Collaborative Care in Cataracts & Ocular Surface Disease

In this special episode of the OIS podcast, we have a discussion that took place during the recent OIS@SECO in Atlanta. Summit Co-Chairman, Paul Karpecki, OD, FFAO, set the stage with some staggering figures which led to an insightful conversation between two ODs and two MDs about Collaborative Care models and the benefits to both patients and practices.

Participants:
Thomas Chester, OD, Clinical Director – Cleveland Eye Clinic
Elise Kramer, OD, FAAO – Miami Contact Lens Institute
William Trattler, MD, Director of Cornea – Center For Excellence In Eyecare
William Wiley, MD – Cleveland Eye Clinic

Moderated By:
Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute

More on OIS@SECO 2020

OIS Podcast Transcript:

OIS Podcast VOG:
In this special episode of the OIS Podcast. We have a discussion that took place during the recent OIS@SECO in Atlanta. Summit Co-Chairman, Paul Karpecki, OD, FAAO, set the stage with some staggering figures, which led to an insightful conversation between two ODs and two MDs about collaborative care models and the benefits to both patients and practices. Let’s listen in.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
Let me start by first of all, thank you very much. Emmett, you know these OIS symposia are just such an incredible opportunity. It’s wonderful having it here at SECO (Southeastern Educational Congress of Optometry) and in his third year now and I can’t say enough about the team at OIS the quality to do. So, we’ve got, a great panel with us today too that I think it’s gonna be… really gonna shed some light on understanding a lot of where the future and the opportunities might be, you know. And from this group we’ve got Dr. Tom Chester, OD is an optometrist, Clinical Director at Cleveland Eye Clinic, Elise Kramer, OD, FAAO, also in Optometry, she’s at Miami Contact Lens Institute, Dr. Bill, MD Trattler is a Director of Cornea is an ophthalmologist Center for Excellence in Eye Care and Bill Wiley, MD, an ophthalmologist from Cleveland Eye as well, Cleveland Eye Clinic. So great visionaries I mean these are the guys who even in the ophthalmology programs are up on the stage. And with them now is of course Tom and Elise Dr. Chester and Kramer. I’m glad to have this panel, and I’m gonna do it the same way, I just want to introduce from here while I was bringing them up. But I’m going to sit down with them too. And hopefully one of these, there you go… work. We’re gonna take you through some need areas. So first of all, thank you very much for making the time. I know you’re all busy and says a lot to be here, for this major optometric meeting and and compliments to all four of you. So first thing want to get into is the whole area of cataracts and looking at some of the numbers. And you may be vary… the numbers we see might vary, but I’ve heard… I’ve heard that there’s 76 million baby boomers that still need cataract surgery. There’s no new ophthalmologist that have graduated in about the last 20 years. It’s still about 431 coming out every year. If you look at full time equivalents, seen estimates everywhere from 16,000 ophthalmologist needed. Where you don’t have 16,000 who, even do cataract surgery. What’s the future as you see it of cataract surgery or these numbers seem plausible to you. Um and how would we address 76 million baby boomers?

William Wiley, MD – Cleveland Eye Clinic:
Yeah, I think collaborative care is key, in the past, let’s say 10-15 years ago, I think it was sort of an option and maybe a unique business model that certain practices were using, sort of a small boutique area. But now, in going forward, I think it truly is key. I think without collaborative care, we’re not gonna be able to serve our patients. And so, either internal Co-Management or external Co-Management one way or the other. I think optometry in ophthalmology, who are now we have to work together to serve our patients. I just don’t think the traditional model of an ophthalmologist seeing they’re patient, every pre-op, or seeing them for primary care for years on end and then doing Cataract Surgery, I just don’t think that’s gonna work to serve this patient base.

William Trattler, MD, Director of Cornea – Center For Excellence In Eyecare:
I think the other challenges, at least right now… most of the patients I’m seeing come into me are not ready for Cataract Surgery. They come in, they have Cataracts, but they’re not ready for surgery. So see them talking about all the options. But I say, wait… you have Dry Eye, MGD or something else. I have to treat their other conditions first, and eventually get Cataract Surgery. I wish it was just, they came in… you know, you’re great for surgery. You’re having surgery next week, but it’s really a long process. And I think again, collaborative care working together as a team is with the key for being successful.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
Makes sense. Tom?

