AAOpt 2024: Knowing when to refer with Dr. Julie Rodman

Julie Rodman, OD, MS, FAAO, discusses her presentation on retinal decision-making, emphasizing the importance of knowing when to refer patients that she gave at the 2024 American Academy of Optometry with Optometry Times. She covered various retinal conditions, including vitreoretinal diseases like macular holes, and peripheral retinal diseases such as retinal detachment. Rodman highlighted the need for timely referrals, particularly for urgent cases like full-thickness macular holes and horseshoe tears. She advised optometrists to refer cases they are uncomfortable with and to seek expert advice when needed. Rodman encouraged continuous education and collaboration among professionals to enhance patient care.

This summary was written by utilizing AI resources.

Video transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Emily Kaiser Maharjan:

Let's shift gears and talk about your other talk, "Refer This, Not That: Retinal Decision Making." Can you give me a little bit of context for this presentation? What went into putting this together?

Julie Rodman, OD, MS, FAAO:

So for those of you that don't know me, I teach at NOVA Southeastern University. I've been there for about 25 years, and so my passion is essentially teaching. And so the reason I said that is because when I put together this talk, I thought about, people reach out to me all the time asking me questions about retina, about, "What would you do with this patient?How you know? How do I know that this one I can hold on to and this one I should refer?" So I thought about all the different retina cases, or all the different retinal presentations where it could go one way or the other way, but sometimes there actually is a reason an appropriate reason for referring. And so what I tried to do is put together topics that not only my colleagues have reached out to me about, but things my students ask me, or things we see in clinic every day where it really becomes a conversation of, "I don't want to be sued. Can I hold on to this case?" Or is there really a legitimate, good reason that this patient needs to be referred? So I went through things such as vitroretinal diseases. So macular holes, partial thickness macular holes, vitreomacular traction, epiretinal membranes, things like that, where, honestly, in a lot of cases, there are things that we could kind of keep, a lot of them are in our wheelhouse. And then there's other situations where we should refer. And then I went into things like peripheral retinal diseases, atrophic holes, operculated holes, breaks in the periphery, horseshoe tears, macula-on, macula-off, retinal detachment. So things like that, where it's really important that we understand, first of all, if we're going to refer, when should we refer. Talking about timely diagnosis, does have to be done in the next day? Does it have to be done that day? So, you know, things like that, where I was hoping to make it easier for my colleagues that are seeing these type of things to make good decisions. And it's actually going to be an ACE session, which is one of these smaller sessions. So when I've done this one before, I do them at dinner meetings, usually, and so we can in we can interact. I can talk to the crowd. I feel like this is a really nice conversation piece, because I get different philosophies from different doctors, different comfort levels. So that's where that came from.

Kaiser Maharjan:

Yeah, absolutely. And I know that this is definitely a situation where it's hard to paint with broad strokes and I'm sure you get a lot of scenarios where it's like, well, it really kind of depends on the details. But when you have a case that's right on that line of like, "I could refer this out, I could keep it in my chair." Do you have any specific things that you look for that push it one way or the other?

Rodman:

Yeah. I mean, there's a lot of different diseases that we could look and talk about, but just for an example, if you have a full thickness macular hole, that's that's a no brainer. That has to go out. If you have a horseshoe tear or retinal detachment, those things have to go out. I think the more challenging part is, if I have a retinal detachment, how soon do I have to send it out? How do they vary? If I have a patient that has diabetic macular edema, I should refer it out, but does it matter if it's closer to the fovea or farther from the fovea? How does that change my course of action? So things like that, where I think that my colleagues know these are things that I need to refer but I live in the middle of the country, let's say, how urgent is it that I get the patient to the doctor tomorrow? So those are kind of the more straightforward ones. But then you have something like vitreomacular traction, my patient is asymptomatic. Do I have to refer that? Or an epiretinal membrane, my patient's vision is 20/40, do I have to refer that? So there's going to be situations that are much more straightforward, and then some that are not. So that'swhat we're going to do.

Kaiser Maharjan:

So do you have any pearls for optometrists who are facing challenging retinal cases?

Rodman:

Well, certainly if you're not comfortable, always refer, right? That's an important clinical pearl is that if you don't feel like it's something that you feel good about monitoring, or you're just not sure, you refer it. If you do love retina, though, and you want to learn more about retina, come to things like this. You know, educate yourself. Go to continuing education meetings and learn about things like this. There are situations where a lot of my colleagues will say, "Well, I feel very comfortable texting my retina friend." Well, certainly then, if you feel comfortable texting someone to get advice, that's never a bad idea. Send a picture to somebody. So those are things that I often do as well. You know, using resources and things that we have around us to make go to clinical decisions. I think the patients appreciate that as well. I've never had a patient say to me, "You're not that smart. You calledthe retina specialist." They appreciate it, right? They want us to interact and ask people that might have more expertise in a certain area.

Kaiser Maharjan:

Yeah, absolutely. And do you have any key takeaways from both of your talks that you would really like to drive home?

Rodman:

The retina is an awesome, fun topic. It really makes me think, and it challenges me every day. And so what I like to do with these meetings, along with my colleagues, is to try to bring forth topics that I know have been challenging for me in the past, and things that I would hope to relay in a more simplistic manner to patients, to my friends, colleagues. Don't be afraid of the retina. Don't be afraid of the vitreous. Come join our talks. Come ask questions. Come learn. And that's it.

Kaiser Maharjan:

Fantastic. Well, thank you so much for chatting with me about all things retina today, Dr Rodman. It's been a pleasure, as always. So thank you very much.

Rodman:

Thank you.