Dr. Chris Wolfe: [00:00:00] Hello, and welcome to the crystal podcast on I code media today, I’m having a great conversation with Dr. Nate light Heiser, who is one of my colleagues and friends and confidants. And in some ways he’s, he’s a mentor to me. Uh, I hope that someday I can mentor him as well. And in general, we we’re. The conversation that we’re about to have is related to the practice of optometry, the profession of optometry, how we can help our patients scope of practice.

Uh, I know it’s gonna be a fun one for you. Please enjoy it as always be sure to subscribe to the podcast, write a review, share it with your friends and support those who support us. So today I wanna talk about the, my day multifocal for just a second. It has been a really great thing in our practice for our patients who are presbyopes of all areas, but you know, those tricky presbyopes [00:01:00] are always the ones that are kind of emerging, where they don’t want to give up any of their far away vision.

But they’re having some struggles up close. And so what, uh, the mighty multifocal has been able to do for us is to allow those patients to transition into a multifocal more easily. And then as we have those patients progress into other levels where they need more ad powers, it’s been a nice, smooth transition.

So the ultimate hurdle that we’ve seen in our practice before the, my day multifocal. We’d have patients who would resist any transition to a multifocal lens because of that distance blur. We just haven’t seen that. So if you haven’t started using mighta multifocal in your practice, I would encourage you to start check it out.

Uh, contact, reach out to your Cooper reps for those trial lenses. Uh, and commit to might a multifocal for your patients. I think they’re gonna like it. If you haven’t checked out Macia health yet for your patients in category one through category four, I think there’s a lot of evidence that you should be considering.

The first is if we just look at a reds two [00:02:00] and what they, they talk about, Mac health is a, so for patients in category three and category four, um, AMD Mac health is a great option for them that follows that entire, um, that entire protocol. And it also add. Meso Z is anthing to the mix, which if you look at some of the evidence, I believe shows me that it’s going to thicken the macular pigment better than without meso Zanine.

It also uses the, a correct, a reds two dose of zinc, uh, at 25 milligrams. And so you don’t have to worry so much about the potential side effects of zinc. The other thing to, to think about, and it’s beyond the scope of this, although you’ve probably heard me talk on other podcasts, is that in patients in category one and two, there may be some additional benefit.

Uh, to supplementing them with something that may be a little bit less than the, a reds two. So you don’t have to add as much to it. And that’s where I use the maca health LMC three. And so I think if you haven’t done this yet, I’d consider Maia health in your practice and for your patients. And it’s been great for my patients.

And, um, and we really feel like we [00:03:00] can have the ability to, uh, help those patients in all categories of macular degeneration. So Nate, I wanted to have you on today because, um, you know, I think you’re the real deal. I think there’s a lot of people that speak all across the country and, and maybe this doesn’t mean anything, but, uh, but sometimes you, you can feel that a guy or a gal.

They’re sort of faking it, you know, they’ve got, they’ve got, um, they’ve got a lot of, of accolades in the sense of companies like to have them out on different platforms, but they don’t have a lot of street cred. And so one of the reasons that I really, uh, wanted to kind of highlight you today is because I know you’ve got the street cred and, and you also get the accolades from companies that want your opinion about things and, and your opinion really matters to them.

And it matters to me and. Um, one of the things that I have recently been able to see with Nate and, and how I know he’s the real deal is that, uh, he was, he came to well, virtually came to Nebraska to kind of help [00:04:00] support some of the things we’re doing legislatively. And, um, and that really gets to allow you to see who kind of understands their stuff and who really understands, um, uh, the nuances of what we’re doing as a profession and how we help patients.

And also because there’s no other financial reward in that, you know, uh, who’s not a faker when it comes to, to kind of caring about the profession. So, Nate, thanks for doing that, man. And thanks for doing this. Appreciate 

Dr. Nate Lighthizer: the introduction, Chris, you know, I’ve looked up to you for a long time. You know, I, I got to NSU OCO in 2009, so our paths, you know, missed each other by a year.

