Management of acute ophthalmic presentations
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Acute ophthalmic conditions present diagnostic and management challenges. To assist in assessing patients with acute presentations, including retinal ischemia, OMIC Committee member Dr. Gaurav Shah and retina fellow Dr. Alex Boutini of Retina Consultants, Ltd (St. Louis, MO) developed an algorithm called Acute Ophthalmic Presentations. We thank them for allowing us to share this decision tree.
Consider sending this decision tree to Emergency Department physicians at hospitals where you take call.
See also the latest AAO recommendations on acute retinal ischemia at https://www.omic.com/management-of-acute-retinal-ischemia/
Coordinating care with optometrists
OMIC policyholders report on renewal applications that they are increasingly incorporating optometrists (ODs) into their practices. While optometrists are independent practitioners, there are differences in education and legal scope of practice between eye physicians/surgeons and ODs, as well as different scopes of practice among traditional optometrists and those with therapeutic certification. All these differences must be respected in order to comply with state laws and provide safe care. Coordinating Care with Optometrist within a Practice addresses the key issues.
For a discussion of surgical comanagement, please see Comanagement of Surgical Patients.
Comanagement of surgical patients
Some ophthalmologists share care of ophthalmic surgery patients with community optometrists or optometrists within their practice. There are patient safety and liability risks associated with surgical comanagement, whether it takes place within a practice or outside of it. Our risk management recommendations in Comanagement of Surgical Patientsare based upon OMIC claims experience. They also incorporate the conditions for safe comanagement that are detailed in the position paper signed by over 60 eye societies entitled Comprehensive Guidelines Co-Management of Ophthalmic Postoperative Care.
Ophthalmologists in Florida use the FL consent form and transfer letter.
Preoperative Medical Assessment
Many patients contemplating ophthalmic surgery have medical conditions that could increase the risk of the procedure and anesthesia/sedation. To prepare for and reduce the risks as much as possible, patients undergo a preoperative medical assessment that usually includes a history and physical examination (H&P). Such an assessment has been mandated by CMS (Centers for Medicare and Medicaid Services). Regulations passed in 2019, however, give surgery centers more flexibility in determining who needs a preoperative H&P and when it must be performed; these new regulations are discussed in Part 2. Ophthalmologists may play a role in these determinations. They may also be performing the H&P themselves. Preoperative medical assessment provides information to guide decision making about the preoperative medical assessment.
Ophthalmic surgical checklist
AAO, OMIC, ASCRS, ASORN, and OOSS Ophthalmic Surgical Checklist
The American Academy of Ophthalmology and OMIC asked key ophthalmic societies to join them in developing an ophthalmic-specific surgical checklist. We would like to thank the American Society for Cataract and Refractive Surgery (ASCRS), the American Association of Ophthalmic Registered Nurses (ASORN), and the Outpatient Ophthalmic Surgery Society, for their assistance in producing this Ophthalmic Surgery Checklist.
This sample ophthalmic surgical checklist was designed to meet the needs of patients having many kinds of procedures. Please make any changes necessary to best address the type of patients, procedures, anesthesia, and facility you have. For example, ASCs whose only procedures are cataract surgery with topical anesthesia may not need many of the listed elements. Check with the physicians, anesthesia providers, nurses, and facility administrators to determine which elements are required under state licensing rules or by accreditation organizations.
