Question: I keep losing my cataract patients to the ophthalmologist’s practice. I thought I was on good terms with this cataract surgeon. What should I do?

Answer: Don’t abdicate the post-op care! You need to take it on and perform as much of it as you can. That’s the best way to retain your patients. And, busy and skilled modern day surgeons embrace this. A lot of them are “drowning” in post-ops!

Unfortunately, some optometrists are not participating to the fullest extent in the post-op comanagement of their cataract and glaucoma patients. This not only impacts the optometrist’s practice—it can mean inconvenience for your patients as well, with multiple trips to an unfamiliar office that often is further away than your own.

It wasn’t always this way, and getting here wasn’t easy. Optometrists have worked diligently for decades to be able to legally and properly provide post-op comanagement. During the past 35 years, we’ve gained not only the necessary therapeutic privileges but also the mechanism to be paid for this care.

But I wonder if we’re losing ground on comanagement. If the patient goes to the surgeon’s practice not only for the cataract evaluation and the procedure, but also for the one-day, the one-week and the one-month post-op visits, then the patient may begin to wonder why they even need to come back to see the optometrist.

Nurse practitioners and physician assistants
are already taking on post-op care in some
large medical practices.
Plus, someone at the ophthalmologist’s practice is likely going to offer the patient an additional service or two, perhaps an Rx for a new pair of glasses. Then other family members could schedule a visit at that practice. And before you know it, years of patient loyalty are down the drain.

Not only that, but that surgeon probably won’t even be the one who provides the post-op care. More than likely, it’ll be another optometrist. If an optometrist is going to provide the post-op care, that optometrist might as well be you.

But an even more worrisome concern is on the horizon. Some ophthalmology practices are hiring physician assistants and nurse practitioners on staff who are more than willing to perform the postoperative care of these patients.1 At the same time, the ranks of ophthalmologists aren’t growing, yet we are about to see an influx of aging patients as the Baby Boomers become senior citizens. Someone’s going to need to care for these patients. If optometrists don’t, these ancillary health professionals likely will.

Face it, we know our patients better than anyone. So, not only should we provide the post-op care but, because we know their refractive needs and lifestyle requirements better than anyone else, we should be advising the patient and the surgeon as to what type of surgery and IOL they need to best meet those goals. Surgeons really welcome and appreciate this advice—they’d rather get it from us than have to draw it out of the patient from scratch.

Likewise, no one else is better attuned to providing the post-op care and reassurance after surgery than the doctor of optometry. Simply put, it’s the type of care and convenience that we should be offering.

We’re in an era when we’re worried about patient volume and retention. But the best way to keep patients is to do as much as you can for each one of them—and that certainly includes post-op care.

1. Helzner J. PAs and NPs can help your practice. Ophthalmol Management. Sept 2012. Available at: