PROVIDING YOUR PATIENTS with a seamless eye care experience can be challenging, particularly when collaboration between ophthalmologists and optometrists is less than smooth.

As presbyopia-correcting drops hit the market, that collaboration will become even more critical. With robust communication between ophthalmologists and optometrists, clinicians can provide patients access to this new pharmacologic option and other eye care services that may surface during eye exams.

In this article, we’ll explore how an integrated practice model benefits both doctors and patients, specifically looking at a large practice based in Minnesota. And we’ll take a closer look at how that practice will handle the advent of presbyopia-correcting drops.

Synergistic Environment

With five locations in the Minneapolis/St. Paul region, Minnesota Eye Consultants boasts a staff of roughly 300 employees. That includes 13 fellowship-trained ophthalmologists, 11 optometrists, two ophthalmology fellows (cornea and glaucoma), two optometry residents, and two physician assistants. The practice was founded in 1989 by Dr. Richard Lindstrom, “one of the first to create a synergistic environment for optometry and ophthalmology to work together,” says Mark R. Buboltz, OD, optometrist and optometric residency coordinator at Minnesota Eye Consultants.

Minnesota Eye Consultants uses the integrated practice model, where ophthalmologists and optometrists work in the same practice. This contrasts with the community model, where ophthalmologists and optometrists work in separate locations but arrange to work together.

Team Approach

The integrated model essentially uses a team approach to care for each patient, explains Mark S. Hansen, MD, Minnesota Eye Consultants, anterior segment and refractive surgeon. In an integrated model, patients will receive a “full, comprehensive experience,” says Dr. Buboltz. “In the integrated practice, the optometrists are able to, for the most part, spend more time with the patients, really addressing their concerns. Before the patients get to the ophthalmologist, usually our optometry team is able to more comprehensively take care of them.”

When patients have been followed in the clinic for some of their more primary eye care needs, “we’re able to really understand exactly their vision goals and guide them in the right direction,” notes Dr. Buboltz.

“I see our optometry team as the primary eye care provider for our patients,” says Dr. Hansen. “Just like the primary healthcare provider, they know and understand the patient and his or her visual needs.”

“Since we work together in clinic, the optometry team can make recommendations for refractive outcomes and provide a deeper understanding of the patient’s desires because of the years of history that they have together. They are better able to provide insights that we might not catch in the 20- to 30-minute consultation before surgery is scheduled.”

In the integrated model, says Dr. Hansen, the optometry and surgical teams work in the same physical area. “The clinic space was designed this way to encourage collaboration and teamwork.”

“It is quite easy to get second opinions and learn from each other when we’re working alongside each other,” notes Dr. Buboltz. “From an optometry standpoint, I find that the more I understand about different surgeries and their mechanism of action, the more I understand about the disease.” In addition, the practice supports meetings and journal clubs so clinicians can stay updated on new surgical and treatment techniques.

Serving a Demanding Patient

As an example of a how an integrated practice delivers high-quality, patient-focused care, consider the case of a patient who had “very high demands for her vision,” as Dr. Buboltz puts it. A wearer of multifocal contact lenses, the patient was developing cataracts that were impacting her vision.

Dr. Buboltz referred her to one of the cataract surgeons at Minnesota Eye Consultants. Based on his years of fitting this patient with contact lenses, Dr. Buboltz observed that this patient was likely not a good candidate for a premium IOL, such as a multifocal lens, because of her high demands.

With this knowledge, the patient received a standard lens and is doing well after being refitted with multifocal contact lenses. She often requires multiple vision adjustments to her contact lenses; thus, a multifocal IOL would have been significantly more challenging to adjust with refractive surgery.

Drops Make Collaboration Even More Critical

With the upcoming arrival of presbyopia-correcting drops, Dr. Hansen expects many patient calls and clinic visits once patients hear of this new near-vision option. “This will begin in both the optometry clinic with routine exams and also surgeon clinics when discussing refractive options for patients,” he notes.

“Presbyopia is a condition that will affect every patient at some point,” he points out. “Due to the large number of patients that will need or want treatment, utilizing an integrated model will be important.”

“We are a refractive surgery practice and have many patients that are trying hard to avoid glasses and contact lenses as much as possible,” says Dr. Buboltz. “I think there will be significant excitement once we are able to start advertising these drops.”

The practice sees many patients in their mid 40s who may have had LASIK and now are frustrated with the loss of near vision, says Dr. Buboltz. Presbyopia-correcting drops will offer “another option for these types of patients, whether they see our optometry team or our ophthalmology team.”

For early presbyopes, these drops may help keep them in a single-focus contact lens for longer before having to shift to readers, or monovision or multifocal lenses, Dr. Buboltz notes. He also is intrigued by the off-label potential to decrease pupil size and thus reduce aberrations, especially for patients bothered by night-time glare after LASIK or multifocal cataract implants.

Today, all the options for treating presbyopia, especially in contact lenses, involve degrading visual quality in one way or another, explains Dr. Buboltz. “If you can just increase the depth of focus with these drops, I think there are going to be patients that are going to be a lot happier than with their multifocal or monovision lenses.”

While the presbyopia-correcting drops may not be a “saving grace” for older patients with more severe presbyopia, cautions Dr. Buboltz, for “the early presbyopes that are struggling, I think it’s going to be a very useful drop before they have to get into next options.”

Dr. Buboltz says advertising and word of mouth about presbyopia-correcting eye drops will cause more people to think about their eyes and schedule an appointment to see if these drops are right for them, and will give eye physicians an opportunity to comprehensively evaluate patients and catch other eye issues, such as dry eye, glaucoma, and corneal ectasia earlier on in the disease path.

Trust and Humility

For clinicians working in an integrated practice model, “It’s a relationship of trust and humility on both sides,” says Dr. Buboltz. He says in a true integrated practice model, where the surgeon is primarily in surgery, and the optometrist handles the bulk of the clinical work, the surgeon must trust the optometrist that his or her surgical patients are being well taken care of on the front and back ends, in order for the surgeon to see success and for patients to receive the best overall care.

An important part of starting an integrated practice, points out Dr. Hansen, is finding partners that have the same patient care goals and practice ideas, and understanding that both parts are critical.

The integrated practice model, says Dr. Buboltz, “lets both the optometrist and ophthalmologist practice to the highest scope of their training, including more surgery time for the ophthalmologist.” ■

Mark Buboltz, OD, serves as the Optometric Residency Coordinator at Minnesota Eye Consultants and is adjunct clinical faculty at the Illinois College of Optometry. He has special interests in dry eye management and specialty contact lenses as well as ocular disease, urgent care, surgical management, and primary care.

Mark Hansen, MD, performs cataract and intraocular lens implant surgery, corneal transplants and other surgeries for patients with corneal diseases, along with a variety of glaucoma procedures. He also performs refractive surgery, including laser vision correction procedures such as LASIK and PRK as well as refractive lens implant surgery.