Thomas Chester, OD, Clinical Director – Cleveland Eye Clinic:
I think hearing from very progressive ophthalmologist. I think that that’s fantastic to hear that, those progressive optometrists have been saying that for years. And I think to kind of have that marry up together. I think, 20 years ago it was that we were the outliers, you know, the progressive OD MD practices and we were out outliers. We were, maybe had arrows thrown at us, you know, so to speak. But now I think out of necessity, you know, in order to provide good patient care. I think, you know, as Bill mentioned, I think we’re gonna have to do that.

Elise Kramer, OD, FAAO – Miami Contact Lens Institute:
Yeah, and I think this is the future for sure. I think that, you know, the more we can collaborate together and the more patients we can see collectively, as we Co-Manage together as they are just echoing what they’re saying, I agree. Definitely.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
What brings up the other area, 15% decline in reimbursement, only to tell… you know, you Will and Bill that very often it will have seen the effects that it’s already having. Obviously one may weigh that, you know, like you as an  ophthalmologist can certainly make that up as in the premium category. But what’s interesting is premium IOLs, and they’ve continued to get better. But the growth has not. There’s still only 6-7%, 8% in one study, that are looking at some of these premium technologies. Yet if you look at the financially, it was a study by Shareef Mondavi that showed about 24% have the money disposable income to have it. So it’s not a financial thing, I mean… it is for the others, but it’s still a big number compared to where we’re at. Is that just lack of education in optometry? On these premium IOLs is it just, a fear? I mean, I’ve had patients heading into my clinic too that have said, you just tell him not to do a multifocal on your eye. That’s what the doc-patient had told me. And sure, there were times where that you have that one case or whatever. But why are… we, why is there such a disparity there. And what could we do in terms of education?

Thomas Chester, OD, Clinical Director – Cleveland Eye Clinic:
I think there’s two things. I think there is a cost issue, but I think it’s not necessarily the patient. I think it’s maybe the provider. I think that we look at it as a cost of a procedure as opposed to a perceived value, maybe a lifestyle change. Patients are willing to spend $5000 on a cruise which lasts a week… but or 28 days for some people, but… fun cruise. But in this case, we’re talking about changing their vision for their… rest of their life and maybe not even to that degree. So I think perceived value is something that we need to address, as opposed to thinking of it purely from a cost standpoint. But I do also think that there’s an education side. Years ago, we spent a lot of time educating Optometry about the Co-Management of Refractive cases. Refractive Surgery, Laser Surgery, LASIK you know PRK, all smile… well, not smile now… but we educated patients for years about that or… providers. But now how much are we really educating about the Refractive Cataract patients?

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
That’s good point. Success was there, too in the Refractive Surgery days because of Optometry driving it. You think of TLC models and all of that. So why did industry and everybody get away from educating Optometry? Or was it our profession? – Elise?

Elise Kramer, OD, FAAO – Miami Contact Lens Institute:
Well, I think we’re so afraid again to talk about money with our patients, and I think that’s our non Entrepreneur side, you know, our more medical side, so that’s we’re kind of like, just… we don’t feel comfortable talking about it. Whereas the patients, are probably willing to pay. I mean, like you said, it’s a one time thing… it’s a one time surgery it’s their eyes. And I think that the education needs to start in the Optometry office, we’re the ones maybe finding the Cataract first, the patient first… and where the ones referring. And so if we already get them, telling them, you know this is the highest technology available, this is the best out there. This is what you should get, then they already walk into their Ophthalmology office, with that in mind.

William Trattler, MD, Director of Cornea – Center For Excellence In Eyecare:
That is a great point, and I think… what I’m still seeing is that… these more advanced IOLs are wonderful. But the success rate still is not always 100%… and part of that still goes back to Dry Eye. How many times we have a patient, we did–the patients paid extra for Presbyopic Lens. They expected to see great, a month later… they’re really disappointed in the results and I’ve seen them. I’ve treat Dry Eye, but the Dry Eye gets worse with all the preservatives they’re using on their eye after surgery or, for whatever reason, it’s worse the dryness that makes their vision worse, and they’re disappointed… That’s going to be challenging, I’m happy to keep treating the Dry Eye. But not all practitioners feel comfortable and they get frustrated by the fact that this isn’t just a one and done… home run type of technology.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
Good point.