Um, or so, and you know, I’ve Chris Wolf is, you know, is a name that’s synonymous with NSU O C. So you are. You you’ve laid a strong foundation for, you know, for yourself and, and obviously are a, a tremendous leader for Nebraska, the AOA. And, uh, [00:05:00] I look up to you a lot as well. So I appreciate the invite and it was my pleasure to, you know, to at least try to assist in Nebraska, as you guys are going through the process of scope expansion.

That’s. Um, it’s been a, a busy, a busy last decade in terms of scope expansion. And I think that’s a very good thing for patient care. So, uh, which I’m sure we’ll discuss in the, in the next, uh, upcoming minutes. You know, so 

Dr. Chris Wolfe: I, I think that’s, that’s a good introduction to, because you know, you focus on patient care and, um, I mean, you couldn’t, you couldn’t look at the 10 states we have now that have pretty significant authority to, to help patients.

And, and it wouldn’t be without the efforts of NSU and, uh, and specifically you and rich Castillo. And there’s a number of others, Joe. Shetler. Jeff Miller and I mean, we can go down. I’m sure I’m missing people. Michelle Welch, um, that over the years have really had a big impact. Um, what’s the most challenging part when you’re educating [00:06:00] optometrists to take these next steps, in your opinion.

Forget all the politics. What’s the most challenging part for the guy. That’s that hasn’t done this in a long time to, to feel comfortable and confident, confident, and competent to provide some advanced procedures over time. 

Dr. Nate Lighthizer: You know, I think one of the biggest challenges that we see is, is just simple busyness and change.

We’re all very busy. We kind of have, we’re entrenched into what we do on a day in and day out basis. So week in and week out basis, whether that’s private practice for many doctors, whether it’s an OD MD center, whatever it is, but, you know, adding something new is like, man, do I have the B. To fit that in to learn a new scale.

How do I let’s say I can learn it, but then how do I incorporate it? How do I get the technology acquisition costs? Do I have the proper patient base? So just the, the busyness, the, the change, and, you know, I’m, I’m doing pretty well right now. Do I really need to [00:07:00] add something in? I, I think that is a challenge, um, that we are overcoming.

Um, and I think it’s getting easier and easier with technology, you know, it’s interesting. I know, you know, who Randall Thomas is, you know, Melton and Thomas they’re, you know, just pioneers in terms of optometric education over the past few decades. And Randall emailed me this morning on, you know, as technology evolves, there’s something called direct SLT.

That’s being studied right now. That’s trans scleral SLT. You know, it typically takes me a minute and a half, two minutes, three minutes, sometimes four minutes. Depending on the patient to do an SLT. And there is a new form of SLT being studied. That’s not released yet. That takes 2.3 seconds and I’ve shown doctors pictures of this, and it’s just their eyes open going.

Ooh. You know, maybe I wouldn’t do SLT in the current form, but as technology evolves, um, I think that’s gonna make ’em even more amenable to that challenge that we are talking about. So it’s just incorporating something new into our busy lives. [00:08:00] Our busy practices, that’s certainly 

one 

Dr. Chris Wolfe: C. Yeah, I think, I mean, I think that’s a, it’s interesting that you make that point cuz you and I haven’t talked specifically about that, uh, ever, but I think that is the biggest challenge as well.

You know, even, even again, break it down to dry eye or anterior segment disease management, when you’re gonna use an amniotic membrane or how you’re gonna do plugs or how you’re gonna do a scleral lens or how you’re gonna do IPL or, you know, You know, even glaucoma management, you know, the, the thing that I’m always really struck by is, and, and I don’t know.

I mean, maybe it’s different. Maybe I had great mentors in school. Um, and I think after school, I had a lot of great mentors as well, but how do you take a patient that comes in with comprehensive, like a managed vision care plan that that’s in their mind, what they think they need. And then how do you detect.

The diseases that you need to detect. And then how do you manage that in a way in a schedule that comports with our clinical practice guidelines, uh, and also allows you to have value for the services you’re providing that, that [00:09:00] actually. For, for guys, like you has become very simple in your mind of, of maybe.

I mean maybe, maybe not, but, but for a very small portion of people, that’s that they get that they understand this cycle of, okay. I can, I can bring patients in. And if our clinical practice guidelines say for moderate glaucoma, you wanna run a field every, uh, every six months on average. Um, depending if things are stable, once they’re stable, maybe you could go every year, but, but the bottom line is you could look at our clinical practice guidelines and say, we’re gonna do this, this, this, this, and this.

