In working with referring optometrists, there are two situations I always want them to be able to recognize to ensure that our partnership works well for us and helps us provide the best patient care in a timely fashion.
Mild dissatisfaction and fluctuating vision
The first of these is one that optometrists can recognize and readily solve on their own. When a patient is complaining of blurry vision, especially when it fluctuates, the first thing I want them to check is the ocular surface. Dry eye is the most frequent cause of mild dissatisfaction or a feeling that the vision “just isn’t great.” In this situation, rather than sending the patient back to the surgeon, the ideal resolution is for the primary care optometrist to start treating the ocular surface and continue to monitor symptoms as they get the patient past this minor postoperative hiccup. At a minimum, comanaging ODs should be able and willing to adjust and reduce topical medications as needed (brand-name drops that allow or lower frequency dosing, preservative-free alternatives), add oral omega supplements and more frequent non-preserved artificial lubrication, and consider punctal occlusion.
At the opposite end of the spectrum is the patient who has a gross refractive error in the early postoperative period. The manifest refraction at the 1-week visit is absolutely critical for identifying a refractive miss. In this situation, the OD should dilate the eye, try to identify the source of the refractive miss and discuss it with the surgeon.
For example, I implanted a toric IOL in a patient to correct 2 D of astigmatism at 90°. One week after surgery, the patient’s refraction was perplexing: –2.00 +4.00 × 90. The optometrist — one I hadn’t worked with much before — sent the patient back to me noting the “wrong IOL was implanted.” Had he dilated the eye, he would have quickly realized that the lens had simply rotated in this very long (28-mm) eye, which resulted in doubling the patient’s astigmatism! Nevertheless, a quick referral back to the surgeon was warranted. I repositioned the lens, and we ended up with a very satisfied patient.
Alternately, if there is minimal refractive error at the 1-week visit or the patient is dissatisfied with the outcome despite reasonably good acuity, that information also provides insight for planning an enhancement and/or adjusting the IOL choice for the second eye.
Disclosure: Yeu reports she is a consultant/adviser for Alcon, Allergan, ArcScan, Bausch + Lomb/Valeant, Bio-Tissue, BVI, i-Optics, J&J Vision, Lensar, Kala Pharmaceuticals, Novartis, Ocular Science, Ocular Therapeutix, Ocusoft, Omeros, Science Based Health, Shire, SightLife Surgical, Sun, TearLab, TearScience, Veracity and Zeiss; does research for Alcon, Allergan, Bausch + Lomb, Bio-Tissue, i-Optics, Kala and Topcon; and has an ownership interest in ArcScan, Modernizing Medicine, Ocular Science, SightLife Surgical and Strathspey Crown.