BLOG: The path forward for optometry

ByScott A. Edmonds, OD, FAAO

The profession of optometry is at a unique crossroad for its role in the health care system. Although much of this discussion will be related to American optometry, the direction that we take here will affect the role of our profession worldwide.

At the center of the debate on our future is the issue of continuing on our traditional path to emulate and eventually replace ophthalmology as the exclusive eye doctors of the health care system or to broaden our role in primary health care. This would mean a change in direction to become more involved with comprehensive wellness and diagnosis and management of chronic medical problems such as hypertension, diabetes and obesity.

Although the profession pays lip service to primary care, and all optometry students know how to use a blood pressure cuff and understand the hemoglobin A1c test, we spend much more time and energy on the diagnosis and management of diabetic retinopathy and retinal vascular complications. Yet we are the ones on the front lines for the prevention of the chronic medical problems that cause these debilitating eye and vision problems.

According to the Vision Council’s 2008 report on vision care in the workplace, many people visit their eye doctor more often than their physician. We are there when they get their first pair of glasses, their first contact lenses and their first bifocals and, oddly, there again when they are in the low vision clinic and have lost their sight from often preventable retinal disease. I addressed this issue when I wrote: “We gotta do a better job.”

So, what is our path forward? Before you consider this, I urge to read some important background information. One is a June 16, 2015, piece in Modern Healthcare by Andis Robeznieks. This piece is titled, “Optometrists eye bigger role in managing chronic conditions.” Note in particular, the number of health systems that are interested in a primary health care role for optometry.

Next, read a very important white paper published by United Healthcare in 2012: “Integrating eye care with disease management: It’s not just about diabetes anymore.” Keep in mind that, according to Fortune magazine, United is the largest health insurer in America with revenue of $130.5 billion and serving 85 million patients worldwide. Note one of the key quotes from this well written and well documented paper by Linda Chous, OD, and Kim K. Christopher, MBA: “Based on an analysis of prevalence, detectability and impact for numerous diseases, 23 chronic conditions, in addition to diabetes, were identified that can be impacted by an eye care practitioner’s identification and integration into care management.” I penned a thought-provoking piece along these lines in 2013, suggesting a new definition for the optometric physician.

So given you read your assignment, what should you now do with this revelation that optometry has a clear path forward? You should take this information to your state association president and your state executive director and request that we stop wasting state association resources and political action committee dollars chasing the ophthalmology practice model and strive for legislation to expand our scope in primary health care.

Next, talk you your friends involved in optometric education about a stronger program for primary health care and the comprehensive management of chronic medical problems. If your optometric educator friend starts to complain to you about all of the new optometry schools, gently remind them that there are not enough primary health care providers in America to meet the growing need, and if the schools move in that direction, we will need more young optometrists than ever before to meet the demand.

Now, I have been beat up by my colleagues in the past who have suggested that I want to convert our profession into primary care physicians. This is not my intent. While we certainly also need more physicians in primary care, young and seemingly healthy patients don’t visit physicians. They often, however, have a host of common vision problems and they do visit their optometrist. The vision issues are often easily resolved, especially with today’s technology, but the opportunity to collect vital signs, query social habits and review family history opens the door to health education and counseling that can make difference in the life of each patient. This is the role of the optometric physician; this is our role in a reformed health system; this is our path forward.

Reference:

Vision Council. Vision care: Focusing on the workplace benefit. http://www.thevisioncouncil.org/sites/default/files/members/Vision%20Coverage%20Report%20FINAL.pdf. Posted October 2008. Accessed August 11, 2015.