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KENT, Ohio— Eyecare at its best, like many things, is often built upon strong relationships. In this case, it’s the relationship between the patient and the ECP, whether he/she is an optometrist, optician or ophthalmologist. These strong and two-way relationships with patients also are often the key to a successful and efficient integrated eyecare practice, as many have noted.





In some instances, optometrists have an ongoing relationship with a patient that has been established over years of interaction and trust. Optometrists know the medical history, vision needs and expectations of their patients. If optometrists are able to have a working relationship with ophthalmologists, then patient care and experience are undoubtedly enhanced.

This is true of Northeast Ohio Eye Surgeons, an integrated practice with five clinic locations and a surgery center operating across three counties just outside and around Cleveland and Akron, Ohio. The practice treats cataract and glaucoma patients, retina and cornea issues, among other eyecare needs, and performs LASIK and/or oculoplastic procedures. These services are offered within each location, which permits the doctors to easily refer to each other.

“I think [integrated care] is a really great way for patients to have a nice continuity of care,” Katie Greiner, OD, MS, MBA, FAAO, and chief executive officer of the Ohio practice group, told Vision Monday. “When patients come in and they see an optometrist in our practice, and they have any kind of surgical needs, I can bring my colleague in from the room next door and have them take a look. [We can] approve a surgery right then and there, which saves the patient time and it saves them energy.”

Greiner has been with Northeast Ohio for about nine years, and she has been the CEO for the past two years after serving as chief operating officer for the three previous years.

Northeast Ohio has six ophthalmologists, who rotate through the different clinics and who are primarily involved in surgical care and procedures. They also see surgical consults, which are outside ODs’ scope. “If something is outside of my scope of practice, then I definitely need the [ophthalmologist] to back it,” Greiner explained. “If I see a central corneal ulcer that the patient’s on the verge of, then by all means I’m going to send it to my cornea specialist and get their opinion. They’ll handle the patient until the patient is ready to come back to the optometrist.”





The practice’s current count of optometrists is 11 following a recent new hire. “We have more optometrists than ophthalmologists, and that’s intentional,” Greiner said, noting the practice prefers to pair ODs with ophthalmologists in the care continuum.

“We want to know the surgeon so well that we can handle their post-operative care. We know how they work in surgery, and we can handle their post-operative care by working alongside and training with them.”

Each of the ODs also has found a care niche that they can specialize in. “My niche is cornea and specialty contact lenses, so I work with our refractive cornea surgeons. I have a VA doctor who came to us and she loves retina. She is the optometrist who works alongside our retina specialist.”

With the aging population and increasing number of eyecare interactions, it seems to Greiner and others that the U.S. needs more optometrists, some of whom will work more closely with ophthalmologists in patient care. “I’ve been seeing ophthalmologists who have practiced for 30 years on their own and they’re now saying, ‘Oh, I need an optometrist.’ All of a sudden they’re realizing this. And I think they’re talking about it, in their meetings, finally.”

Greiner added, “I’ve always been one who wanted to break down the barriers [between] ophthalmology and optometry. … The number of ophthalmologists is not growing at the rate that it should. Optometry is trying to keep up by adding schools and enlarging class sizes. And so there are a lot of optometrists who can do primary care and actually secondary care… By working together, the surgeons understand what the optometrists are actually capable of, and they allow us to stay within our scope… We’ve taught our ophthalmologists that model, and they’ve loved it because they want to do surgery.”

In addition to medical optometry and surgery, Northeast Ohio has a significant presence in contact lens fulfillment and optical sales, Greiner noted. The practice was founded 40 years ago without an optical segment, but added eyewear about 13 years ago.





One key element of the optical side is the practice’s commitment to have patients who have been referred to Northeast Ohio return to their original OD for eyewear fulfillment and service. If an outside OD is referring a patient to Northeast Ohio for cataract care or LASIK, “we will not ‘capture’ that patient and we will not sell them glasses,” Greiner said. “The way we do this is by making sure that our EHR is very clear on a co-managed or referred patient. The screen literally lights up neon yellow, so we know this is not our patient.”

Another important element of the integrated care model is that optometrists refer to other optometrists as part of the continuum of care. “There’s such an importance, coming from an optometrist, that optometry refer to optometry,” Greiner said. “I love that, and we see that a lot in our integrated model.”

An example of this is when an OD with a small private practice refers a glaucoma patient to another OD who is a glaucoma-trained optometrist, but not a surgeon. Then, if the second OD believes the patient should see a surgeon, he/she can refer to a surgeon.

Once ODs start following that model, and they begin to trust each other then it becomes optometrists referring to optometrists. “In this way, we haven’t burdened the surgeon by asking him/her to see every glaucoma evaluation,” she added. “They don’t have time to do that, and they need to see the tubes and the shunts and those things.”