Connecting optometry and the retina subspecialty

Image credit: AdobeStock/rh2010

The retina terrified me. I graduated from optometry school with many ocular pathology courses and disease-heavy rotations, but I still felt trepidation when examining, diagnosing, and managing diseases of the posterior segment. I was lucky to secure a residency in a multispecialty referral center, where my interest in and knowledge of the retina continued to expand under the guidance of 2 fellowship-trained vitreoretinal surgeons.

However, I realized that the more I knew, the more I became aware of what I did not know. To be transparent, the journey that led me to be the first retina optometrist at Colorado Retina Associates (CRA) was driven by fear. I would lie awake at night, stressing about my patients. Did I miss a tear? Did I refer this patient appropriately? And the worst one: If I made a mistake, would my patient lose vision? Because I was determined to know I was doing the absolute best for my patients, I spent every free moment in the retina clinic soaking up each drop of wisdom.

A new opportunity

Three years into practice, when the largest retina practice in the state opened a position for an optometrist liaison, a dream job I did not even know could exist was suddenly within my grasp. Amid COVID-19, after 4 Zoom interviews, I had an offer. This was uncharted territory for everyone involved. There was no contract. I was told on my first day that the position would be reevaluated in 3 to 6 months to determine whether an optometrist role was viable for the practice. CRA took as big a chance on me as I did in pursuing this job. Three and a half years later, I am still here.

I spent my first 6 months at CRA in clinical rotations, spending 2 weeks with each of the 13 specialists in clinic and surgery. I woke at 4 AM daily to research each patient on the schedule to be prepared. I examined the patients and presented their cases to my attending physicians. I read landmark papers and studied the trials that dictated standard of care. As my knowledge and confidence grew, so did my CRA physicians’ trust in my skill and judgment, which was crucial for me to grow in this role.

Education and connection

The key to the success of this optometric liaison position is removing barriers between the retina specialists and the referring optometric community. We approached this goal from 2 angles: streamlining patient care and educating referring physicians.

I started a “curbside” consultation service, where referring optometrists can text me cases for a quick second opinion on a Health Insurance Portability and Accountability Act–secure text line. Does this patient need to come in? How quickly should they be seen? What are my differentials? What am I looking at in this diagnostic image? I receive, on average, 25 cases per week from the referring community and treat each as a teaching opportunity with the goal of improved understanding of disease states and practical diagnostic and management tips. I run a medical retina clinic, which is helpful for referring physicians who want a second set of eyes on their patients but are unsure whether a surgeon is required or for those who do not have access to the necessary equipment to monitor the patient’s pathology. This clinic also benefits CRA physicians and patients, who can schedule routine follow-ups in the medical retina clinic, maximizing surgeon availability for those requiring urgent treatment.

The educational component expands beyond the individual cases to the multitude of CME lectures that CRA extends to the referring community. Having answered thousands of case questions over the past 3 years, I possess a unique insight into the content that helps bridge the optometric referral base and retina subspecialty. I use this knowledge to curate our CME lectures, ensuring the topics are relevant, with clinical and didactic pearls.

Growing in the practice

One year ago, in addition to my clinical and marketing responsibilities, I became the clinical director of CRA. As someone whose role falls between staff and physicians, I troubleshoot clinical operation issues while balancing staff and physician interests. This job has evolved into more than I could have imagined 3½ years ago when I started. The beauty of such a unique and unconventional position is the ability to mold the job with my growing confidence and interests. This job has allowed me endless fun and new challenges for my personal and professional growth. I am beyond grateful for the ingenuity and progressiveness of CRA, which allowed me to be the first retina optometrist in Colorado.