The Independent Advantage S01 E03: Stress-testing potential comanagement relationships from the MD’s chair

In this segment of The Independent Advantage video series by Optometry Times, host Diana Canto-Sims, OD, an optometrist and practice owner in Chicago, interviews Giannie Castellanos, OD, a Florida-based optometrist with a background in pediatric care and myopia management. The central theme is the communication gap between optometrists (ODs) and ophthalmologists (MDs) in the referral process and how improving this relationship can dramatically elevate patient care.

Canto-Sims introduced Castellanos as a clinician and entrepreneur who has deeply studied weaknesses in referral communication. Castellanos created The Chiasm, a network designed to connect ODs and MDs, streamline referrals, and enhance bidirectional communication. The premise is that collaboration between ODs and ophthalmologists can offer a level of care that neither provider can achieve alone, provided the communication is clear, efficient, and intentional.

When asked where communication tends to break down, Castellanos explained that current referral systems are antiquated. She noted that many practices still rely on fax machines, or worse, texting patient information, which is a HIPAA violation. Others simply hand the patient a paper note and send them off with vague instructions. As a result, the referring OD may never know whether the patient was actually seen, what treatment occurred, or how to continue care.

She further pointed out that follow-up and coordination often fall apart because referrals are not a priority amid the daily pressures of running or working in a practice. Whether in private practice or corporate settings, ODs are typically focused on “seeing the next patient,” and the extra work required to manage referrals properly is undervalued.

Castellanos stressed that building strong, intentional relationships with the right ophthalmologists is critical. She described examples where she referred a glaucoma suspect due to insurance limitations, only to have the patient return having undergone cataract surgery and laser procedures that were not the original intent. This highlights how limited networks, capitated plans, and lack of direct communication can lead to misaligned care.

To improve referrals, she recommends that new and relocating optometrists proactively meet ophthalmologists in their area—through societies, networking events, and especially by visiting their offices. She advises evaluating the practice environment, staff, equipment, and insurance knowledge, and even shadowing the ophthalmologist for an hour. This allows ODs to determine whether this is a provider they trust with their patients and who will communicate back effectively.

From the ophthalmologists’ perspective, Castellanos explains that they primarily want to be top-of-mind for referrals and to receive complete, organized information. Instead of informal texts, ODs should contact the correct referral department, ensure all demographics, medical records, test results, and ICD‑10 codes are included, and understand that some cases require prior authorizations from PCPs. Missing codes or documentation can delay or block care.

She referenced an optometric symposium where a neurologist encouraged ODs to give specialists the “Lightening Process”—sending all essential testing and documentation upfront so patients can be seen rapidly, especially in urgent cases such as stroke-related visual field defects. Castellanos also notes that some ophthalmology practices have robust referral portals and structured workflows; these systems make it easier for optometrists to send complete information and are often the best partners.

Overall, the discussion emphasized that modernizing referral processes, prioritizing communication, and deliberately choosing strong referral partners are key to improving outcomes and maintaining strong OD–MD relationships.