Comanaging with the goal of better patient care

On February 7, ODs and MDs gathered to discuss innovations and advancements in glaucoma treatment at Glaucoma 360. The Eye Care Network sat down with Shan Lin, MD, and John Berdahl, MD, for exclusive insights into the future of comanagement.

"As our health care system evolves, of course, we need to all work together on this, and so often optometrists are the very first line of seeing and screening patients, and also starting to get them treated, or getting them to the right ophthalmologist for further treatment as well," Lin said. "So I look forward to a very collaborative role, especially as medicine evolves. There's just going to be this explosion, or this wave, of new glaucoma patients. As people live longer and our population just expands, we're going to have more and more glaucoma. Most of us can't see all the patients that need to come to us. So I think this collaboration is very important."

According to the 2020 US Census, 1 in 6 people were 65 years old and over.¹ The Population Reference Bureau estimates that the number of older Americans will rise 47% from 2022 to 2050.² Subsequently, the number of US patients in glaucoma is predicted to double between 2022 and 2050, from 2.7 million to 5.5 million cases.³

Although glaucoma has proven its prevalence, patients may have difficult finding an ophthalmic surgeon with a subspecialty in glaucoma. A recent study found that rural patients are increasingly outnumbering ophthalmic surgeons practicing in rural areas.⁴ Between subspecialties cornea, glaucoma, oculoplastic, and retina, glaucoma surgeons were found to have decreased the most (3.3%) between 2012 and 2022. John Berdahl, MD, highlights the importance of comanagement in rural areas to alleviate the burden on ophthalmologists.

"We live in a rural state. It is not uncommon for a patient to drive 4, 5, 6 hours for them to have their glaucoma surgery, cornea transplant, even cataract surgery, sometimes with me," he said. "Now, we have a same mission: take care of eyeballs. Can't we can do that together? We want to respect the boundaries of training, but what we always want to do is put the patient first.

"I have the privilege of working with 2 absolutely stellar optometrists in my practice that provide excellent clinical care and pretty much run the day-to-day clinic. And then I get involved when we have to make surgical decisions and if something bad is going on, or if we're having an outcome that isn't right, and otherwise, we're working together to make sure that these patients get the most effective and most efficient care possible so that we can take care of our rural state."

References:

1. Caplan Z. US older population grew from 2010 to 2020 at fastest rate since 1880 and 1890. United States Census Bureau. May 25, 2023. Accessed February 20, 2025. https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html

2. Mather M, Scommegna P. Fact sheet: aging in the United States. Population Reference Bureau. January 9, 2024. Accessed February 20, 2025. https://www.prb.org/resources/fact-sheet-aging-in-the-united-states/

3. Prevention CfDCa. Vision loss: a public health problem. 2022. Accessed February 20, 2025.

4. Ahmed A, Ali M, Dun C, Cai CX, Makary MA, Woreta FA. Geographic distribution of US ophthalmic surgical subspecialists. JAMA Ophthalmol. 2025. Epub ahead of print. doi: 10.1001/jamaophthalmol.2024.5605