Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: We gotta do a better job

As a Philadelphian, I am especially fond of our football team. After several years of having a contender for the playoff games, our longstanding coach seemed to have had the team in a rut. Each week, we would lose or at least play badly, and the coach would be on the morning sports radio program with his only response to all questions being: “We gotta do a better job, a better job!” Yet each week nothing changed.

The problem was that we had the same players doing the same thing and yet we expected a different result. Fortunately for us, that attitude finally forced our old coach out, and our new coach is running the team in a very different way. This new routine has led us to first place in our division with a similar quality team.

I find a similar problem with my colleagues in optometry when it comes to our new role as primary health care providers. We cannot just keep doing the same eye exam and expect that we are going to make a difference in improving the health of our nation’s citizens. I have been around the country promoting the use of primary health care data points by optometrists. The collection of these data points are all tests that can be accomplished by a staff member as part of the pretest work-up for the eye exam. The points are:

  • blood pressure
  • height
  • weight
  • pulse
  • body mass index
  • lifetime glucose profile

The optometrist will then need to review these points either individually or as part of a primary care report card. The result may lead to patient education, open the door to more follow-up care or prompt a referral for medical intervention. 

I agree that the evaluation of these data points and providing this level of health care is a paradigm shift for optometrists. I hear comments from my lectures such as, “My patients are coming to me for eye care, not health care” or, worse, “My patients come to me for eyeglasses” and the ever-popular, “I am already taking a deep discount for the eye exam and now you want me to do more?”

Optometric education has changed dramatically over the past 30 years. Our schools provide a much more medical-oriented curriculum. We have expanded our scope to include medical care in all 50 states. Many of our colleagues use the title “optometric physician.” Yet, in reviewing optometric charts, I see, on average, very little medical care. Medical histories are weak, and there is seldom any mention of medical issues in the clinical impressions or the management plans.  Basically …. We gotta do a better job.

According to the largest vision care carrier in the U.S., in the year 2011, there were 95 million patient encounters with a primary eye optometrists. Now consider the impact if all those primary eye care visits would have included the collection and review of the primary health care data points. 

Can we have an impact on the prevention, early diagnosis and management of chronic medical problems? You bet we can. But….We gotta do a better job!