Opportunities For Integrated Care: Working With Retina Specialists

Communication is key.

By Rebecca S. Harris, OD

Primary eye care providers today are fortunate to be able to comanage cases with retina specialists who are at the forefront of research and patient care in their field. Treatment options for our patients are changing at a rapid pace, and it is often difficult to keep up with all of the trials, newly approved drugs, and advances in surgical techniques in retina.

This article highlights a few things I learned while working with retina specialists that can enhance your experience as well as that of your patients.

COMMUNICATION

Good communication with both your patient and the specialist to whom you are referring is crucial to providing good patient care.

Show a Picture
Modern imaging technologies, such as optical coherence tomography and digital fundus photography, make us better equipped to diagnose and educate our patients prior to their visit with the retina specialist. These imaging modalities provide visual aids that help us emphasize to patients the importance of the referral and to educate them regarding their condition

Write it Down
Always write out the patient’s diagnosis (or potential diagnosis) for him or her. If you don’t know what the diagnosis will be, don’t be afraid to tell patients that you are not sure, but you are sending them to someone with the ability to make the correct diagnosis. Always prepare patients for their visit by explaining to them what will take place, such as dilation of their eyes, imaging tests such as angiography, and so on.

Visit the Retina Specialist
The only way you will know what patients can expect from their visit is to spend some time yourself with the retina specialist. This will allow you to see how the retina specialist works and gain insights into the quality of care your patients will be receiving. If given the opportunity, spend a day in the OR. Doing this will not only allow you to keep up to date on how various conditions are treated but will also give you valuable insights into the way a retinal specialist approaches surgical decision making. Ask the surgeon for the postoperative handouts that patients receive, so that you can familiarize yourself with how patients are managed.

Communicate Efficiently
Once you spend some time in the clinic and the OR with a retina specialist, you quickly understand how busy their schedules are. Whether you decide to communicate by phone or fax, be clear and concise, and highlight the important issues concerning your patient. Your communication style may vary depending on the details of the case and the urgency of the referral. Most important, find out the communication style that works best for both you and your retina specialist.

THINKING OUTSIDE THE BOX

We may come across retinal diseases in practice that have been thought to be nonprogressive or untreatable. Because retina therapies are evolving so rapidly, it is important to know what your retina specialists can offer, even for previously untreatable conditions such as geographic atrophy secondary to dry age-related macular degeneration (Table 1). For retinal diseases currently being treated with vascular endothelial growth factor-blocking therapies, it is worthwhile to be familiar with the numerous completed and ongoing studies comparing the efficacy of the different antivascular endothelial growth factor medications available (Table 2).


Keeping up with advances in research can help patients who previously had no options for treatment. It can also make us aware of data that may lead to discoveries in the near future. Use the worldwide web as a resource. There is a vast amount of information available online. As primary eye care providers, we must take the extra steps to look into what is available and help educate our patients.

The National Institute of Health’s website www.clinicaltrials. gov is a great resource for finding current and completed clinical trials. In addition, most retina practices that participate in clinical trials will have a resource such as a webpage or brochure with information about ongoing clinical trials in which they participate.

Good retina specialists are always up to date on the most current research and are great resources for new treatments for ocular diseases that might make a difference in the quality of life for your patients. Primary eye care providers should not pass up the opportunity to attend educational forums and peruse newsletters from these specialists.

REMEMBER YOUR ROOTS

We need to remember that patients we refer for treatment of retinal disease still need our primary care services. Get to know your retina specialist to the point where you can talk candidly about what you like to manage. Let them know if you feel comfortable following patients with stable age-related macular degeneration, and if you have diagnostic equipment such as optical coherence tomography to do so routinely.

Whether patients continue to see the specialist on an ongoing basis or have finished treatment and returned to our practice, we still play an integral part in their eye care. Providing care for patients with retinal diseases can be both challenging and rewarding. The services we offer are valuable and can aid the specialist in improving your patient’s vision and overall quality of life.

Rebecca S. Harris, OD
• Practices at Klosterman Eye Associates in Harrodsburg, Kentucky
• (859) 576-3606; rebecca.schleter@gmail.com