In the course of a year, how do I space that out in a way that makes sense for my practice? So it doesn’t bog it down. And then when things come back abnormal, we can order those. Is it okay to order another field? How many fields am I gonna be audited if I order too many fields in a year? I mean, these are the things that go through people’s minds and it’s almost stifling, you know, they they’re.

They’re worried that these things are, are gonna be insurmountable. And I see that as well from my perspective. And I think [00:10:00] that’s the biggest challenge when integrating any new technology. Um, and, and, um, yeah, so, so, uh, that’s an interesting thing that, that of all those things, it’s not the technical aspects of the surgical procedures that you’re training.

Dr. Nate Lighthizer: It is not, I mean, you know, you and I, you know, very well know and, and many doctors out there know, you know, when you’re just talking about the technical aspect of, let’s say SLT, And it’s one of the most enjoyable things, um, that I see as we go through our laser course and our surgery courses is kind of the light bulb go on.

And doctors, they always say demystify is the biggest word that, that that’s, that was told to me and rich Castillo, as, as we go through that course going, you know, I came into this course not knowing if I could. Or should be able to do this and it just, the light bulb goes on going, oh, I have most of the skills already to do an SLT or a capsulotomy or a lesion removal, whatever it is.

So it’s not the technical aspect. Um, [00:11:00] optometry is very well equipped and very well trained to do these procedures that we are discussing. But anytime we step into an element of the unknown. Don’t we all kind of hesitate a little bit. Most of us do myself included. It’s just, boy, I don’t know. You know, I don’t know about this.

Um, it’s gonna take energy. It’s gonna take time. Do I have that energy and time? I’m busy. I’m doing great. The way things are right now, let’s just keep it like it is, you know, so that’s one of the challenges that we’ve discussed. 

Dr. Chris Wolfe: So convince me. So let’s, let’s say that I’m a doc out there thinking we’ll just talk about SLT, cuz that’s what we’re dealing with in, in Nebraska and it’s kind of front of mind.

Yep. But there’s also a lot of changes that I’m not convinced that most general ODS or MDs for that matter, um, have really thought through and embraced. Actually, I can tell you for sure that most O MDs have not really thought through, uh, the place, the application of SLT and when I was being trained, you know, SLT was a close second.

Uh, [00:12:00] I suspect that’s how it was when, when you were doing your residency at NSU and. And there’s sort of been this flip. And so I want you to talk a little bit about the, the evidence for that, that sort of shift over the last 15 years and how we get to this point of, of having SLT as kind of a primary treatment or, um, you know, very close secondary, you know, how you, how you want to go back one and, and two, so kinda lead us up to the light study in your mind, and then kind of, kind of knock the light study outta the park and what that says to you clinically.

Dr. Nate Lighthizer: Yep. Yeah. So, you know, I did my residency in 2009, 2010 at NSU, and we were doing 180 degree SLTs at the time. And we were, I mean, why did we do 180 degree SLTs because alt was done 180 degrees. Um, and because that form of laser trabecularplasty, that’s how it was done. When SLT came about, it was like, well, we probably should start doing it that way as well.

Um, and we were typically reserving it until [00:13:00] they were on drop number one, drop number two, drop number three, you know, drops were still fairly solidly entrenched as the first option. And then laser trabecularplasty was an a, a close second, as you said now again, why was it that way in the late 2000.

Because alt was clearly a second line option because there was more tissue destruction. It was a photo coagulative laser destroying tissue. So you didn’t wanna destroy tissue early in the course of the disease, if at all possible. And that’s why alt tended to be a second line therapy. And when SLT came about, that’s kind of where it started.

And then you had the SLT med study that came out in 2012. And that was by Dr. Jake hats outta Will’s eye. We’re all very, I’m gonna pause you 

Dr. Chris Wolfe: just, I’m gonna pause you, uh, because you’re starting to remind me, um, there’s, there’s a, a guy I listened to his name’s, uh, Peter McCullough and he’s, uh, he’s in Texas and he is, uh, cardiologist and he can cite every single paper he’s ever written.

