Working within a multi-specialty hospital provides a fantastic opportunity for collaborative care, with numerous benefits to the patient, their owners, and our valued referral partners. Over the past five years, the Ophthalmology Services team has strengthened its relationships with a few departments to provide the highest quality collaborative care.
Here’s why this is so important.
- Anesthesia & Pain Management: The most common type of patient with ocular disease is brachycephalic. These patients need individualized anesthetic plans, intraoperative monitoring, and specialized recovery to prevent complications related to their narrow tracheas, elongated soft palates, and small nares. Other patient types that frequent the Ophthalmology surgery suites are diabetics. Keeping their blood sugar and blood pressures regulated on a surgery day is crucial for a smooth recovery and quick release to the owners so they can go home where they are less stressed and eating again for glucose regulation.
- Surgery: The Ophthalmology and Surgery teams collaborate on hundreds of cases each year. Not only do they offer concurrent brachycephalic correction when undergoing an ocular procedure, the teams will often combine forces to have cutaneous and even internal tumors removed concurrently under a single anesthesia for less risk to the patient and less cost for the owner. For example, adrenalectomy and cataract surgery or TTA with v-plasty.
- Cardiology: Patients with possible hypertension (we see stressed cats with a blood pressure of 170 mm Hg, too) and those with known hypertension, undergo a complete dilated exam by Ophthalmology for a baseline. Subsequent visits include an evaluation of the posterior segment to help guide the longstanding control of the blood pressure since last examined (similar to a fructosamine in a diabetic). Some patients “spike” their blood pressure and these ocular exams help to support the clinical level of blood pressure control.
- Radiation Oncology: Patients undergoing radiation therapy in the head and neck region are more susceptible to radiation and/or anesthesia ocular side effects. Patients receive a complete dilated exam prior to the first treatment. If the globe or periocular area is in the radiation field, side effects are managed together by both teams for the best outcome. The patient is then reevaluated on the last day of radiation to complete their treatment plan and to determine any long-term follow up.
- Dermatology: Most patients with allergic disease will have ocular manifestations. The Dermatology and Ophthalmology teams work together to minimize ocular irritation and treat other conditions that often accompany atopy such as dry eye, blepharitis, and periocular pyoderma.
- Internal Medicine: The ever-popular “the window is the eye to the soul” does not resonate more than with the cases shared between Internal Medicine and Ophthalmology. From diabetes control to infectious disease with ocular side effects, Internal Medicine and Ophthalmology co-manage more patients together than any other department. Many clients schedule appointments back-to-back on the same day for the most collaborative care and “best practice”.
- Neurology: From Horner’s syndrome to facial nerve paralysis, granulomatous meningoencephalitis, and non-ocular/central blindness, the Neurology and Ophthalmology teams share many cases for appropriate diagnostic and treatment plans. The patients often have diseases that are slow to respond to treatment and the departments help create treatment plans to improve patient quality of life as quickly as possible.
- Medical Oncology: When a patient is diagnosed with an ocular neoplasia having metastatic potential, a consultation with Medical Oncology provides owners with treatment options and prognoses for all types of care, even if just palliative. The Medical Oncology service often consults with Ophthalmology when multicentric disease, most often lymphoma, includes the ocular form.
- Radiology: The Radiology Department of MedVet intertwines with all the listed departments above as Ophthalmology and they work together. They perform diagnostics that help drive collaborative care as it relates to geriatric screening, preoperative surgical planning, MRI or CT scans, and ultrasound guided aspirates.
- Emergency: The ER department takes in cases after hours and sends the ophthalmologists photographs of ocular conditions to provide immediate consultation and to start a treatment plan. This type of care allows documentation of the initial condition of disease so that when it is rechecked by the Ophthalmology Services team, the photos can be referenced.
If you have a patient that you think would benefit from collaborative ophthalmic care, please let us know. We are happy to offer in-house consults between departments, and owners are always welcome to schedule “dual appointments” to have one-on-one direct conversations with both departmental clinicians and care teams. If you’re uncertain where to start, call the Ophthalmology location nearest you and a member of the Ophthalmology team can collect information and work with the Ophthalmologists to determine the best place for the initial consultation.
