AAOpt 2022: Comanagement helps elevate the full holistic standard of care for the patient

Alexis G. Malkin, OD, FAAO, associate professor at New England College of Optometry, and Anita Gulmiri, OD, FAAO, assistant professor at New England College of Optometry, speaks with Optometry Times®' Kassi Jackson on highlights from their discussion titled, "Intersection of low vision and contact lens: unique examples of co-management," which theyco-presented during the 2022 American Academy of Optometry (AAOpt) annual meeting in San Diego.

Editor's note: This transcript has been edited for clarity.

Jackson:

Hi, everyone. I'm Kassi Jackson with Optometry Times, and I'm joined today by Doctors Alexis Malkin and Anita Gulmiri, faculty at New England College of Optometry.

They're here to share highlights from their discussion titled, "Intersection of low vision and contact lens, unique examples of co-management," which they are co-presenting during the 2022 American Academy of Optometry meeting this year in San Diego. Thank you both for being here.

Gulmiri:

Thanks for having us.

Malkin:

Thank you.

Jackson:

Of course, so would you please share with us some key takeaways from this presentation?

Gulmiri:

So yeah, this has been a long time coming for both of us. You know, we've managed a few different cases together before, that we thought why not present this to the rest of our colleagues? Because we find the mission to be extremely important.

So the intersection of low vision and contact lens, you know, we've found that managing each of our specialties is extremely rewarding. But when we get to collaborate and work together, it's been, you know, even more rewarding for both of us. And it gives us a chance to elevate the standard of care for our patients as well.

Malkin:

Yeah, I would agree with that. And just say that, even though this is just 3 examples that we're discussing, they're just ways to think about how to co-manage, and there's many more patients that we do work together on.

And I think, as Dr. Gulmiri just said, our patients are really appreciative of when we bring in other specialists to make sure that they're getting the absolute best visual outcome that they can.

Jackson:

Great. So why is this important for optometrists to discuss?

Gulmiri:

So sometimes what happens is when we are, you know, focused on our own particular specialty, either we're working on improving the patient's function, or cosmesis, when it comes to, at least for me—contact lenses as my specialty—so sometimes we're looking at just one aspect of it. And so the other piece can get left behind or we don't have a chance to really center around it.

So, you know, really taking a step back and holistically looking at the patient and figuring out okay, what is it that others can provide for this patient, as well? What other specialists should I include in the management of care? And that's really where low vision comes in when we're looking at contact lens patients. And I think vice versa for Dr. Malkin.

Malkin:

Absolutely. I think we often focus so much on that ideal glasses prescription [and] what low vision devices are going to be most helpful, but in the cases that we discussed in particular, sometimes the devices couldn't even be used until we connected with contact lens and took care of some of the visual issues related to anterior segment anomalies or profound glare sensitivity. And we bring in people to be more effective in the low vision care we were providing.

Jackson:

Elaborating on the patient care piece. What does this co-management mean for patient care?

Gulmiri:

...It's kind of interesting that we've both kind of referred to each other when we've needed to. So sometimes the patients actually will present to me first, looking for some sort of contact lens solution, whether it's a prosthetic lens, or even just contact lenses to improve their visual function. And then as we're kind of going through the course of the fitting process, I'll find, okay, I think that, you know, the visual function is limiting us in whichever way it might be. And then that's when I'll pull in Dr. Malkin, and I'll say, "Okay, maybe she can provide, you know, some low vision devices that can further elevate the patient's visual function."

So that's really how we're working right now is the patients are presenting to either one of us, and then we're pulling the other person in. And then we're connecting with each other every few weeks or months—whenever it might be—along the way just to update each other and just run cases by each other to see what else can be done in order to improve.

The other thing I want to add, as well, is the community aspect of it that Dr. Malkin has been able to provide—the resources that she's been able to provide—for some of my patients that don't have insurance coverage for their medically necessary contact lenses. And she's been able to pull, you know, resources from the community in order to pay for their lenses, which has been a big deal for a lot of my patients.

Malkin:

Yeah, thank you. I think that is one of the key areas. You know, in the low vision specialty, we often work closely with Lions Clubs or with other fundraising organizations, because it's less common that low vision devices have insurance coverage, even medically necessary low vision devices. So we have those established relationships. Whereas in contact lens, frequently, there is good medical coverage of these medically necessary lenses.

And one of the cases in our course, not only did we have the Lions Club cover the contact lenses for the patient, we actually connected the patient with the Boston University's School of Occupational Therapy and they were able to provide him with an iPad for all of the accessibility features he needed so that he could continue on his journey to become a medical interpreter. So he's right now a stay-at-home dad who is going to school to get his Medical Interpreter Certification. And so helping him—he picks up some some odd jobs here and there, but helping him be able to continue on that journey, combined with, you know, contact lenses plus low vision aids, it just really showed that symbiosis. And he still texts the occupational therapists he works with to tell them how he's doing and how happy he is with both his low vision and his contact lens outcomes, which is really, really rewarding.

Jackson:

That's awesome. Well, it sounds like that relationship is very important and very empowering to your patient base, as well. Is there anything you guys would like to be sure to touch on that we didn't talk about already?

Malkin:

I would just say, you know, always ask your patients about their function. Don't assume that when they show up to your clinic—if you're in low vision—that they're in the best possible contact lenses, or that glasses are going to be the only way to maximize their function. And I think the same is true from contact lens...ask your patients how they're doing. If you get them corrected, and they're happy with improvement, make sure that you've kind of touched base with a low vision specialist. Could there be even more that could be done to improve it?

Because I think across all of optometry, it's really important just to ask those questions to know what other specialties do and to know that you can share patients with each other to really provide the best possible outcomes.

Gulmiri:

Yeah, I think I would just highlight the last point that Dr. Malkin made, I think it's really easy for us to be the savior for our patients and want to be the one to take care of all of their needs. But in reality, you know, we can only do so much, so I think really pulling in our colleagues who have other specialties and really just working to elevate the full holistic standard of care for the patient is, I think, really important.

Jackson:

Well, Dr. Malkin, Dr. Gulmiri, thank you so much for your time today.