William Wiley, MD – Cleveland Eye Clinic:
Yeah, I totally agree. I think… the technology in the space, diagnostics… therapeutics, around Pre/Post OP, Dry Eye treatment. We didn’t really have, great technology even to diagnose dryness or treat it in the past. And now you know every patient, that’s coming through the clinic, you know, Tom’s integrated some new Dry Eye questionnaires that are really trying to identify it on the front end, treat it and then increase that chance for success. So I think the Perioperative care is really increased, but also… the technology the lenses, have come a long way. I look back to the original, you know, Array Lens that we were using 20 years ago, and it was really problematic to the restored, to the tecnis. Now we’ve got two great products. I think the Panoptics has been fantastic with a trifocal, that really delivers on that vision… that the patient’s looking for. Also the light adjustable lens is a great technology. We make it into it a little bit more… I think it’s great.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
Now would be a good time… I mean, you’re you’re thinking about, you know, this is now the future might be this adaptability the fact that you could, you know, treat a patient after you do the surgery. Whether it’s, you know, Olympia… which has ophthalmics, it has the piece of the IOL, the artificial IOL they’re working on where you may interchange/exchange lenses in the future or, as you said, or X-Sight where you could do an adjustable lens modification after surgery. Will that make a difference for Optometry and how?

William Wiley, MD – Cleveland Eye Clinic:
Yeah, I mean, I think… the adjustable lens is a great place for a collaboration. You know, Tom and I have been collaborating with this. We’ve been doing these studies going back about four years, and what’s great about the adjustable IOL is the patient gets to experience what division’s gonna be like before they lock it in. So we’ll start with maybe a mono a vision one eye distance one eye near, and if the patient likes that great. We’ll lock that in… if they don’t like that, we can adjust… and not only adjust, mono vision or not, but what type of mono vision. Do they want intermediate or up close? Or how close do they want it? And you know, having that ability to fine tune it to the patient is a great option. And I think you know, Optometry is very, you know, used to that. Working with contact lenses, adjusting, you know, either multifocal contact, or mono vision contact. You’ve got the skill set and the mind set to work with a patient, and I think it’s a great opportunity. There’s also the newest version of the adjustable lens, has the ability to add on extended at the focus or a presbyopic solution on top of that lens, so you can start with mono vision. If it’s not quite near enough, you can add on an extended depth of focus and maybe trial it first with a contact and show them. So anyways, I think it’s a great place where Optometry is not gonna be pulled further in, into the perioperative care in that, you know, premium lens segment.

William Trattler, MD, Director of Cornea – Center For Excellence In Eyecare:
So I’ve been really happy. We just started with the light adjustable lens as well in our center, and now we have a solution for patients that have really tough situations. Keratoconus patients, patients with previous Radial Keratotomy where it was very difficult for paces to end up on target after Cataract Surgery. Now we have a great solution, but takes time and collaboration because they need multiple post OP visits. We have to keep refracting them, figuring out what they like, and for RK patients, you could take a couple months until they get to the final… final refraction. So working together is really key here.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
Makes sense. And do you see that being a shared Co-Management fee more so because of the fact that there is more time, allotted to Optometry.

William Wiley, MD – Cleveland Eye Clinic:
Yeah, for sure… it is… Yeah, no, I think there’s definitely as Tom can say, there’s some heavy lifting in that perioperative care, it’s like more or less two or three Lasik “eval’s” as you’re working through those adjustments.

Thomas Chester, OD, Clinical Director – Cleveland Eye Clinic:
Yeah, I think, with regard to collaborative care, I think the concept shouldn’t necessarily. I guess the big fear is that it’s a pay for referral. But I think what we really need to look at is pay for service, you know, the provider that’s performing the service is being paid for that service. And so if there’s perioperative care on the front end, whether it’s managing the oculus surfaces Bill mentioned or post operatively fine tuning the contact lens refraction you know, to demonstrate mono vision or multi-focality, things like that, then that provider is actually being compensated for their time… chair-time, etcetera. So, that’s where the collaboration is gonna come from… on the financial side, because they’re being paid for the work that they’re doing.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
Bill, you mentioned Keratoconus, Elise may have you comment on this as well. You know, obviously Corneal Cross-Linking… you know, new advances taking place there. It will continue to advance. How’s that handled in a collaborative care approach right now… or is there an opportunity around that?

