Panel: primary care optometrists provide most needed vision care

Issue: December 2003

Comprehensive management

Douglas W. Hopkins, OD, FAAO: Primary care optometry is the comprehensive management of a patient’s visual function, ocular health and any related health care. The primary care optometrist, therefore, assumes ongoing responsibility for the total visual, ocular and related care of the patient.

This will naturally involve a breadth of knowledge over every subject that would affect the visual and ocular systems. It demands a base of knowledge in many areas, including binocular vision, contact lenses, refractive surgery, pediatrics, refractive care and ophthalmic lenses, developmental vision, low vision, ocular disease management including glaucoma, ocular surgery comanagement, geriatrics and occupational vision. Any and all of these areas may be equally important in primary care.

This does not mean that the primary care optometrist must be an expert in each of these areas, but it does mean that the doctor must understand them all well enough to manage the case accordingly. This management will vary as indicated by the patient’s condition or as required by the practitioner’s expertise and interests. Education of the patient and potentially the patient’s family is also a critical element of primary care.

The doctor also must be able to coordinate and manage the patient’s care with a wide range of other specialties, including ophthalmology (both secondary and tertiary care), family practitioners, other medical specialists, nurses, other optometrists, teachers, social workers and family members.

Primary care involves the integration of many areas of knowledge and expertise. It is the ability to manage, integrate and oversee all of these areas for the benefit of the patient that is the essence of primary care.

Douglas W. Hopkins, OD, FAAO, is chair of the American Academy of Optometry’s Primary Care Section Executive Committee. He can be reached at 4040 E 82nd St., Indianapolis, IN 46250-4209; (317) 595-8855; fax: (317) 595-8866; e-mail: dhopkins@insightbb.com.

Fundamental care

Kerry L. Beebe, OD, FAAO: Primary care is the chief or fundamental care that a patient receives. A primary care provider is the provider who is foremost in the patient’s mind from whom to seek initial and ongoing diagnosis and treatment services. It is the provider who is trusted and called upon to provide or coordinate basic health care services to a patient and his or her family. In eye care, that provider is the optometrist.

By definition, optometrists are independent, primary health care providers who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions. Optometrists prescribe and provide eyeglasses, contact lenses, low vision aids and vision therapy. They prescribe medications to treat eye diseases and perform certain surgical procedures. Optometrists also conduct testing to determine the patient’s ability to focus and coordinate the eye, judge depth perception and see colors accurately.

Primary eye care services are provided to patients of all ages, from infants to the geriatric population. Services may be delivered in the clinic, hospital, nursingfacility, home or wherever eye and vision care is needed. Primary care providers need to be accessible to patients both in location and available hours.

Primary eye care involves both knowledge about the patient’s general health status and the entire eye and visual system. It involves coordinating care for specialty services and being the patient’s trusted resource and advocate regarding eye and vision care.

The profession of optometry provides primary eye care services.

Kerry L. Beebe, OD, FAAO, is chair of the American Optometric Association’s Clinical Care Group and a private practitioner. He can be reached at Brainerd Eyecare Center, 506 Laurel, Box 803, Brainerd, MN 56401; (218) 829-0946; fax: (218) 829-1279; e-mail: klbeebe@brainerd.net.

Wide range of modalities

George W. Comer, OD, MBA: Primary care optometry is the examination, diagnosis, treatment and management of diseases and disorders of the visual system, the eye and associated structures including systemic disorders that may manifest in these areas. The disorders may range from refractive conditions such as myopia, presbyopia, hyperopia and astigmatism; to functional conditions such as amblyopia and strabismus; to the enhancement of remaining vision function via low vision rehabilitation; to ocular disorders such as cataracts, glaucoma and macular degeneration; to disorders involving the visual pathways, such as stroke and intracranial masses.

Some of these may be systemic disorders that manifest in the eye, visual system and associated structures. Therefore, optometrists are involved in screening for these and their manifestations in the eye or visual system. These disorders include systemic hypertension and diabetes. Primary care optometry is often the entry point of patients to the health care system. Primary care optometry encompasses a wide range of management modalities including eyeglasses, contact lenses, vision therapy, low vision rehabilitation and medications.

George W. Comer, OD, MBA, is chief of Primary Eye Care at the Eye Care Center, Southern California College of Optometry. He can be reached at SCCO, 2575 Yorba Linda Blvd., Fullerton, CA 92831; fax: (714) 992-7878; e-mail: gcomer@scco.edu.

Point of entry

Kevin L. Alexander, OD, PhD: I have always defined primary eye care as “taking care of most eye problems, of most patients, most of the time.”

Following is an expanded version from my textbook The Lippincott Manual of Primary Eye Care, page 2: In summary, the primary eye care optometrist serves as the best point of entry into the health delivery system for eye and vision problems and is able to efficiently treat most of his or her patients most of the time in a highly cost-effective manner.

Kevin L. Alexander, OD, PhD, is dean of the Michigan College of Optometry, Ferris State University. He can be reached at 1310 Cramer Circle, PEN 405, Big Rapids, MI 49307; (231) 591-3706; fax: (231) 591-2394; e-mail: alexandk@ferris.edu.