And who wrote that paper? So you [00:14:00] just gave me a, you, you cited who wrote that paper? So, sorry, I gotta mention. That’s not a plug one way or the other phrase podcast, but, uh, but you reminded me of, I can’t cite, uh, authors that well, so keep going and keep citing them. That’s that’s wonderful. 

Dr. Nate Lighthizer: Yeah. So, you know, the SLT med study and we’re all familiar with Will’s eye.

And it was really in my mind, the first big study there’d been some internationally, but the first big study coming outta the United States that directly compared to SLT to prostaglandins for first line therapy, we all know prostaglandins have been solidly entrenched as first line therapy. And what was interesting is it did this at a hundred shots.

For the SLT. So we did 360 degrees went all the way around and it really was the study that changed our protocol from doing half the eye, 180 degrees to going all the way around to 360 degrees for most types of glaucoma, not all types of glaucoma. If they’ve got significant pigment, we’ll still do less [00:15:00] degrees, 180 or maybe even less.

But it was the study that really convinced us that we need to start doing 360 degrees. Again, in late 2012, 2013, their conclusion of the SLT med study in September of 2012 was SLT was equivalent to prostaglandins in terms of I O P reduction and SLT can be used as a safe and effective initial therapy in open angle, glaucoma and ocular hypertension.

Again, that was a decade ago, hard to believe that’s been 10 years ago. So it just slowly evolved. You know, it takes time to change mentality. Somebody once told me it ch it takes like a generat. To change a, a way of thinking. And our way of thinking has been drops. First drops, second drops, third. Then we consider laser and then we consider surgery and really over the last decade with SLT, with minimally invasive glaucoma surgery MIGS, as you’re very well familiar with it’s this mindset of interventional glaucoma.

We don’t need to burden the patient with drop one, drop two, drop three. You know, [00:16:00] Chris, I bet if it was your eyes, if it was my eyes, absolutely time, I would wanna LT first line. Yeah. I say 

Dr. Chris Wolfe: it all the time. And I even tell my patients and, and make, I, I, I tell my patients that, you know, look, we have these two options.

This is, um, this is how I would want it managed. And this is, you know, and you can pick which one you want to start with. If you have a strong preference and the very first question and you know exactly what I’m gonna say, the very first question is mm-hmm well, can you do. What would you do? Which I can’t and in, and when I say no, I’m gonna send you over over to, to Dr.

So-and-so and, and they take great care of you. Um, I think I’ll just start with the drops and see how that goes. However, when I had that exact same conversation in Oklahoma, um, when we said, yes, we can do it in this clinic, they would, they would opt more likely than not to opt for SLT first or very close second than adding a second medication.

Uh, so anyway, sorry, keep going. But I, but I, I see that all the time. No, I. 

Dr. Nate Lighthizer: All the time and, you know, they ask, you know, okay, we have two great first. [00:17:00] It’s exactly how I phrase it to patients. We have got two great first line options. We’ve got eyedrops that work well, we’ve got this laser therapy called an SLT, works great, very gentle to the tissue and, and they, they often ask, well, doc, what would you do?

You know, they don’t always ask, but they often ask what if it was your eye doc? What would you do? And I tell ’em, I would have an SLT and then it’s pretty easy for me to then walk him across the hall in Oklahoma and do it myself. You know, I was lecturing somewhere a number of years ago and I think it was in, I can’t remember somewhere on the east coast and a doctor raised his hand and he said, Nate, you know, I hear all what you’re saying.

This is great. It’s pretty easy for you to recommend SLT. When you can walk ’em across the hall, I’m in private practice. Can’t do the procedure in my state. It’s not allowed. I’ve gotta refer them. They may not get the procedure I ask the patient may not come back to me because of that. There are certainly issues that they have to deal with.

And he was absolutely correct. So, um, you know, those are issues that docs in other states, uh, that can perform SLT have to deal with. And that’s why I told you [00:18:00] in our hearing a couple weeks ago, I believe it would be a huge public health win. If optometrists, uh, had the scope of practice to allow SLT, it would decrease the burden on many patients anyway.

