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Should an ophthalmology practice employ optometrists?
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Better access for patients
At Virginia Eye Consultants, we employ optometrists in our practice, and they are essential members of the patient “care team.” Our optometrists go through a small mini-fellowship with each of the ophthalmology subspecialists when they start, which spans upward of a year, where they work closely alongside me and my patients to understand the nuances of anterior segment surgery, postoperative cataract management and corneal disease management.
It is helpful because the scope of what we do as ophthalmologists ranges from primary eye care to higher level acute and surgical care. As a specialist, I work at multiple offices throughout the week, so there are limitations to where a patient can go as well as limitations to my schedule. Having optometrists who are specifically trained through a residency for primary medical care and medical management work with my patients, particularly those who are more stable or who are routine postoperative patients, allows me to provide more complete medical care.
Our in-house optometrists serve as physician extenders and provide a different function from the optometrists who refer patients to our practice. We do not do refractive spectacles or contact lenses, which helps in the management of scope of practice with optometrists who refer patients to us vs. those who work in our practice.
Elizabeth Yeu, MD, is OSN Cornea/External Disease Section Editor. Disclosure: Yeu reports no relevant financial disclosures.
Depends on logistics, geography
There is no one-size-fits-all answer. The decision to employ an optometrist is a decision of logistics and geography. We should all want our patients to have excellent eye care, and part of that is having regular contact with a trusted doctor who creates a sense of felt safety for the patient.
Ophthalmologists and optometrists train differently and have significantly different skill sets. Our optometrist sees routine pediatric and adult patients for contact lens and low vision exams, as well as low-risk medical diagnoses. We shift complex eye disease to the ophthalmologists, using all providers in a manner that maximizes their utility while meeting the patient need of consistent care. We provide a full spectrum of comprehensive eye care, and patients in our community appreciate the accessibility and expertise located in-house. Patients who need routine vision care often have family members or friends who need more complex eye care from an ophthalmologist or vice versa. This enables us to receive diverse referrals from primary care physicians, other eye care providers and patients without being dependent on one referral base.
We also have optometric students rotate through our practice, where they see through the MD lens. Without exposure to the myriad technical complexities in surgical eye care, it can be oversimplified from the OD view. You don’t know what you don’t know, and in this vein, it is beneficial to have cross-exposure.
Yet, practices must also be cognizant of their environment. An urban subspecialty-only practice may not have a need for an optometrist. In rural areas, ophthalmologists may be less available than optometrists. To maximize resource allocation in this setting, it may be beneficial for practices to focus on providing only medical/surgical eye care without employed optometrists and to work within an optometric referral system, maintaining the referral base by not having in-house competition.
At the end of the day, we should all be in this to provide high-quality, safe eye care. This can be delivered over a spectrum of models based on the community and available resources. When we focus on what we have been trained to do well, on what gives both us and the patient joy through the gift of sight, then we are on the right track.
Douglas M. Wisner, MD, is an attending surgeon and co-director of the Microsurgical Training Program at Wills Eye Hospital. Disclosure: Wisner reports no relevant financial disclosures.