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Comanagement is the term used to describe situations where someone other than the surgeon provides the preop and postoperative care. Usually, this other provider is an optometrist, but it can be an ophthalmologist. The comanaging provider will receive a portion of the global surgical fee for providing these services. Comanagement is a very controversial practice, since money is changing hands-arguments are frequently made that optometrists refer not to the best surgeon, but to the highest bidder-a situation which is not only unethical but also illegal.

Comanagement has its place, but patients need to understand several things. First, the patient must be given the option of seeing whomever they want for the pre and postop care-they must not be forced to have aftercare at a clinic other than the clinic they had surgery with. Unfortunately, this is rarely done since a patient who chooses the aftercare with the surgeon will cause the referring practitioner to not receive any money. Also, comanaging doctors need to be upfront about what fees they receive from the surgeon for doing this work.

An optometrist who steers a patient strongly toward a certain surgeon may be letting financial gain cloud his or her judgment. A prudent patient would do their own research to find out who the "best" surgeons and clinics are.

Comanagement works best when the surgeon is located far from the patient, and it would be inconvenient for the postop visits to be done in the surgeon's office.

How Surgeons manage Comanagement

Survey of Surgeons on the issue of Comanagement

Physicians and Legal experts discuss Comanagement

Information from the American Academy of Ophthalmology on comanagement

Article from the Sacramento Bee, 4-29-2000, on comanagement

Opinion article on comanagement from EyeNet Magazine

Position Paper on Comanagement from the American Society of Cataract and Refractive Surgery and the American Academy of Ophthalmology

What's the difference between an Ophthalmologist, an Optometrist, and an Optician?

Ophthalmologist
The highest level of training an eyecare provider can have. An ophthalmologist is a medical doctor (MD), who completes four years of college, four years of medical school, a year of medical or surgical internship, and three to four years of residency training in medical and surgical eye care. Ophthalmologists can perform surgery, treat any eye-related medical problems, prescribe any medications, as well as measure for and prescribe glasses and contact lenses.

Optometrist
An optometrist, or doctor of optometry (OD), is a specialist in optical disorders of vision. Their primary role is to measure for and prescribe glasses and contact lenses. They are not trained nor permitted to perform surgery. Recent legislation has allowed optometrists to prescribe certain medications, if the optometrist has 80 hours of classroom work and 65 hours following an ophthalmologist to get these privileges.

Click here to read details about the requirements from the California State Board of Optometry which allow an OD to be able to prescribe medicines.

Optician
An optician is a specialist in making and fitting glasses. They are not permitted to perform surgery, perform eye exams, or prescribe any medications.