Elise Kramer, OD, FAAO – Miami Contact Lens Institute:
Yeah, so a lot of patients, come to me… I’m specialized in Scleral lenses and contact lenses in general and in Keratoconus. So I see Keratoconus all day basically, and I refer all of them for a Cross-Linking. And the reason for that is because we know… that the nature of the condition is to progress. And so even though I can improve the vision, all my patients with Keratoconus, PMD, post Lasik. You know, the ones with Ectasia are educated about progression, and they’re referred for that… for Cross-Linking consultations. So even though I can make the vision really, really good with Scleral lens or another type of specialty lens, the condition will probably progress. And so, that’s where the Co-Management comes in. And so I know that after the patient is referred and seen by a Cornea Specialist who performs Cross-Linking that, they have the best of both worlds because they have the vision improvement that I can provide. And they have the halting progression that the Ophthalmologist can provide, the Cornea Specialist.

William Trattler, MD, Director of Cornea – Center For Excellence In Eyecare:
Elise you made such good points there. And I think one of the biggest misunderstandings is what is Cross-Linking really do for patients with Keratoconus? It does more than just halt progression. We typically see improvement in Cornea shape and some patients that could actually look back to normal. I just presented a case last week were my patient, three years after Cross-Linking has a completely normal looking Cornea, while three years previously, they had obvious Keratoconus. You get his improving Cornea shape and improving vision. But for most patient with Keratoconus, we can perform Cross-Linking, but they’re not going to see any better right away. It’s a long process, and having an expert like Elise, and other experts… make such a difference for these patients they can now function, drive and work. Scleral lenses have been game changing for for these patients.

Elise Kramer, OD, FAAO – Miami Contact Lens Institute:
So it’s it really is a combination, you know, the Cross-Linking and specialty lenses together.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
Nice collaboration, that’s well said. So a couple–I’ve got five minutes for two other sections. One is macular, that whole area of Retinal disease, but in particular Macular Degeneration. A good presentation there on dark adaptation, obviously very exciting. More technologies coming in that obviously are much more into the optometric space. I don’t see any of my Retinal Specialist, looking to that by any means. Also my Retinal Specialists always say things like, I don’t want to see a basic patient, you know, I want to see only the stuff I’ve got an inject or surgically take care of. And again, you guys aren’t–you know, you work in practices that have that there. But you see collaborative care opportunities in other spaces besides Cataracts? Such as in the world of AMD – Bill?

William Wiley, MD – Cleveland Eye Clinic:
Yeah, I think… just like all the other specialties, I think more and more. We’re going to see the ophthalmologist being in the OR and just to take care of that volume of patients. So, the key is, you know, there’s so much work to be done that, any way we can collaborate on patient care. So Macular Degeneration, Diabetes, Glaucoma. There’s so much primary care that goes into those fields that, the surgeons are gonna lean on Optometry to guide those patients in those before surgery or after surgery. And monitoring the disease progression, So, I see for sure. You know, in our practice, we have Dry Eye Specialists, we have Glaucoma Optometry Specialists, we have Low Vision Specialists, you know, we have Glaucoma Specialists, and Optometrist. You know, I can see right now we don’t have that Retina Optometric Specialist, but I could see that… for sure, working with, you know Retina, hand in hand. And you know, you’re collaborating on those patient’s care.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
On adaptive technology… really, You know, which was featured earlier, really takes these technologies and puts them in primary care Optometry, as opposed to just Low Vision Specialists – Elise

Elise Kramer, OD, FAAO – Miami Contact Lens Institute:
Just back to what Bill was saying earlier about Dry Eye, any type of procedure you do on the eye, whether it’s Cataract Surgery, Retina Surgery, injections, all of those are going to temporarily increase inflammation on the ocular surface. And if these patients already have Dry Eye but they’re, let’s say asymptomatic. A lot of them might blame their symptoms on the procedure after it, when it could have been treated beforehand. And so I think that’s an excellent opportunity for collaboration as well.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
So where does Dry Eye come in then in that range? Let’s say, a patient who sent in from an independent private practice Optometrist, he sends the patient in… you diagnosis enough Dry Eye that you can’t figure out your IOL calculations. What’s your next steps? You call the doctors? Don’t embarrass the patient. Don’t embarrass the doctor.

