This article is more than 5 years old. Information may no longer be current.
BLOG: Optometry beyond the phoropter
Click Here to Manage Email Alerts
As fall slowly creeps into the Northeast, changes are in the wind. The air is cooler with the strong scent of leaves, pine and wood smoke. The days are shorter, but the skyline is a blaze of color.
This fall, there are also changes in the wind for the profession of optometry. At the coffee tables in the back of the room at continuing education meetings, there is a lot of buzz about online refractions and glasses as well as the addition of more optical stores owned by vision plans. On the bright side, other coffee circles were discussing the expanded scope of optometry in several progressive states and the plethora of new diagnostic instrumentation for medical eye care. There would be a good chance that the topic of the lecture of the day would be related to the expanded role of optometry in the care of patients with diabetes.
According to the Association of Regulatory Boards of Optometry’s Council on Optometric Practitioner Education, there are more than 80 active courses on diabetes in the systemic disease category. I have personally been attending some of these at various optometry meetings for the past several years. Each time I attend one, I learn a little more about the scope of the disease and pick up some tips that I can apply back in my office for the care of people with diabetes.
This month, I have been involved with three separate projects that expand the role of optometry in diabetes care. The first of these is related to new activities of the Pennsylvania Diabetic Eye Health Alliance which is sponsored by the Pennsylvania Optometric Association. Initially developed as a simple pledge to provide a dilated retina exam for patients with diabetes and send a report to the primary care physician, the program has now expanded to working with health plans to assure appropriate optometric care for its members.
The second program is a joint venture between the American Optometric Association and Johnson & Johnson’s program for transforming diabetes care. This program has also moved from a provider education program to a pilot program to expand the role of the optometrist in glucometry-based measurement of blood sugars. The optometrist and the patient work together, in concert with the primary care physician, to better manage the blood sugar as a more effective way to treat end organ diabetic changes. The pilot will study the clinical long-term diabetes outcomes for patients where optometry was included the systemic disease management.
The third project for this month is a new pilot from OcuHub, a web-based platform that bridges that data in the optometrist’s electronic health records with that of the primary care physician. This pilot program is also sponsored by a yet another health plan. The program involves the OcuHub care coordinator, who identifies patients with diabetes that have not eye care within the year. Clinical data is collected from the PCP, and the patient is electronically scheduled in the office of a participating optometrist. The optometrist provides the required eye examination; collects vital signs; reviews and/or orders blood sugar, HA1c and urine tests; provides required follow-up with education and counseling; and transfers all data back to the PCP via the web-based OcuHub care coordinator. The OcuHub data analytics team can then tabulate the clinical outcomes of patients with diabetes who are managed in a collaborative model that electronically pairs optometry with primary care medicine.
The optometrists who participate in these programs are progressive and willing to think beyond the phoropter. Time must be spent in continuing education to learn current concepts in diabetes management and the host of new systemic medication options. The patient care required for these programs is medically based and often nonrefractive. These programs may be bringing new patients to the optometry practice that have good vision and do not wear or need glasses or contact lenses.
Diabetic care, glaucoma care and dry eye care are important elements of optometric care. They are not, however, going to replace our core vision care services. Our place on the primary care team is related to our unique skills in improving and maximizing vision. In executing our primary mission of vision care, we need to provide primary medical eye care and primary medical health care in a collaborative, clinically effective and cost efficient care delivery model.
It is clear that health plans are interested in this collaborative model of diabetes care. It is also clear that some optometrists are willing to rise to the challenge. The traditional optical goods-based practice model does not drive these optometrists. It is these optometrists that will move the profession into the future.