Yeah, absolutely. You know, fast forwarding after the. Fast forwarding after the SLT med study, you know, there was just a slow inching forward 2012 to 15, 16, 17, and then you get to the light study released in March of 2019 by Gus Goard as the lead author. And it really was a shove forward going their ultimate conclusion is SLT.

Not, could be. Should be offered as first line therapy, supporting a change in clinical practice. I mean, that is some big words. There should be offered, supporting a change in clinical practice, basically telling 

Dr. Chris Wolfe: clinicians before you get to that we haven’t seen in the last three years, anybody really 

Dr. Nate Lighthizer: dispute that.

I, I haven’t seen anybody dispute it. I mean, it’s, it has basically. Yep. Uh, because, because again, when you ask doctors, what would you do [00:19:00] for your eyes? Most doctors, the ones that know what’s going on and understand all the options. I’ve asked that question hundreds of times, Chris, and I will tell you, it’s always between 85 and 95% of eye doctors.

Said if it was my eye first line I’d want an SLG. You know, you know, one 

Dr. Chris Wolfe: of the things it really I’m seeing is, you know, I think we’ve been in practice now long enough, and I have enough patients that have aged and with me and have been on glaucoma treatments for long enough. And I’ll tell you while I, while I, I still use prostaglandins as a first line treatment when patients don’t want to have an SLT and they’re super effective.

I mean, I’m seeing more and more patients, um, With kind of just these chronic red eyes, worst dryness, worst mg D. And when we can get them off, like when I can finally convince a patient to, to use an, you know, to get an SLT and they’ve been on even just three or four years of a, of a prostaglandin, and that’s not say they’re bad medications, just that, um, They come back.

I had one just the other day, come back. [00:20:00] Finally convinced her to get an SLT. We’ve been able to pull that prostaglandin away and I haven’t seen her eyes look this good, just white and quiet. And I mean, in, in a, in a year, probably a year, I haven’t seen her and symptoms under control. I mean, Oculus surface looks wonderful.

It’s just something that’s kind of ringing true. I’m seeing more and more of that over time. And it that’s even just more compelling to me to, to continue to make the case for, you know, for those patients early 

Dr. Nate Lighthizer: on. Yeah. I mean, how many of our patients battle compliance, battle cost issues. We all know we deal with that and that’s not even mentioning what you just said of how many of your glaucoma patients also have ocular surface disease have MGD and our glaucoma medications.

Our eyedrops are helping. To lower the pressure they’re helping the glaucoma, but are they exacerbating or worsening, you know, other conditions? I think that happens quite a bit. So, uh, you know, and then finishing with the, the light study, you know, from 2019, it really helped to [00:21:00] answer the criticisms. Of the SLT med study, which is that the SLT med study in 2012, didn’t have huge end numbers.

And it was only a one year study, uh, versus the, the light study had huge end numbers. There was 320 plus patients that went down the SLT arm. And that went down the prostaglandin arm. So huge end numbers in each arm. And it was a three year study multicenter. And that’s why the conclusions were very, very strong, uh, when it came to the light study and again, 2019, and it really was just a shove forward going, we now have two first line options.

We’ve got drops. We’ve got laser. I’m not saying one is better than the other, but that’s how I present it to patients. We’ve got two. First lines options. And I actually quote a stat from the light study that, and I tell patients this, when we talk about the pros and cons of eyedrops and the pros and cons of SLT, um, I tell them that there is a 75 to 80% [00:22:00] chance.

If we choose the SLT that we can keep you drop free for the next three years. So 75 to 80% chance, the downside with this laser is it’s not going to last forever. We’re probably gonna get somewhere between two years and six years, somewhere in there. Sometimes it’s a little shorter. Sometimes it can be longer the bulk of the time it’s right in the middle.

Um, so sometimes it, it can be shorter. Sometimes it be longer, but two to six years, the downside is it doesn’t last forever, but here’s the really good news. You can do it again. And we do it here right in the office. It just takes a matter of minutes. Um, so that’s what I tell patients. You had a 75 to 80% chance to keep you drop free for the next three years.

We likely will need to do this again. Um, but, um, that’s okay. We can do it again. It’s very repeatable. Yeah. 

