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Cover Focus | May/June '15

Current Trends in Shared Care

The growing complexity of surgical planning and rising patient expectations necessitate increased MD-OD communication.

The patient comanagement model used successfully by many practices in the refractive market provides an interesting comparison to today’s growing area of premium cataract surgery management.

As new and more advanced diagnostic and surgical planning technologies are used in the clinical setting for cataract surgery, as well as during the postoperative analysis process, the comparison to customized refractive surgery is clear. Just as early refractive surgery methods became more precise and complex with the addition of diagnostic imaging for customized treatment planning, cataract surgery is incorporating more diagnostics and intraoperative technology to measure and guide procedures.

To go along with these more advanced surgical planning and treatment methods, the constant challenge of setting proper patient expectations and delivering high-quality patient outcomes is assisted by improved communication between surgeons and comanaging optometrists.

Use of more advanced diagnostics before, during, and after surgery allows for total data flow to develop more refined surgeon-specific nomograms. The use of corneal topography and high-resolution imaging for cyclotorsion registration of incision placement or toric IOL positioning, for example, is analogous to customized corneal ablation. Advanced optical biometry and intraoperative wavefront analysis are being used to further refine cataract procedures.

A key part of MD-OD communication is to ensure that postoperative imaging and data are routinely collected for use in outcomes analysis. Recognizing that future surgical planning can be enhanced by analyzing surgeon-specific and procedure-specific outcomes is important to move the results trend within a busy surgical practice.

It seems that during every conference discussion of surgeons and optometrists directly involved in surgical care, the goal is always to find ways to improve patient outcomes. The past focus on refractive surgery comanagement is now shifting to include customized femtosecond laser cataract surgery, presbyopic corneal surgery, and microinvasive glaucoma surgery implants during cataract procedures.

The fact that surgical planning has become much more complex while patient expectations have risen clearly presents a need for increased MD-OD communication. Comanagement of the patient today also means more comanagement of outcomes data than ever before.