Thank you for co-managing your patients with Southeast Connecticut Eye Care LLC. We'd like to coordinate our care with you to ensure your patient has a pleasant, safe, and seamless surgical experience. Below please find some information that will describe our standard clinical pathway and give you some helpful information about caring for cataract surgery patients with us.
Some patients' care may deviate from this pathway. Always use your clinical judgement in deciding on the care of a particular patient. Please call the surgeon at any time if you have questions. Our telephone number is 860-373-4148.
Good candidates for cataract surgery include patients with cataract who:
Note that the standards for Medicare coverage of cataract surgery have changed. There is no longer a requirement that the patient be 20/50 or worse for Medicare to cover surgery. The Medicare Local Coverage Determination (LCD) for cataract surgery now allows us to perform surgery when it is medically necessary and does not specify an arbitrary visual acuity standard for surgery.
We strongly believe in the potential benefits of co-management for your patients. Co-management is usually more convenient for the patient and minimizes travel time. It allows their primary eye doctor to be more involved in their care and promotes a team approach in the perioperative period.
Whether to co-manage is always the patient's choice. Most of our patients do choose to have their care co-managed, and we will notify you when the patient elects this option.
The best (and fastest) way to refer a patient to us is to use the online referral form. Your front desk staff can enter basic information in the form and we will call the patient. It is HIPAA compliant and secure. If you give us the patient's cell phone number, they will automatically receive a text with our information. We will call the patient, and track the referral to make sure we see them and that you receive a letter.
Of course, you can always call our office (860-373-4148) to refer a patient if you prefer.
This is the usual schedule of visits for a patient having cataract surgery.
| Visit | Timing | Physician | Description |
|---|---|---|---|
| initial consultation | within 4 months of surgery | surgeon | At the initial consultation the surgeon takes a history to determine indications for surgery. He examines the patient for the presence of cataract and findings that may affect the surgery. He will discuss with your patient the risks, potential benefits, and alternatives of cataract surgery. Together, the patient and the surgeon will decide whether to schedule the procedure or not. If they schedule surgery, the patient will receive a date for a preoperative appointment. (S)he will also receive a handout on cataract surgery, directions to viewing educational material on our website, a booklet on the surgical center, and forms needed for scheduling the procedure. | preop | within 30 days of surgery | surgeon | The patient will have their A-scan (laser interferometry or immersion ultrasonography) at their preoperative appointment. The patient chooses their lens option at this visit, or later after discussing their lens options with the surgeon. The patient receives prescriptions for perioperative medications to use, with written instructions on their use. We complete all paperwork and make postoperative appointments at this visit. | surgery | usually a Monday | surgeon | One day prior to surgery, the surgery center staff will call the patient with a time for surgery. The patient will arrive at the Constitution Surgery Center East in Waterford. The entire visit normally takes about two hours. The actual procedure usually takes about fifteen minutes, more if the surgery is complex. The patient will receive postoperative instructions prior to leaving the surgery center. | postop 1 | day of surgery, or day after | surgeon, optometrist, or technician | At this visit, we ask how the patient feels, check visual acuity and pressure, and review the drop instructions with the patient. The patient's vision may be excellent, somewhat blurry, or poor at this visit. We review activity restrictions with the patient and answer any questions. | postop 2 | 1-2 weeks after surgery | surgeon or optometrist | At this check the physician asks the patient about their vision and comfort, checks visual acuity, IOP, and performs an anterior segment examination. Unless there is concurrent pathology that restricts vision (eg ARMD), the patient's best-corrected vision should be reasonably good at this visit. If the patient is still phakic in one eye, it is important to review with the patient at this visit whether the patient still needs surgery in the other eye. Surgery may be cancelled if the patient is happy with their vision, and if there is no other indication for surgery. | second surgery? | 2-3 weeks after first surgery | surgeon | If surgery is indicated in the other eye, the patient undergoes surgery, with two postop visits as above. The optometrist may perform one or both postops according to the patient's wishes. | final visit | at last visit | surgeon or optometrist | At the the final visit in the process (usually the second visit after the second eye), the physician assesses the patient's satisfaction with their vision, checks visual acuity and IOP, examines their eyes for residual inflammation, and usually performs refractometry. If needed, the physician gives the patient a prescription for spectacles. The physician makes appropriate followup appointments. |
Some things to check after surgery include:
Below is a list of the usual drops our patients use for surgery. Sometimes their drops may differ from these, if the patient is allergic, or for financial or insurance reasons.
The patient receives a written schedule for their drops at their preoperative appointment. If they need a new one, you can print it from our website.
| Time | Medications |
|---|---|
| Starting 3 days before surgery | Prolensa: 1 drop in the surgical eye 1x/day |
| Starting after surgery | Prolensa: 1 drop in the surgical eye 1x/day Lotemax SM or prednisolone: 1 drop in the surgical eye 4x/day |
| Starting five days after surgery | Prolensa: 1 drop in the surgical eye 1x/day Lotemax SM or prednisolone: 1 drop in the surgical eye 2x/day |
| 30 days after surgery | Stop all drops |
This course of medications may be adjusted based on the clinical situation, of course. Please note that we are no longer using perioperative antibiotic drops, as Dr. Cranmer uses intracameral moxifloxacin at the time of surgery. If the patient is allergic to fluoroquinolones, we will normally give that patient Polytrim drops (start 3 days preop, stop 5 days postop).
Elevated IOP is common in the immediate postop period. Some ocular anti-hypertensives that are useful after surgery are:
Avoid use of carbonic anhydrase inhibitors in patients who are sulfa allergic, and be careful about using beta-blockers in patients with breathing problems (asthma, COPD and others), cardiac issues (bradycardia or others), or diabetes.
Please call the surgeon immediately for serious complications or for any questions regarding the post-operative care of the patient. Serious complications that you should call the surgeon for include:
If you are uncertain about how to best manage a complication, please call the surgeon.