Dr. Chris Wolfe: I think that’s a, I mean, it’s, it’s again, it’s, it’s so compelling to me. It’s so compelling to me that I actually. At this point in time, and that’s why, you know, that’s kind of what we’re focused on in Nebraska.

But at this point in time, [00:23:00] I have my opinions. So I’ve already kind of disclosed those. If you think about laser procedures, capsulotomies peripheral, autotomies, you know, the common ones that we would think about. Selective laser trabecularplasty in your mind, across the country. Which one do you think people automatically think about first?

When they think about laser procedures from an OD perspective of what they want to change, but which, and which one? So that’s the first question. The second question is which one do you think is most impactful to our patients? 

Dr. Nate Lighthizer: Yeah. So this is a clear answer to me. I think doctors think the first one is gonna be Ja caps.

I think that’s the, I don’t know flashy is the right word, you know of that, but it’s, it’s probably the number one. It’s not probably, it is the most commonly performed laser procedure by optometrists in the 10 states that have lasers. It’s number one. And it’s what doctors think about because they remember that patient that.

PCO with [00:24:00] decreased vision. Um, and you do the procedure and the patient’s thrilled and it’s, it’s a very, very rewarding procedure to do. An optometry is well qualified. So I think that’s the one that pops to the mind. First. I feel very strongly that the one that would have the greatest impact is SLT because of everything that we have talked about.

I mean, and, and I still see, and I believe that SLT is underutilized by optometry in the states that have it in Oklahoma include. There’s a lot of doctors doing ya caps and they’re not doing SLTs. And it’s again, I think it goes back to that takes some time to have a change of mindset we’ve been trained for decades on drops, drops, drops for glaucoma.

So I think it’s under utilized. So YAG cap is the one we comes to the mind. The first. But SLT to me would have the greatest impact. 

Dr. Chris Wolfe: You know, I’m gonna, I’m gonna round this out. The, you know, with our last hearing that you were participating in, there was a woman that they brought out and you can never know me.

I, I made this comment during the [00:25:00] hearing is that it’s very hard to know exactly what happens in an exam room and exactly what a patient prefers, et cetera. but they, but they brought out in her testimony was that she had been, uh, placed on four medications. Uh, and she was seeing a glaucoma specialist who happened to be an optometrist, but she didn’t know that they were an optometrist.

She thought they were, for some reason they, she thought they were a, her claim was. That she thought they were a, a medical doctor, again, the idea. So, and then she was rushed. She saw a glaucoma specialist ophthalmologist and she was rushed into having what sounded like trabecularplasty. And you know, when you think about the legislature and you think about, or in our case, a, a review committee who, you know, um, Is not in the legislature, uh, is consists of a lot of lay lay people.

The nuances of glaucoma management are really challenging to articulate. I [00:26:00] mean, the fact that you can stick well, first of all, the fact that optometrists can absolutely be glaucoma specialists and that, and the, this idea. Because they were an optometrist. They weren’t a glaucoma specialist, I mean, is just baffling to me.

But, but how do you articulate that? Well, to, to a lay person, they, they don’t have any idea. And, and the nuances of articulating that are, are challenging. Um, and mm-hmm and the fact that the idea that most general ophthalmologists don’t really like glaucoma that much, they, they wanna do cataract surgery.

They want do LASIK, you know, they’ll, they’ll treat glaucoma with some medications, just like most, you know, most medical minded optometrists. And they’ll do maybe some SLTs here and there, or they’ll refer, you know, out for tr traps. But most of ’em aren’t doing traps, you know, most general ophthalmologists aren’t doing traps unless they’re in a small community.

Dr. Nate Lighthizer: Um, and I think they underutilized SLT, which like optometry does. I think glaucoma specialists. [00:27:00] And maybe they underutilize it, but general ophthalmologist. I agree with what you said, cataract surgery. LASIK they’ll treat glaucoma, but if they want surgical glaucoma, they’re usually spending to sending to a ophthalmology, uh, glaucoma 

Dr. Chris Wolfe: train specialist.

And so that, that patient, you know, what’s really hard is that even if that patient had seen another glaucoma specialist, ophthalmology, glaucoma special. They might not have rushed her into surgery, you know, rushed her in for a trabecularplasty because they couldn’t wait for her pressure to be lower from an SLT.

