May 31, 2019 Conference


The Role of Collaboration Between Ophthalmic Plastic Surgeons and Ocularists in the Co-management of Anophthalmic Patients

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Elizabeth Cretara (Presenter)
Kaylee Dougherty, Boston Ocular Prosthetics, Inc.
Dr. Daniel Lefebvre, Massachusetts Eye and Ear Infirmary

Ocular implants can improve the quality of life of patients who have experienced globe loss.
While expert opinion has suggested that collaboration between ophthalmic plastic surgeons
and ocularists is important to optimize patient outcomes, we are presenting the first survey-
based investigation of this important relationship. We distributed an electronic survey to 208
practicing and retired members of the American Society of Ocularists regarding collaboration
with ophthalmic plastic surgeons. Our goal was to elicit their perspectives regarding
communication with surgeons, patient education, implant size, eyelid position at time of
referral and selection of surgical materials and techniques. We had an 18% response rate
(38/208). 98% of respondents worked in USA/Canada, 60% had 30 years or more of experience
and 75% received referrals from 5 or more ophthalmic plastic surgeons. 87% reported that
collaboration with ophthalmic plastic surgeons was critical to successful patient outcomes,
while only 68% reported that collaboration was “always” or “often” adequate. 47% stated that
patient education prior to referral for first visit was inadequate, 34% reported difficulty
contacting referring surgeon, and 10% reported that their concerns were not taken seriously by
the surgeon. Regarding size of implant, 55% reported problems with size of implant, with 37%
reporting too large, 25% too small, and 37% variable. 50% reported problems with lower lid
laxity or upper lid ptosis upon initial evaluation. Ocularists identified “good surgical technique”
as the most important factor in technical success. They preferred acrylic, bio-integrated, and
porous materials. Pegging was the least desirable technique. Our data suggest that while the
majority of ocularists are satisfied with the level of collaboration, there remain opportunities
for improvement in ease and quality of communication, patient education prior to referral, as
well as improved selection of surgical materials and techniques. We suggest future research is
needed to improve the quality of care we offer to patients who have experienced globe loss.