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: Practice trends in optometry

In contrast to the workforce trends in health care, eye care continues to favor the independent optometry practice as the dominant model. The unique aspects of optometry that shelter this profession from the rapid workforce change of other health care disciplines are the emphasis on vision correction and the direct supply of optical goods to achieve vision correction.

The winds of change, however, are starting to carve changes in the landscape that will require changes in independent practice if it is to remain the dominant force.

Although independent practice remains strong, the solo provider is being replaced by group practice, and the sizes of the groups are growing. The larger groups have been able to afford new technology for medical eye care, and these group often include young optometrists that have superb training in medical eye care and are comfortable prescribing medicines and treating chronic medical problems such as glaucoma and ocular surface disease.

The shift into medical eye care has been a healthy move for both patients and practice. This aspect of practice has offset the loss in optical goods from both vertically integrated vision plans that block access to private practice in favor of their owned locations and the uptick of online marketers of optical goods.

As a senior member of a large group practice, I can attest that this short-term strategy has been effective. However, this requires that the practice develop expertise in the health care insurance and the managed care industry. In addition to coding and billing we must follow the changes as dictated by health care reform. Looming large on the horizon is the issue of value-based care.

Value-based care will require optometry to move away from our traditional silo of care that has existed for many years. Vision care and even most primary medical eye care has required very little communication or collaboration with other providers.

Providing medical care in a value-based system, however, will require extensive communication and collaboration, so much so that some experts are suggesting that it will require some form of consolidation rather than the traditional comanagement or collaboration.

Consolidation may seem like the end of private practice, and many organizations, often backed by venture capital, may suggest that selling the practice may be the only alternative. I know that our group practice has been approached by more than one of these groups.

To meet the standard of value-based care, some type of clinical integration program that is practical, effective and operational must be developed. This program must lead to superior outcomes, lower cost and happy patients.

The delivery models to achieve this may be independent practice associations (IPAs), clinically integrated networks or business models. According to heath care consultants at Deloitte, the business entity must be strong enough to meet regulatory requirements, negotiate value-based contracts and access capital for expensive health information technology and reporting investments.

Value-based care contracts will require optometry to be clinically integrated with ophthalmology to manage chronic medical eye problems that may require surgical options such as glaucoma or cataracts. It will also require us to be clinically integrated with physicians to manage chronic systemic problems such as diabetes, hypertension and dyslipidemia. These are programs that will not be available to us in the optometry silo.

The trend in private practice optometry to move into medical care has been an important milestone in our evolution as a profession. Although short-term success in the fee-for-service arena has been rewarding, it comes with the responsibility to grow and change to meet the demands of health care reform and the changes in health delivery. We all must learn to navigate these systems and be open to changes in our practices.


Deloitte. Six physician alignment strategies for health systems. Accessed July 24, 2018.