William Trattler, MD, Director of Cornea – Center For Excellence In Eyecare:
I mean, I think at this point what I’m doing and I know, you gotta work with my local Optometrist, but I’m um…
Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute
Now to be fair Optometry’s picking up on Dry Eye

William Trattler, MD, Director of Cornea – Center For Excellence In Eyecare:
Oh they are definitely you know. I think there are also barriers. I mean, there’s so many great new medications we have, Cequa you know Xiidra, but there’s a lot of difficulty prescribing them sometimes. So if they want to prescribe, if we want to, anybody want to prescribe them, you know there’s all these prior authorizations that can block doctors from prescribing these medications so it can be difficult. But, when I identify patients I put them on a Dry Eye therapy and bring them back a month later to do one more set of readings. That’s really my strategy.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
That’s fair… and then you got to communicate between the two. Really again jumping around a little bit – I liked your idea of collaborative care and you see, a lot of these new technologies coming out by a matter process are obviously we have MIGS procedures with Hydrus and, and others that are newer, and more coming down the pipeline Glaukos, others have that. Where’s the collaborative care opportunity that you see… in that space and is that something you’re already starting to work with your Optometric community and colleagues in developing.

Thomas Chester, OD, Clinical Director – Cleveland Eye Clinic:
I think the MIGS procedures offer a tremendous opportunity. Gone are the days of having to worry about, like a Trab and a Shunt and the Co-Management aspect of that and those are pretty intense procedures, I think now with the MIGS, you know, incorporating in with a Cataract Surgery. Not much is really that, different. And so, you know, there’s a little bit of an increased. Probably the biggest challenge at that point is kind of tight trading off of medications, which happens, you know, six day weeks afterwards. But but really postoperative, you’re still seeing the same patient, you know, one week, one day one week, one month. You’re still worried about elevated pressure, you’re still burping a wound if you need to so, the same things that you would be doing with Cataract Surgery you’re doing with, you know, MIGS procedures, with the exception of perhaps, Gonioscopy. Which you need to do you know, once… you know, post operative. But other than that, I don’t think that it really adds a lot of difficulties.

William Trattler, MD, Director of Cornea – Center For Excellence In Eyecare:
So, I just added MIGS into my practice armamentarium this past year and hasn’t changed at all. I’ve been able to still cover with all my referring Optometrist. There was no difference. They’ve been following, and we were working together. As he said the key issue’s when to stop the medications, that’s the hard part, is their pressure low enough? Can they stop the medication.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
That makes sense… So, you know, I’ve never interviewed an Ophthalmologist like Cataracts Surgeons like yourselves, where I’d said, you know or heard the answer, would you rather do surgery or medical eye care – Dry Eye, Macular Degeneration. I’ve never heard any of you ever say anything but surgery. What’s it gonna take between Ophthalmology and Optometry for that to kind of become the realm? Because there are as we talked about Bill, patien–Ophthalmologists who, still hang on to the Dry Eye. Even though they don’t have the capacity and don’t, can’t really get into it. And Optometrist who still wanted to more medical but aren’t doing it quite to the level we need for the future. What are the solutions, as we are in our last four minutes here.

William Wiley, MD – Cleveland Eye Clinic:
Yeah, I think, Ophthalmologist just have to realize the amount of patients that are out there that needs surgery. And I’ve… a lot of it boils down to what do you like doing. There are Ophthalmologist that love Dry Eye and so they will stay in that space. But a lot of Ophthalmologist will say, You know what? I’d rather be in surgery. If that’s the case, you can start working your schedules saying, okay, I don’t want a schedule Dry Eye patient that’s going to go to the Dry Eye Specialist, Dr. Chester, whoever that might be in the practice. And I, have this theory, you know… every time you know an Ophthalmologist, you know, going into the future sees a Dry Eye patient. There’s a patient out that’s going blind from Cataract Surgery – you know from Cataracts. So, we’ve got to stay… you know, we’ve got to stay in the OR. There’s a lot of opportunity for for Ophthalmologist to be in the OR. And I think there’s a ton of opportunity for Optometry to step up in those areas like Dry Eye, you know, Glaucoma, Retina, all those things. So it’s a perfect… perfect storm for these opportunities.

