factors that can significantly influence surgical outcomes. By doing “due diligence” before surgery, the team can help reduce surgical complications and improve overall success rates.

Coats stressed that involvement in both pre- and postoperative care is beneficial not only for clinical outcomes but also for practice growth and long-term patient relationships. Even once patients are pseudophakic or post-LASIK, they remain lifelong patients who will continue to need comprehensive eye care. This continuity allows optometrists to maintain and deepen the therapeutic relationship while adding value to their ophthalmology colleagues through careful screening and management of ocular surface health.

A major clinical opportunity highlighted is the need for optometrists to become more proficient with biological markers, tear osmolarity, and corneal topography, and to integrate these data into pre-surgical decision-making. Coats tied this directly to dry eye disease and ocular surface optimization, noting that untreated or underrecognized ocular surface issues can compromise surgical results.

The discussion then turns to cosmetics and preservatives as underappreciated contributors to ocular surface disease. Coats acknowledged that raising concerns about makeup use, particularly when applied to the waterline, can be socially awkward. Instead of confronting patients with technical labels, Coats recommends a more patient-friendly approach: simply asking, “How are you removing your makeup?” or “What is your current protocol for this?” This opens a natural, nonjudgmental conversation about healthier practices and products.

Finally, Coats underscored that preservatives in cosmetics, surgical preparations, and contact lens solutions cumulatively impact the ocular surface. Persistent exposure to harsh chemicals may blunt the effectiveness of dry eye treatment. Therefore, reducing preservative load—especially in frequently used cosmetic products—is framed as a critical, and often overlooked, component of optimizing ocular surface health and enhancing refractive surgical outcomes.