AAdvances in the science of eye care over the past 10 years have led to dramatically better results for many people with vision problems. For example, take anti-VEGF medications for age-related macular degeneration (AMD). Anti-VEGFs, which are injected into the eye, slow the growth of blood vessels that often lead to wet AMD, a leading cause of blindness worldwide. In a study funded by the National Eye Institute and the National Institutes of Health, half of those with wet AMD who were injected with an anti-VEGF drug still had 20/40 or better vision after five years of treatment. These results would have been unimaginable two decades ago.
Despite all the advances, too often patients do not receive optimal care due to poor coordination between optometrists and general ophthalmologists and the ophthalmologists who provide specialist care.
Ideally, having identified a condition requiring specialist attention, the primary ophthalmologist will promptly refer the patient to the appropriate specialist. The specialist provides the necessary care and refers the patient to the primary eye care provider for follow-up. As I have seen in my 30+ years as a retinal specialist and surgeon, when managed effectively, this landmark cycle ensures that patients receive timely, high-quality, end-to-end care.
But too often primary eye care providers and subspecialists work in silos, leading to fragmented care. Research shows that only 40%-55% of eye patients follow referrals. Without strong coordination between primary eye care providers and subspecialists, patients can fail, with poor outcomes and a higher, more expensive and often more painful standard of care than initially required.
Now, a new treatment available for people with geographic atrophy, an advanced form of dry age-related macular degeneration, is making it more urgent than ever to address this problem.
Nearly 1 million people in the United States and 5 million people worldwide are estimated to be affected by geographic atrophy, in which sections of the retina stop working, leading to irreversible vision loss when central vision is involved. Until recently, patients with geographic atrophy were mainly managed by optometrists and general ophthalmologists because the main approaches to slow disease progression were diet, vitamin supplements, lifestyle changes (i.e. cessation of smoking) and the management of comorbidities such as hypertension.
However, with the recent FDA approval of Syfovre (pegcetacoplan), a new injectable treatment shown to slow the growth of geographic atrophy, the care of these patients will change. Patients who are eligible for treatment with Syfovre will receive it from a retinal specialist. But as the pharmaceutical industry is scrambling to claim market share in the geographic atrophy space, the ultimate success of Syfovre and its competitors, as well as the preservation of patients’ vision, will depend on an effective baseline cycle.
Optometrists and general ophthalmologists will play a critical role in identifying candidates for the new therapy, determining their suitability, appropriately referrals to retinal specialists, and provide information on potential benefits. In turn, retinal specialists will need to inform referral providers if the patient is following up on injections and managing overall eye health. The longer treatment is delayed, the greater the risk that eligible geographic atrophy patients may lose their vision.
To ensure that eye patients receive the seamless care they need quickly and safely, it’s not just providers that need to change. We also need to improve the systems and processes that deliver patient care.
In my experience working with both optometrists and general ophthalmologists, three key steps are required to create an integrated and effective eye care:
1. Build a community-based network
While we optometrists and ophthalmologists have historically operated in separate spheres, effectively managing patient referrals requires that we build familiarity with other eye care providers within our communities. Understanding the specialties of other professionals is the basis for collaboration. Both sides of the patient management equation, primary providers and specialists must make a deliberate effort to interact with one another in order to best serve the patient. For Syfovre to reach its full potential to help people, we need integrated educational events covering how the drug works, who the ideal patients are, and how to use diagnostic tools to best identify eligible geographic atrophy patients and help build a shared understanding of the geographic atrophy treatment landscape. In-person events will also allow us to build these needed networks.
2. Establish shared systems and protocols
As in many specialties, the variety of electronic health record platforms used by eye care providers make it more difficult for us to share data between systems and can slow down the referral process. To remove these barriers, some practices offer an online referral portal to share information and allow both optometrists and referral specialists to stay up-to-date with their patients. Technology solutions such as portals can play a critical role, but their successful implementation will ultimately depend on the willingness of eye care providers to adopt new practices and take intentional steps to ensure patient referrals are handled smoothly.
3. Create a dedicated support team
Even in the best-case scenario, managing insurance and reimbursement issues between different eye care reports can be complex. Forming a dedicated team to handle these issues can help streamline the process. This is especially true for patients with geographic atrophy because insurance coverage for new treatments can vary significantly from plan to plan. Additionally, having a dedicated patient call center can ensure that all operators, patients and support staff are on the same page and receive consistent communications. This will help ensure that patients have the best experience and receive the care they need in a timely manner.
Experts predict that the number of Americans with vision impairment and blindness will double by 2050. As these trends continue, the health of patients with chronic eye disease will depend on how well their providers work together. An integrated approach to eye care enables more efficient and effective healthcare through improved communication between primary eye care providers and subspecialists.
This is a win for the system but more importantly, it is a win for the patient.
Antonio Capone Jr., MD, is a retina specialist at Associated Retinal Consultants and clinical director of EyeCare Partners.
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