And I would assume that all of that’s that might be normal. They, they might have rushed her into cataract surgery with a MIGS. Uh, would that make the, the glaucoma surgeon that rushed her in for a tra wrong? Would that make him wrong? Um, there’s so, so the, the nuances of even just glaucoma, I mean, you know, this idea that you can stick, uh, you know, a hundred glaucoma specialists, optometrists send ophthalmologists in a room and present ’em one case and say, [00:28:00] what do you do?

And there’s gonna be optometrists ophthalmologists on both sides. And some of ’em will say this and some of ’em will say that. And, and that’s the, that’s the challenge with, with glaucoma? It’s the fun. And it’s also the patient, you know, the part that every single one of them could be entirely wrong in that specific patient scenario, because they didn’t actually sit down and, and have a conversation with the patient and know what their wants and desires and, and needs are.

And that refines how you, how you approach that patient. And so it’s just a really hard, a hard thing to articulate. What are your thoughts about that? And, and how could we have done that better for, for. The presentation that was made a, a few weeks back. Any insights 

Dr. Nate Lighthizer: glaucoma is, is such a, a gray area as I call it the nuances as you called it, you know, black and white.

There’s a little bit of black over here, and a little bit of white over here, and a tremendous amount of gray. In the middle, just like you said, you know, you, you can’t, you, you [00:29:00] present a glaucoma case to five optometrists and five ophthalmologists and they, they give their answers. So the other ones can hear, and there’s gonna be so many different ways that you can manage glaucoma and none are more right or wrong than the other one.

Um, it’s just different now. There’s always a, you know, kind of a pedestal that ophthalmology is put here in optometry. And it’s unfortunate for optometry because we will always be questioned and we will be always second guessed when, um, I do something this way. And an ophthalmologist does it a different way, just because of the nature of, you know, kind of the, the tiers or silos were put in, we will always be questioned as an optometrist.

So I think it’s unfortunate in these hearings going, okay, here’s one particular case that may or may not have been managed differently may or may not have, have not went the way we want. Um, but that’s, everybody makes decisions in an exam room based on the information that you’re given. And we all do things a little bit differently and those [00:30:00] nuance.

To me really should prevent us from questioning, um, another doctor in what this management they did, because there’s just so many different roads that you can go down and so many different ways that glaucoma can be managed. 

Dr. Chris Wolfe: I think it leads to the idea of, you know, there are there’s bad care. And then there’s poor outcomes.

You know, you, when, when optometry in these hearings, when, when something goes bad or, or doesn’t go perfectly in an optometrist’s hands it’s bad care. That’s how ophthalmology wants to, to make it sound when it goes bad in an ophthalmologist’s hands, it’s just a poor outcome. It’s just to a foreseen complication.

And you know, we’re, that’s a, it’s a battle. We have to find things happen. Right, Chris, they just happen. Yeah. That. That’s right. But so here’s, here’s what I wanna do. I, I, I’m gonna, I’m gonna ask you online [00:31:00] so people can hear you say yes, but I wanna talk to you about a number of other things related to other surgical procedures and kind of your, your experience across the country.

But I wanna do that in pieces. So I’m gonna probably reach out to you again multiple times if you’d be open to it, because I think there’s this whole story that we can tell over time. That will be much more interesting. Then, if we tell it all at once, so I’m gonna ask you to come back and, um, you know, we’ll, we’ll have you back for other, other, uh, topics.

Would you be interested in that? 

Dr. Nate Lighthizer: Absolutely. Yes. That either the answer is yes. 

Dr. Chris Wolfe: Awesome. Awesome. Well, I’m gonna be respectful of your time, Dr. Nate light Heiser. You’re the man. Thanks for doing everything you do. Um, thanks for coming on. I appreciate it. Appreciate it, Chris. Very 

Dr. Nate Lighthizer: much. Uh, I appreciate the invite.

Always enjoyed chatting with you and I look forward to next time.[00:32:00] 

The case for slt 

the case for slt 

the case for slt

The case for slt 

the case for slt 

the case for slt