Would ophthalmologists be less skeptical of optometric skill levels if imaging accompanied referrals or phone questions?

"Would ophthalmologists be less skeptical of optometric skill levels if imaging accompanied referrals or phone questions?" --Richard Hom tweet from Sep 12, 2009

This tweet that Dr Hom posted this past week, and our exchange of responses that followed, is what inspired us to start this blog on how best to have Eye Care Providers (ECPs) work together. Although micro-blogging with Twitter can provide some instant feedback, many potential great learning moments can just go unnoticed in that medium. Hence, the chance to continue where we left off by having people add their comments.

My view as an ophthalmologists, sub-specialized in glaucoma, may differ from that of other ECPs. For me, if I receive as part of a consult request, a series of appropriate tests, it would make me think highly of the skills of the optometrist. But is also must be recognized that not every optometrist is going to have the latest nerve head imaging device or perimeter if they do not have to deal with a lot of glaucoma patients themselves. Therefore, knowing when a patient is at risk of having glaucoma is also something that would rank highly in my books.

Having a good working relationship with optometrists can help assure good pre-consult testing is performed. For example, in my practice, I do offer optometrists the opportunity to send patients in just for diagnostic testing with the Heidelberg Retinal Tomogram (HRT) or standard automated perimetry (Medmont) if they would like to order those tests but do not feel they have enough information yet to warrant sending the patient in for consultation. As the tests can be fit in most every day, the patient does not wait 4-6 months to get to see me only to have to perform these tests once or twice more to reach any conclusions. Once the optometrist has the benefit of the proper diagnostic tests over enough time to look for stability or change, then they are in a better position to refer appropriately.

By working together, Eye Care Providers can assure timely assessment and interventions for patients with glaucoma.