The Independent Advantage S01 recap: How to improve your comanagement relationships

In The Independent Advantage’s first season, conversations with Kevin J. Kovach, MD, and Giannie Castellanos, OD, centered on how optometrists can thoughtfully select and collaborate with ophthalmologists to protect and enhance patient trust and clinical outcomes. With conversations led by Diana Canto-Sims, OD, the eye care providers framed referral relationships not as a simple handoff, but as a critical extension of the optometrist–patient bond.

In the first episode, Canto-Sims opened by underscoring that choosing an ophthalmologist is one of the most consequential decisions in an optometrist’s career. Patients place immense trust in their optometrist, and that trust is either reinforced or undermined the moment a referral is made. The implication is that referrals are not purely transactional; they are a reflection of the optometrist’s judgment, values, and standard of care.

During the conversation, Kovach focused on the clinical and communication dimensions of comanagement. He noted that many optometrists are comfortable performing day‑one postoperative visits, while others are not, and ophthalmologists must understand these varying comfort levels. A key theme is the importance of detailed, clinically meaningful information in referrals.

Using keratoconus as an example in Episode 2, Kovach highlights that ophthalmologists need to know precisely why the condition is suspected—whether there has been a significant jump in astigmatism, documented topographic changes, or shifts in automatic keratometry readings. The more granular the data sent with the referral, the better the consultation and the patient experience. Additionally, Kovach stressed that the education patients receive from the optometrist at the point of referral sets the stage for an informed discussion about risks, benefits, and alternatives to treatment.

In Episode 3, Castellanos spoke on practical strategies for evaluating and building relationships with ophthalmologists. She encouraged optometrists to meet local ophthalmologists through societies and networking, but also to physically visit practices: assess whether equipment is up to date, observe whether the front desk is overwhelmed, and gauge staff competence with insurance and overall professionalism. Shadowing an ophthalmologist, even initially in the context of job interviews, can reveal whether this is truly a setting where one would feel comfortable sending patients.

A strong professional ethic ran through Castellanos’s comments in Episode 4: optometrists should first consider referrals within their own profession—such as to a colleague who specializes in dry eye or vision therapy—rather than trying to do everything themselves. When collaborating with ophthalmologists, the emphasis is on finding those who are ethical, patient-centered, and have the time and commitment to “do right” by referred patients.

Finally, Castellanos underscored persistence and consistency in relationship-building with ophthalmologists, pediatricians, and primary care physicians in Episode 5. Initial interactions may be imperfect due to staffing changes, bad weeks, or vacations, but optometrists are encouraged to give practices another chance and continue working toward reliable, trust-based referral networks.