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BLOG: Beyond the phoropter – Reprise
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In my original blog on this theme, I discussed the expanded role of optometry in the management of patients with diabetes. For any optometrist who is practicing in the “medical model,” this is an urgent public health need and a large opportunity to expand your practice.
Today I want to discuss an opportunity for the more specialized optometrist who is practicing in a low vision or vision therapy setting.
Over the past few years, I have become keenly interested in the role of optometry in the management of patients suffering from acquired brain injury. I became interested in this aspect of our profession while serving on the Accreditation Council for Optometric Education. I had an opportunity to chair a site visit for an optometric residency that provided experience and training in this growing area of the profession. I was impressed and amazed with both the program and the care that they provided to patients with these unique vision problems.
I began a quest to gain the knowledge and experience I would need to expand our low vision practice into this new area of optometric care. I had a strong background in low vision and primary care but read books and literature on neuro anatomy, functional neurology, vision therapy, rehabilitation and eye movement disorders. I spent some time with optometric practitioners who provided this aspect of optometric care on both the East and West Coast. I then had a unique opportunity to spend 18 months observing, learning and ultimately providing clinical care at the Magee Rehabilitation Hospital in a joint venture with Salus University.
With this new training, I expanded our low vision practice at the Wills Eye Hospital to offer optometric services for patients who had vision problems related to acquired brain injury. As with diabetes care, I once again found a great public health need for this type of optometric service.
The Wills experience led me to find a whole new venue of networking opportunities with physiatrists, neurologists, sports medicine physicians, physiologists, physical therapists, occupational therapists and other rehabilitation professional. All of these professionals are dedicated to helping patients recover from traumatic events and neurological disorders. All were more than welcoming to optometric care for the vision-related issues of these neurological problems.
This fall, I started to provide optometric services at the Jefferson Comprehensive Concussion Center at the Philadelphia Navy Yard. Ironically, I started my career as an optometry extern at the Philadelphia Navy Regional Medical Center on the same Navy base. The U.S. Navy is long gone, as is the hospital, but many of the decommissioned ships remain, and the base has been re-purposed for business and health care.
Although we have an eye room and a vision therapy room in the suite, I provide much of my clinical care in a standard physician treatment room. These rooms have no phoropter, no slit lamp and no chair/stand. You see, much of my optometry work is actual “doctoring.” When I finish with my patient, the next phase of my new role is “toe-to-toe” communication and collaboration with the other physicians, counselors and therapists who will also be seeing my patient. Indeed, this is optometry beyond the phoropter.
Although it took some work to get to this place in my career, I can tell you that this type of optometry is exciting and exhilarating. Every day is a new challenge, a new learning experience and a new opportunity to share optometric expertise with other health professionals and work together to help our patients.
I must say that I envy the optometry students. What a great time to be training in this dynamic profession. There are so many new clinical pathways and opportunities. This generation will have the chance to harness a wealth of new technology, to benefit from expanded scope of practice and appreciate being designated as an essential primary health care profession as part of the ever-evolving aspects of health care reform.
A hit Broadway musical comedy from the 1960s was called How to Succeed in Business Without Really Trying. In this show has a classic warning line: “Don’t get stuck in the mail room.” I have a similar warning for young optometrists: “Don’t get stuck behind the phoropter!”