VEE 2023: Legal perspective on keratoconus management

Katie Gilbert-Spear, OD, JD, MPH, caught up with Optometry Times®' editor, Kassi Jackson, to share highlights from her 2023 Vision Expo East presentation on the legal perspective of keratoconus management at a primary care optometry setting.

Video transcript

Kassi Jackson:

Hi, everyone. I'm Kassi Jackson with Optometry Times, and I'm joined today by Dr. Katie Gilbert-Spear, who spoke on the legal perspective of keratoconus management at a primary care optometry setting during Vision Expo East 2023 in New York City. Thank you for joining us, Dr. Gilbert-Spear.

Katie Gilbert-Spear, OD, JD, MPH:

Thank you for having me.

Jackson:

Of course. So, will you please share with us the key highlights from this discussion?

Gilbert-Spear:

This discussion was around the new standard of care in keratoconus treatment. In the past, there really hasn't been a lot that we could do for our keratoconic patients besides just providing them with good vision through contact lenses or glasses. But now in 2016, that changed because the FDA approved corneal cross-linking. It's the first time that they've approved corneal cross-linking treatment for keratoconic patients, and so what that does is it slows—or halts—the progression of keratoconus for our patients. And up until this time, we didn't have anything to slow or halt progression. So when that happened in 2016, it really changed how we treat our patients. And in 2018, the American Academy of Ophthalmology changed their preferred practice guidelines to include corneal cross-linking. So now, for optometrists who have keratoconus patients—which we all do, it's important for us to identify patients early. So if we see progression, we get them in for corneal cross-linking sooner rather than later so that we can hopefully halt or slow progression.

Jackson:

Great, and how does the legal perspective of this management kind of play a role?

Gilbert-Spear:

So from a legal perspective, anytime the standard of care changes, we have to change our treatment patterns. And that's really what we're seeing in keratoconus management is that the standard of care is shifting because, like I said before, it was just giving them contacts or glasses, and now it's: when we see progression, we have to refer the patient for corneal cross-linking to see if we can slow progression. If we don't diagnose these patients early enough to get them the treatment and they progress and have a bad outcome, then we could face some liability.

Jackson:

Gotcha. So you kind of just touched on this. But why is this topic so important for optometrists to address and be aware of?

Gilbert-Spear:

I think it's twofold. One, because we want to take good care of our patients. Optometrist in general are just really good people, and so we want to take good care of our patients—so if we have a new treatment that we can provide to them, then we want to provide it for them. And two, we want to protect ourselves because if we don't refer early enough to get that treatment so that the patient doesn't progress, then we can face the liability. Also with corneal cross-linking, there's only one FDA approved corneal cross-linking, but there are some ophthalmologists who provide corneal cross-linking that's not FDA approved. And so when we do make those referrals to ophthalmologist who are providing the services, we need to ensure that we're actually sending them to ophthalmologists who are providing FDA approved treatment, not just whatever they think is good.

Jackson:

So what do you hope optometrists walked away from this session with?

Gilbert-Spear:

I hope that they walked away with new knowledge on how that standard of care is changing. And so when they go back into their offices, one, they're going to start looking for these patients earlier, really doing a good screening process. The screening process for keratoconus should be like the screening process for glaucoma, we should be screening for it on every single patient. Because now we have a treatment—we have a treatment that can slow or halt progression. So we've got to screen for it like we do glaucoma patients, and when we see it, we identify it and then we follow them appropriately so that when we do see any type of progression, we get them into the right ophthalmologists providing FDA approved corneal cross-linking.

Jackson:
Yeah, so kind of just building off of that. What does this knowledge mean for patient care?

Gilbert-Spear:

I think it's great for patient care, because honestly, up until this type of treatment patients with keratoconus, we just waited until they got worse and we changed contacts, change glasses, and then there are a certain percentage of keratoconik patients that do go on to have corneal transplants, which is never good—we never want that to happen. But now we have a treatment that could potentially stop patients from needing a corneal transplant down the road. So I think it's really important for us and it's really important for our patients.

Jackson:

Yeah, and you mentioned the relationship of referrals. So how important, in your opinion, is building that referral network with ophthalmologist to be able to provide that care to patients?

Gilbert-Spear:

I think it's incredibly important. I mean, typically when we refer patients to ophthomology we don't really have a lot of liability necessarily once we've made the appropriate referral because ophthalmologist, their board started but they have the proper training and they're providing the proper care. But in this situation, because you do have some ophthalmologists who are providing non-FDA approved treatment, and we have an FDA approved treatment, we just got to be really careful about who we're referring to. So I encourage optometrists to call ophthalmologists that they're wanting to refer patients to, go in and see their office, and see what they're providing. Not only will it ensure that you're you're making the appropriate referral, but also when you educate your patients on why you're referring them and who you're referring them to, you then you have a better understanding and you can educate your patients better.

Jackson:

Well, Dr. Gilbert-Spear, thank you so much for your time today.