William Trattler, MD, Director of Cornea – Center For Excellence In Eyecare:
And I also think there’s more solutions for Dry Eye that you know, I think there’s gonna be more excitement around Dry Eye. So I think that’s gonna really help to get doctors who maybe weren’t interested in Dry Eye in the past. ODs that were focused, perhaps, maybe less, on medical. There’s so much, so much excitement around this. It could really make such a big difference. The impact patient’s are so happy afterwards. That’s what makes patient– that’s what makes doctors happy, and that will bring more ODs into managing more Dry Eye, I think.

Elise Kramer, OD, FAAO – Miami Contact Lens Institute:
And also having more events like this, where we have innovative Ophthalmologists and Optometrists at the same event that can learn from people who do this on a daily basis, who Co-Manage to collaborate on a daily basis. Just spread the word, you know.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
And then from your standpoint, so you got a minute and Tom will have you do the last word here. So we had a good presentation of lens tech, maybe a new future, you know, approach to contact lenses. We haven’t had anything like that in a long time, and obviously you do much more specialty contact lenses is more your focus Elise. But, is there a role in educating our profession around all of that as well? And then focusing on the, kind of the more… difficult fits is that kind of approach, because that is a little bit of collaborative care in of itself.

Elise Kramer, OD, FAAO – Miami Contact Lens Institute:
Right… So, you know, I collaborate with, I don’t just collaborate with Ophthalmologist. I also collaborate with other Optometrists and that’s, you know, a little bit difficult, because Optometrists are, we all learned the same thing. So some think you know… I can do this, but the reality is there’s… If you don’t do this type of work every single day, then the patient might be better off going to someone who does. And so that’s where you know, I educate Optometrists all the time, and I want… you know, them to learn about all the new technology. But the reality is, unless you do this type of thing every single day, then… the patient might be better off with someone like that.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
Let’s focus that – Tom?

Thomas Chester, OD, Clinical Director – Cleveland Eye Clinic:
To piggyback on something that Whitney said earlier… I think you have to have a passion, and I think from an Optometric standpoint. You know, it’s one thing to say you want to be more medical and you want to practice more medically. But really, with just for today example, like all the things that are coming down the pipeline… like you really need to stay out in front, you need to validate that credibility and look out there as far as what’s coming and just kind of be more of an innovator in the sense of Optometric, you know, practice so that you can see those patients medically. Because if you’re still practicing, you know, I think Doug made the comment that you know about being archaic 10 years ago. If we’re still practicing as Optometrist that we we did 10 years ago, then yeah, that’s… that’s old school. That’s archaic… and that’s not necessarily the most up to date medical model. And I think we need to, you know, continue our education. Push forward, go to meetings like this, as Elise said and stay at the forefront of that innovation so that way we can participate in the medical model as well.

Paul Karpecki, OD, FAAO, Associate Professor – UPike College of Optometry/Kentucky Eye Institute:
Great, well… I certainly want to thank this panel of experts. That is exactly what we’re looking for today, wonderful… wonderful insights. Really incredible opportunities. Just shows how much need there still is from industry. And we have a lot of industry year in terms of education. To, you know, major educational initiatives such as SECO (Southeastern Educational Congress of Optometry) that have doing this for years and/or decades, and the impact they can have in just a entirely other area of opportunity where collaborative care does exist in one of the medical opportunities for Optometry become more paramount for the future. I think you guys covered it beautifully. Thank you very much.

William Wiley, MD – Cleveland Eye Clinic:
Thanks, Paul.

OIS Podcast VOG:
We hope this episode gave you a broader perspective on collaborative care models. If you missed this year’s OIS@SECO. Be sure to join us next February in Atlanta for the 3rd Annual Ophthalmic Innovation Summit at SECO. Stay tuned for more great episodes.