Bridging disciplines and elevating care: A Q&A with John Gelles, OD, and Steven Greenstein, MD

Since its inception in 2021, the Collaborative Care Symposium has helped eye care providers bridge the gap between optometry and ophthalmology. Cochaired by John D. Gelles, OD, and Steven Greenstein, MD, the symposium offers a unique, free, and entirely virtual platform designed to foster deeper collaboration and practical learning across the eye care spectrum.

In this Q&A, the cofounders reflect on what inspired them to launch the symposium, what makes this year’s agenda especially exciting, and why the future of refractive care depends on stronger collaboration between ODs and MDs.

The two of you founded the Collaborative Care Symposium together and are cochairing the meeting again this year. Can you tell me about what inspired you to start this meeting?

John D. Gelles, OD: Collaborative Care Symposium has been and will continue to be a free virtual program to promote mass attendance for more widespread knowledge. The program originally came about because of gaps in knowledge we observed from students, interns, residents, practicing doctors and even patient feedback. Much of what doctors knew about refractive surgery was what they were taught in their formal education, from the optometry aspect they had some general knowledge about what LASIK and PRK are, but their education was heavily focused on complications, many of which are rare or outdated due to technological advancements. Many of these doctors reported they felt uncomfortable with refractive surgery, had little to no first-hand experience with it, and would shy away from it in clinical practice.

Steven Greenstein, MD: So yeah, we're really excited to continue the Collaborative Care Symposium, which we started in 2021 and has continued each year now, in partnership with MJH. One of the great things about the symposium is that we really work on the combination of ophthalmology and optometry, the cutting-edge technologies that exist for refractive surgery, and even some glaucoma and retina care, and how that affects refractive surgery, and where both the ophthalmologist role and the optometrist role fit in this. We have particularly some highlights where we talk about some of the law related to the ophthalmology and optometry relationship. We have expert lawyers who come on and discuss updates in that different symposium on patient experience through refractive surgery, both in the optometry and ophthalmology setting. It's really a unique chance of learning both clinical information, but also really practical information for your practice that you can implement immediately.

Absolutely, and I think it's super cool that you guys balance the conversation between optometry and ophthalmology and bringing in all of the legal aspects of it, because that's always changing.

Greenstein: So that's always the thing that I think is front and center on a lot of people's minds. There has been a definite changing landscape over the last few years. So really, 1 of the highlights tends to be the expertise from our invited law team to discuss those topics.

Are there any other topics that you're discussing or conversations that you're planning to have that you're really, really excited about?

Greenstein: So I think every year it's exciting to really explore the unique nature of the refractive surgery space. It is a unique place where ophthalmology and optometry can work together to treat our patients. We always look forward to the topics which discuss some of the new and cutting-edge changes in refractive surgery, in refractive cataract surgery, and even in MIGS and glaucoma management in refractive surgery patients. These are things that really come up on a day-to-day basis, and can, like I said, be implemented on day 1.

Gelles: All of these talks are exciting; we have been fortunate enough to have access to the absolute top speakers for this program. The session that is a consistent favorite amongst attendees and one we explore every year is the medicolegal aspects of comanagement because it teaches the pitfalls and how to be compliant.

Collaborative care is in the name of the meeting. So what do we gain as ECPs when we learn together?

Greenstein: That's the great part of this meeting is that each lecture usually has an ophthalmologist and an optometrist doing them together, so you can get into the minds of both in 1 topic. You can really see how each side thinks about their patients. And then it helps, really in real time, see how you can bridge that thought process between the 2 fields. So you're watching that relationship in real time happening through each lecture, which I think really mimics the clinical world. I think that's how we really work nowadays. And there are multiple ways that ophthalmologists and optometrists interact, and that's 1 of the nice things on this meeting. We have different ways that comanagement happens. We have some people who are going to speak about more traditional comanagement, where patients are being sent in for surgery to the ophthalmologist and sent back to their optometrist for post op care, and they're happening in 2 separate places, other places where it's all sort of happening under one roof, but with the same kind of distribution of care, and in certain circumstances, like Dr [John] Gelles and myself, where we have real partnership that we complement each other in the same care: for example, our keratoconus patients.

Gelles: At Collaborative Care Symposium we tie in other aspects of care. We discuss how the care doctors are already providing is collaborative and relevant to refractive surgery. For instance, Myopia control helps maintain lower levels of myopia, which preserves options for future refractive surgery. Additionally, effective myopia management can reduce the risk of retinal detachment during procedures like refractive lens exchange or cataract surgery later in life, especially if a shorter axial length is maintained. Orthokeratology offers a glasses- and contact lens–free lifestyle, which can become permanent once a patient reaches ocular maturity. Managing ocular surface disease ensures a smooth corneal surface, allowing for more accurate measurements and better visual outcomes. Ongoing treatment helps sustain these improvements. For glaucoma patients undergoing intraocular refractive procedures, there is a unique opportunity to combine the surgery with minimally invasive glaucoma surgery (MIGS), which can reduce the long-term treatment burden. It all ties together.

What about the Collaborative Care Symposium you are proudest of?

Gelles: Over the years I ran multiple polls during other online programs focused on general optometry to get a feel from practicing doctors and found that very few were talking to their patients about refractive surgery as an option, if bringing it up at all, they had some awareness of other primary refractive surgery options like SMILE, ICL, or RLE but were significantly less comfortable in the management of these patient than those undergoing LASIK or PRK. Doctors working in refractive surgery would tell me the primary reason patients would say they were coming in for a consultation was Google–and when they would tell the patients, "You're a candidate for refractive surgery," they would most likely respond with, "Why didn't my eye doctor tell me this was an option for me?" There were also misnomers about the financial and medicolegal aspects of comanagement.

This program was created to increase knowledge, instill confidence, and encourage us all to work together to provide patients with the full range of vision correction options. We are all better together.

Greenstein: So I think it really reflects the relationship that Dr Gelles and I have created over the years. So I think 1 of the things that we felt internally in our practice was that our relationship, clinically, really complements one another. So we felt that we manage our keratoconus patients best because of the fact that we're actually working together. We do separate parts of the management, but we're doing them to complement one another for each patient. And 1 of the things we felt that was lacking and sometimes harder to see was even though we knew was out there – we knew that that same complement existed across the refractive surgery space – it wasn't being really talked about enough. It wasn't really being something that you would see happen in a meeting. Most meetings were really relegated to 1 side or the other. And so we felt that, because of our own experience, we wanted to try to see whether we could bring that to real life through a virtual forum, and it's really only taken off from there. It's only gotten better and better with more diverse lectures as the years have gone on, and more diverse topics to continue to grow the meeting.

Fantastic. And is there anything else that you want to mention about the meeting that I haven't asked you about?

Greenstein: I think the key feature of the meeting is really the practical take home messages that are conveyed in this meeting. I think the meeting is really geared for doctors, both in optometry and ophthalmology, that want to learn about both practical clinical things to be implementing for comanagement and also administrative, law, and business, all kind of combined in one.