In the first episode of Inside Intrepid, Damon Dierker, OD, FAAO and Nick Bruns, OD, FAAO discuss the evolving role of optometry in ophthalmic surgery and co-management.
Redefining optometry’s role in surgical eyecare
“The patient journey starts in the referring optometrist’s chair,” says Dr. Dierker. However, optometrists are no longer confined to merely identifying surgical candidates; they’ve become increasingly central to shaping patient outcomes across the entire patient journey, from initial counseling to post-operative care.
In fact, the patient experience with cataract surgery is increasingly expectation-driven and highly dependent upon pre-operative preparation—of the patient and the entire care team. Both Drs. Dierker and Bruns emphasize that delaying patient education until the surgical consult is a missed opportunity.
As Dr. Bruns explains, “The more you can prep your patients before they get through our doors, the better. Think about what we're doing in modern surgical eyecare. We are helping patients navigate a problem that needs surgical intervention and we have tons of new technology that can become complicated.”
“And then, a lot of these things have price tags on them. That can be just massively overwhelming for patients. So the more you can start that dialogue earlier as a referring optometrist, the better,” he added.
This aligns with evidence showing that pre-operative expectations significantly influence patient satisfaction, even when visual outcomes are objectively good. Patients undergoing cataract surgery—especially those receiving premium IOLs—often expect spectacle independence, and unmet expectations remain a leading cause of dissatisfaction.1
Ocular surface optimization is non-negotiable
One of the most impactful areas where optometrists contribute is ocular surface optimization. “Any disruption in the tear film ... can really have an influence and sometimes takes patients out of candidacy,” says Dr. Bruns.
The TFOS DEWS II report identifies dry eye disease (DED) as a major source of variability in pre-operative measurements.2 Studies show that tear film instability reduces keratometric repeatability and increases the risk of refractive error following surgery. This makes early intervention critical: initiating dry eye therapy prior to referral allows time for stabilization, improving both measurement accuracy and surgical outcomes.3,4
Post-operative care beyond the operating room
Dr. Dierker frames surgical collaboration as “a triangle with the patient in the center”: the referring OD, the OD in the surgery center, and the ophthalmologist, each of whom play a distinct but critical role. Effective co-management of this sort depends on communication—the “two-way street” of collaborative care, as Dr. Dierker puts it.
Most importantly, surgery is not the endpoint. Dr. Bruns describes it as “the peak of the mountain—the summit—but you still have to get back down.” Post-operative care falls within the optometrist’s scope, which means everything from managing inflammation to monitoring for complications.
Communication continues to be critical across this process, and breakdowns at any point can lead to patient confusion, dissatisfaction, and poor outcomes.
The future of surgical collaboration
With more than 4 million cataract surgeries performed annually in the United States—and demand expected to rise—collaborative care models are increasingly necessary.
As Dr. Dierker notes, “the best surgeons really want strong optometrists working with them ... because it gives the patient the best chance to have the outcome and experience they deserve.”
