As many of you know, I have always been a big proponent of expanded optometric practice. I am proud of how our profession has evolved over the past 3 decades, and, as a provider, I am equally proud of how this has translated to improved, more comprehensive care for the patients we serve.
While these advances are primarily rooted in changes in our formal educational training programs and continuing educational efforts, they are also the result of technology advances. For sure, most of us cannot imagine managing our glaucoma or macular patients today without ocular coherence tomography. Nor can we conceive of providing vision shaping therapy without the benefit of corneal topography. In short, technology has enhanced the breadth of services we — as primary eye care providers — offer our patients.
Michael D. DePaolis
With today’s primary care optometrist providing an increasingly diverse range of patient services, the trend begs one question: At which point is patient referral indicated? As you might imagine, it is not always an easy question to answer.
Granted, in the case of a retinal detachment, mature cataract or a glaucoma patient failing maximum medical therapy, the answer is evident. On the other hand, how would you manage a symptomatic convergence insufficiency patient; an individual with age-related macular degeneration in need of low vision services; or even someone with keratoconus requiring contact lens correction? To refer or not to refer, that is often the question.
I would argue that today’s well-trained clinician — embracing and leveraging technology — is aptly qualified to manage many such patients. For sure, the Convergence Insufficiency Treatment Trial has provided us much-needed guidelines in caring for symptomatic convergence insufficiency patients. Likewise, improved optical and nonoptical devices (think iPad) have put many low vision services within the realm of a primary care optometrist. Certainly, new soft contact lenses designed specifically for keratoconus provide all of us with yet another tool to manage these folks.
While it is clear that knowledge plus technology equals expanded patient care, there is one fact that remains: It is the reality that certain patients really do need the services of a specialist. For these patients, the question is not one of “to refer or not to refer” but, rather, “to whom to refer.” I would contend that many times these specialty services are best provided by — you guessed it — another optometrist.
So, while I am passionate about primary care optometrists providing an ever-expanding range of services, I am equally adamant about referring within the profession. After all, who is more qualified to provide vision training, low vision or specialty contact lens services than a colleague with an expertise in that area? It is the right thing to do for our patients and for our profession.