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    Managing the non-surgical aspect of comanagement

    Cooperative management means preparing the patient for a successful surgical outcome


    n previous installments, I have written about the meaning and definition of comanaging our patients. The lines between a surgical management and non-surgical management are more defined in states where surgery is performed by only ophthalmologists. However, the non-surgical management of our patients can be a little blurred and subject to your own personal acumen. Yet, regardless of the office setting, we can still become a center of cooperative management for our patients.      

    Choosing not to comanage PVD  

    Cooperative management

    In the arena of surgery, it is not apparent to the patient that he may be in need of a surgical intervention. Your cooperative management begins by simply explaining in common terms what is needed to achieve better outcomes for his vision. Your center can start this cooperative attitude by helping your patient visualize what is limiting his ocular shortcomings. Use a camera, and it doesn’t have to be all Iggy Azalea—that is, “Fancy” for the country music lovers—however, the image should be large enough that your patient can see details. There are digital systems you can attach to the slit lamp or adaptors for your smartphone that you can purchase. In fact, the Journal of Mobile Technology in Medicine has a MacGruber step-by-step method to make your own adaptor.1 MacGruber! The key to this cooperation is actually taking the time to take a picture of your patient’s eye and providing him details to what is normal and what is abnormal, as well as what treatment will best suit the patient.

    Managing ocular health

    Leaning back from your slit lamp and showing your patient the milky nuclear sclerotic cataract that has been inducing a myopic shift for the past decade is an easy discussion. “You have a cataract, and we are going to work to have that removed and give you clear vision.” Cooperative management doesn’t stop by referring this patient to a surgeon who you work with. Moreover, it starts with your preparedness for the patient to have a successful outcome, au contraire, mon frere. (Sorry, just got back from France.) This is where the management of our patients needs to stay in the office, for as long as it takes to stabilize the ocular environment. It has been well documented that untreated—yes, you have to treat—lid disease and dry eye will have a negative impact on the visual acuity.3,4 Thus, you need to outfit your office with the tools to treat and cooperatively manage lid disease.           

    In your lane, you should be prepared to measure osmolarity and inflammation with point-of-service diagnostics. You have your camera to take pictures of your patient’s lids and corneal surface as an illustrative example of what to treat. This is where the cooperation really kicks in—by telling your patients what they need to use to help manage the disease. Simply saying, “Use a warm compress” is tantamount to your doctor saying, “Take two aspirin and call me in the morning.”

    Point-of-care diagnostics change the way we manage patients

    There are amazing tools you should be providing to your patient, for sale, such as the Bruder Moist Heat mask (Bruder Healthcare) or Tranquileyes (Eyeco). OCuSOFT and BioScience have in-office kits that you can sell for demodex and dry eye treatment. Should you decide to send your patient to the pharmacy, Akorn’s SteriLid has 10 percent tea tree oil to help manage the demodex over the long haul. My point is you need to manage in your office and get your patients to cooperate with this treatment. We are not just talking about your patient’s vision; a recent study in Japan concluded that dry eye disease is associated with deterioration of mental health in male Japanese university staff.4 Stop the insanity!  


    As a huge fan of the “Twilight Zone,” I find myself thinking back to Rod Sterling saying, “Imagine, if you will,” and I envisage him articulating, “Imagine, if you will, a time when a patient ventures into his eye doctor, an optometrist, the primary-care physician of the eye, who is specially trained to manage all ocular conditions and help to prevent the deterioration of vision, cooperating with other modalities to ensure long-standing vision; he is unaware that his vision is need of help, and through pictures and words he leaves with treatment and management. Yes, you have entered the Tw-eye-light Zone!”ODT


    1. Journal of Mobile Technology in Medicine website. DIY—Smartphone Slit-Lamp adaptor. Available at: http://www.journalmtm.com/2014/diy-smartphone-slit-lamp-adaptor/. Accessed 08/01/2014.

    2. Tauste Frances A, Ronda-Perez E, Segui Crespo M del M. Ocular and visual alterations in computer workers contact lens wearers: scoping review. Rev Esp Salud Publica. 2014 Mar-Apr;88(2):203-15.

    3. Kastelan S, Lukenda A. Salopek-Rabatic J, et al. Dry eye symptoms and signs in long-term contact lens wearers. Coll Antropol. 2013 Apr;37 Suppl 1:199-203.

    4. Tounaka K, Yuki K, Kouyama K, et al. Tohoku Dry eye disease is associated with deterioration of mental health in male Japanese university staff. J Exp Med. 2014;233(3):215-20.


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