AS PRESBYOPIA-CORRECTING drops enter the market, seamless collaboration between optometrists and ophthalmologists will take on a new level of urgency and importance. In a community model of practice, independent eyecare providers collaborate in a synergistic relationship for the good of their patients. In this article, we’ll discuss how we employ the community model for our patients, touching on these presbyopia-correcting drops.

Working Together

In the community practice model, doctors from different practices arrange to work together. This model compares with the integrated practice model, in which ophthalmologists and optometrists work in the same practice. (For more information on the integrated practice model, see “Increasing Collaboration with an Integrated Practice” in the November 2021 issue of Presbyopia Physician.)

In our case, Dr. Schaeffer refers to Dr. Albright patients from his general optometry practice who need cataract surgery. After surgery, Dr. Schaeffer sees these patients for postop care.

We’ve successfully maintained this arrangement for at least 20 years. Dr. Schaeffer refers roughly 75 to 100 patients to Dr. Albright each year. We don’t have a formal agreement in place, nor do we think having one in place would benefit our patients. We base our relationship not on a contract but on the strength of the services we provide and our robust communication.

In the decision to work with Dr. Albright, Dr. Schaeffer was looking not only for optimal surgical outcomes for his patients but also excellent patient treatment by the practice and its staff. That approach includes excellent preop and day-of-operation procedures, as well as fluid communication between offices, including transitions and handoffs between the practices. Other aspects include:

• How does the referral process work?
• How quickly can Dr. Albright see a referred patient?
• What types of procedures are performed?
• What lenses does Dr. Albright offer?
• How are difficult or complicated cases handled?

Relationship of Trust

Our relationship is based on several factors. One of them is simply the convenience of our locations for our mutual patients. Both offices are located in the city of Birmingham, AL, and serve patients from the greater Birmingham metro area.

A far more important key to our success is our relationship of trust. Dr. Schaeffer, as the primary eyecare provider, has built a relationship of trust with his patients. When he refers a patient to Dr. Albright, he is conferring that trust onto Dr. Albright. This gives patients a great deal of comfort and ensures that we achieve our goal of excellent continuity of care.

Consistency of message is another key to success. Good communication is essential for doctors who work in the community model. We have an “open door” policy, with each of us free to communicate as needed with the other. Dr. Schaeffer never wants a patient to hear something for the first time from Dr. Albright. Hearing the same message from both of us helps to smooth the process and increase the level of patient comfort. Otherwise, the patient may feel uncomfortable and unsure about his or her care.

Specifically, as far as communication goes, Dr. Schaeffer sends a referral letter and referring notes to Dr. Albright, who in turn sends Dr. Schaeffer his preop and postop notes. An outreach coordinator in Dr. Albright’s office can help to facilitate communication. For complicated cases, we may talk on the phone.

As an example of the level of communication that leads to excellent outcomes, recently Dr. Schaeffer treated a patient in her late 30s, a mother of three young children who had developed cataracts secondary to retinal detachment surgery. She was highly myopic: around -12.00D in the right eye and -18.00D in the left eye.

We discussed her options for lens implants, especially considering her lifestyle needs of good near vision for computer work, and she understood that multifocal lens implants are not manufactured in the power she needed. We decided that her vision goal was to be mildly myopic with excellent uncorrected near vision, mimicking her natural eyesight prior to cataracts.

After she was cleared by a retinal specialist, Dr. Schaeffer communicated the vision targets to Dr. Albright. Surgery resulted in an excellent outcome, and the patient is thrilled with her vision. She progressed from needing custom contact lenses to function to the flexibility to choose when to wear her glasses.

Also of note, Dr. Albright’s practice offers continuing education on topics such as the latest technologies in cataract surgery. This helps to keep Dr. Schaeffer up to date on different lens technologies, for instance. It also helps to ensure again that patients aren’t hearing something from Dr. Albright for the first time and have heard it previously from Dr. Schaeffer.

Drops Open the Door

Collaboration between our practices will continue to be key to our success as we enter the era of presbyopia-correcting drops, giving patients a way to see up close without surgery or reading glasses. In October 2021, Allergan announced that its prescription drop Vuity (pilocarpine HCl ophthalmic solution) 1.25% had been approved by the FDA, the first and only FDA-approved eyedrop to treat presbyopia.

The opportunity for providing care to patients is tremendous, as presbyopia impacts 100% of the patient population at some point during their lifetimes. Some data suggest that 31 million Americans buy over-the-counter reading glasses,¹ and many of those people likely have never seen an eye doctor. Thus, potentially millions of people are essentially self-treating. As providers, we have an excellent opportunity to provide care for those who have never set foot inside an eyecare provider’s office.

As an optometrist, when Dr. Schaeffer asks his patients if they’d like to not have to wear their reading glasses, their ears perk up. This offer resonates with patients. While these drops may not eliminate reading glasses, they can certainly help to reduce reliance on them.

We have an interest in various special patient populations related to these drops. The first is patients who need cataract surgery and are already using presbyopia-correcting drops. These patients may be more inclined to want seamless vision, near to far, after cataract surgery, making them excellent candidates for multifocal intraocular lenses (IOLs). This fact increases the number of patients who could end up with less reliance on glasses postsurgically.

Another population consists of patients who have undergone LASIK. This is a great opportunity to prescribe a drop that will give them a boost up close so they can have as near to spectacle-free vision as possible.

A third population consists of presbyopic patients who have had difficulty adapting to progressive bifocals. These patients have opted to correct for their near vision but did not get the results they desired. This population could benefit from topical therapy to expand their depth of field.

One other patient population to consider for presbyopia-correcting drops consists of patients with extended-depth-of-focus (EDOF) IOLs. The EDOF lens implant technology improves intermediate vision but can fall short for true near vision. In certain patient populations, EDOF IOLs are preferred since they may lead to less visual disturbance, such as glare and halos. Presbyopia-correcting drops provide a way to potentially further the patient’s near vision, while keeping the patient in the ideal lens technology for his or her best vision.

Ultimately, we should tell all patients with presbyopia about the new presbyopia-correcting drops as part of our discussion of treatment methods. As eyecare providers, our job is to help the patient to navigate and choose the best option.

Change for the Better

Although we have what we believe are sound practices in place, we’re never averse to changing our practices for the good of our patients. We strive to continuously nurture our relationship.

In many ways, after years of working together, we have adapted to each other’s practices. Dr. Schaeffer has a good feel for what Dr. Albright typically offers patients, and Dr. Albright understands how Dr. Schaeffer will manage patients before and after surgery. In this way, the relationship between us tweaks itself, enabling us to use the community model of practice to provide excellent patient care. ■

Reference

1. VisionWatch – The Vision Council Member_Benefit_Report, September 2016. The Vision Council website. Accessed February 6, 2022. https://www.thevisioncouncil.org/sites/default/files/research/VisionWatch_VisionCouncil_Member_Benefit_Report_September%202016_FINAL.pdf .

Dr. Schaeffer is an optometrist practicing at MyEyeDr in Birmingham, AL. He practices full-scope optometry from refractive care and contact lenses to managing ocular diseases.

Dr. Albright is a cornea and refractive surgeon at Eye Health Partners of Alabama, Birmingham, AL. He performs anterior-segment, refractive, and corneal-based surgery.

Disclosures
Dr. Schaeffer serves as a consultant and receives honoraria from: Alcon, Allergan, Bausch + Lomb, CooperVision, Horizon, Kala, Johnson & Johnson, Sight Sciences, and Tarsus. Dr. Albright has no professional relationships to disclose.