Co-Management

Co-Management Opportunity: LASIK Pre-Op and Post-Op Care

By Jeanmarie Davis, OD


Let your patients know that refractive surgery is a vision correction option–and that you participate in its delivery. You can then participate in the preoperative and postoperative care of that patient–and receive 20 percent of the LASIK surgeon’s fees for the procedure.

ROB Bottom Line
LASIK Co-Management
Range of LASIK fees (varying depending on conditions such as astigmatism, which make it more costly)

$1,900 to $2,400 per eye

OD typically receives 20 percent of surgical fees.

If you gained at least one LASIK patient per week at a $2,000 per eye rate

$800 per week x 52 weeks

=$41,600 annually

Equipment Needed
A hand-held pachymeter can be purchased for as little as $2,400 to $2,600.

Chair Time
Expect to add an additional 15 to 20 minutes to your regular comprehensive examination to conduct the preoperative evaluation.

You may be surprised at how many of your patients are either planning to have LASIK procedures without your guidance, or would love to speak to you about it, but do not realize there are LASIK-related services that you provide. ODs who discuss LASIK with as many patients as possible may find as many as two patients per week who are interested in having the procedure.

While ODs are not permitted to perform LASIK surgery in the U.S., there is a role for us to play in preoperative and postoperative care. In addition to our patients benefiting from our care before and after this procedure, ODs have a financial stake in taking advantage of this opportunity.

Providing patients with preoperative and postoperative Lasik surgery examinations is beneficial to patients. ODs can assess whether the patient is a good candidate for LASIK, and can follow-up with the patient after the procedure to ensure that the patient’s eyes are healthy.

Participating in preoperative and postoperative LASIK care also is a great business opportunity for your practice.

Many LASIK centers and ophthalmology offices offer financed options for LASIK, some at zero interest. Educate your patient about these options, and partner with more than one LASIK surgeon to give your patients options.

Offer Comprehensive Preoperative Evaluations
There are physical reasons, such as corneas that are too thin or pupils that are too big, that make LASIK a too-risky procedure for patients. It is your job as the preoperative evaluating doctor to determine whether your patient has any of those disqualifying corneal characteristics, or any other condition that would derail the procedure’s success. For instance, you also are screening for retinal problems and cataracts. In addition, the preoperative evaluation should include cycloplegic refraction in which cycloplegic drops, which keep eyes dilated for as many as 24 hours, are used.

This screening often takes place as an extended annual comprehensive exam, with a pachymeter and Orbscan used for the corneal examination. A corneal topographer or keratometer can also come in handy for screening patients with astigmatism for LASIK. The procedure has been refined enough that patients with up to moderate astigmatism are still candidates. Most ODs already have either a pachymeter or a corneal topographer, but if you don’t, it’s not a big investment (see sidebar).

Guide Patient Expectations Preoperatively
It is the doctor’s job to not just wait for patients to ask questions about the procedure, but to take the lead in asking specific, probing questions about the patient’s expectations about the surgery’s outcome. Along with ensuring that the patient’s eyes are a good fit for LASIK, you also need to determine whether the patient’s expectations for the outcome are realistic. Let them know that their final visual acuity may not be apparent until a full month after the procedure. Also, be sure to let them that even if their vision is corrected to 20/20 acuity, they still will need to see you for annual examinations to safeguard their eye health.

You should ask patients whether they are happy with the way they currently see in their eyeglasses or contact lenses. Many patients assume that they will see better following LASIK than they currently see with corrective lenses, and that is usually not the case. Other patients make the assumption that if they have LASIK they will never again have to wear eyeglasses, and that is not so, as LASIK does not prevent the onset of presbyopia when patients hit middle-age. Some patients even assume that LASIK will cure them of discomforts such as ocular allergies and dry eye.

Detail Surgery’s Risks, Have Patient Sign Consent Form
If you determine the patient is a good candidate for LASIK, talk to them about the risks of the surgery, and provide them with a consent form to sign that puts all the risks you discussed with them in writing, and have them sign it. Before the patient has the surgery, the LASIK surgeon will also require them to sign a consent form, but that consent form does not protect you should the patient have an outcome they are not satisfied with and decide to bring a lawsuit against both the OD and surgeon. You should have your own signed consent form on file. Most surgeons also will have copies of consent forms, as well as other pre-op and post-op instructions, available to you.

Provide Preoperative and Postoperative Instructions
Once you have determined the patient is a good candidate for LASIK, and the LASIK surgeon has agreed with you and has scheduled the surgery with the patient, you need to provide the patient with preoperative instructions, including samples of or a prescription for antibiotic and steroid eye drops to be used before and after the procedure to prevent infection and inflammation. You also need to advise patients on what to wear on the day of the procedure. In cold climates, for instance, fuzzy sweaters are out of the question because of the danger of flying particles of sweater in the operating room. You also should advise the patient that they will be taking a sedative before the procedure, and that they will need someone to drive them home afterward.

Conduct Postoperative Exams
Patients are typically seen one time preoperatively and four times postoperatively, with the OD sharing in 20 percent of the LASIK surgeon’s fees.
One day after the procedure, the patient will visit either the OD or the LASIK surgeon. If you are handling the next-day exam, you will check the patient’s visual acuity, examine the cornea to check that the corneal flap is intact and in good position, and to check for inflammation. You also will counsel patients if they are disappointed with the result that it is too soon to make judgments about the outcome. They will not know for sure for sometimes up to a few weeks or a month about their level of visual acuity. Along with the examination, the doctor should review the postoperative instructions with the patient, including activities to avoid, their eye drops regimen and whether they are wearing the prescribed protective shields around their eyes while they sleep.

One week later, you should see the patient again. You will do all the same things you did during the day-after visit, but you will also give instructions about when to discontinue using the eye drops and when they can stop taking protective measures such as avoiding activities like swimming. If the patient is still unhappy with their visual acuity, some doctors also will conduct a refraction at that point. Measurement of intraocular pressure is performed via Goldmann tonometry after one week post-op.

Three weeks later, or one full month after the surgery, the OD sees the patient again. You will check the patient yet again for corneal issues and also check eye pressure during this visit and conduct refraction. After one month, the patient’s postoperative visual acuity should be apparent.

The last postoperative visit should occur at the three-month mark. You should check visual acuity again and examine the cornea once more to ensure that the corneal flap is still in good shape and placed properly. You also would check the patient’s eye pressure again.

Nine months later, during the patient’s annual comprehensive examination, you evaluate the results of the surgery once again.

By providing thorough LASIK preoperative and postoperative care you can help protect your patients’ eye health, and further establish your practice as a source of medical eyecare services.

Related ROB Articles

Making the Co-Management Network Work

Enhance Dry Eye Treatment to Better Serve Patients

Opportunities Treating Ocular Allergies

Jeanmarie Davis, OD, recently joined Alcon’s Global Performance Development department. To contact her: drdavis2020@yahoo.com.

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