As patient volumes rise and the complexity of care deepens, ophthalmology is confronting a reality long seen but often underaddressed: Vision loss carries significant emotional and psychological consequences that can directly impact outcomes. At the Flaum Eye Institute, David A. DiLoreto Jr, MD, PhD, has helped pioneer an integrated behavioral health model designed to meet those needs within the eye clinic itself.¹ DiLoreto is chair of ophthalmology at the School of Medicine and Dentistry and director of the Flaum Eye Institute at the University of Rochester in Rochester, New York.

In this Q&A with the Eye Care Network, DiLoreto discusses what prompted the shift from traditional referral-based approaches, how embedding behavioral health professionals into ophthalmology workflows is changing the patient and clinician experience, and why he believes this model represents an important step toward more comprehensive, patient-centered eye care.

Note: Transcript edited for clarity and length.

What inspired you to integrate behavioral health support into traditional eye care workflows, and what unmet needs were you aiming to address?

David A. DiLoreto Jr, MD, PhD: In my role as chair of ophthalmology and director of the Flaum Eye Institute at the University of Rochester, one of my core responsibilities is to anticipate where care models are failing our patients and then design systems that close those gaps. Over the past 5 years, the Flaum Eye Institute has grown from approximately 80,000 to nearly 150,000 patient visits annually. With that growth came a clearer view of something we had previously underappreciated: the profound emotional, psychological, and social burden carried by many ophthalmology patients.

Patients were arriving with significant anxiety, depression, fear of vision loss, and difficulty coping with life-altering diagnoses. These challenges were directly affecting their ability to engage in care, adhere to treatment, and even show up for appointments. When we attempted to refer patients externally, we encountered an overwhelmed behavioral health system with long wait times and limited access.

At that point, it became clear that simply “referring out” was not a solution. If we wanted to meaningfully improve outcomes, access, and patient experience, we needed to redesign the care model itself and integrate behavioral health into ophthalmology rather than treating it as separate.

How does this model work in practice, and how are behavioral health professionals embedded into the clinic?

DiLoreto: We deliberately designed this as a systems-based innovation rather than an isolated service. The foundation of the model is a clinical social work training program, in which a licensed clinical social worker, Kwasi Boaitey, PhD, LCSW, supervises 4 to 5 trainees completing their 2-year clinical requirement. This is paired with the involvement of a psychologist, Steve Silverstein, PhD, who collaborates with both the behavioral health team and our ophthalmology faculty.

What makes this novel is that the behavioral health team is embedded directly within the ophthalmology environment. They are accessible to clinicians in real time, available for warm handoffs, and positioned as part of the care team rather than as an external referral.

This structure allows us to intervene immediately during crises, support patients during emotionally charged visits, and develop longer-term therapeutic plans when needed. Care includes individual counseling and group-based interventions. Importantly, the model is designed to be scalable, educational, and sustainable rather than dependent on a single provider.

How does this interdisciplinary approach change care for patients and clinicians compared with traditional models?

DiLoreto: Historically, ophthalmology has focused—appropriately—on technical excellence in diagnosis and treatment. But vision loss is not purely a biomedical event; it is a life event. Our interdisciplinary model acknowledges that reality.

By addressing behavioral health needs proactively, patients arrive to their visits better prepared, less anxious, and more able to engage in shared decision-making. Communication between patients and clinicians improves. Adherence to treatment improves. Missed appointments decrease. Clinicians also feel better supported when caring for complex patients because they are no longer managing emotional crises alone in a high-throughput clinic environment.

This is not just about adding a service; it is about fundamentally redesigning the care experience to be more human, more effective, and more aligned with real-world patient needs—aligning with our biopsychosocial approach of health care at the University of Rochester.

What have been the biggest challenges in implementing this model?

DiLoreto: We are early in the process, and one of the most striking findings has been the sheer scale of unmet need. That both validates the importance of the work and underscores the complexity of doing it well.

Operationally, ophthalmology is a fast-paced, high-volume specialty with short visit times and intense clinical demands. Integrating behavioral health into that environment requires intentional workflow design, clear pathways for clinician access, thoughtful patient engagement strategies, and ongoing culture change.

We are actively working on:

• creating simple, efficient mechanisms for clinicians to engage the behavioral health team;
• normalizing patient acceptance of behavioral health support within an eye clinic; and
• designing a model that is financially and operationally sustainable over the long term.

These are not small challenges—but they are exactly the kinds of system-level problems academic medicine should be tackling.

What do you hope other ophthalmology practices take away from this work?

DiLoreto: I don’t believe every practice can or should replicate this model exactly. Private practices and many academic centers are operating under real financial and structural constraints.

I do believe the field needs to begin rethinking the boundaries of ophthalmic care. Vision loss affects identity, independence, mental health, and quality of life. If we ignore those dimensions, we are only delivering partial care.

One of the most important aspects of this initiative is the clinical social work training program. By training providers with specific expertise in the psychosocial dimensions of vision impairment, we are helping to build a workforce that can carry this more holistic, integrated approach into other institutions and settings. That, ultimately, is how meaningful innovation scales.

David A. DiLoreto Jr, MD, PhD

E: [email protected]

DiLoreto is chair of ophthalmology at the School of Medicine and Dentistry and director of the Flaum Eye Institute at the University of Rochester in Rochester, New York. He has no relevant disclosures.

Reference

1. Laird Z. Seeing the whole picture: a new model of behavioral health in ophthalmic care. Flaum Eye Institute news blog. December 9, 2025. Accessed March 23, 2026. https://www.urmc.rochester.edu/eye-institute/about/fei-news-blog/december-2025/seeing-the-whole-picture-a-new-model-of-behavioral-health-in-ophthalmic-care