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: Aligning your wellness resources for primary care

With the year winding down, many of us are reviewing the numbers for 2019, looking for Section 179 purchase items for this tax year and planning for the new year of the optometrist, 2020.

If your practice is like mine, you may have noted that the biggest area of revenue growth in 2019 has been in medical care and wellness care. Unlike medical and vision care, patients are not only willing, but often eager to pay out of pocket for wellness-based products and services.

Wellness service are not just a line item, however. When properly deployed they are the foundation of primary medical care.

Some wellness services such as widefield retinal imaging and OCT are universal or a good idea for everyone. There is an expanding body of evidence indicating that wellness screening with noninvasive retinal scans can reveal risk or even frank evidence of systemic pathology. This involves well-known vascular problems such as diabetes, hypertension and dyslipidemia, and the newer evidence now includes Alzheimer’s disease and a host of other neurologic problems (Doustar et al.).

Other wellness strategies are more targeted and should be deployed based on risk factors uncovered in the comprehensive eye examination. These factors include family history, social habits, vital signs and the results of the physical eye examination. Risk tools are available and should be used to recommend lifestyle changes, supplements, exercise programs or formal wellness counseling. The American Diabetes Association has a great online tool to help you guide your patients with risk factors in this area. Likewise, the American Heart Association has a downloadable risk calculator that is available to help you manage cardiovascular risks for your patients.

Your office might like to offer supplements to help manage certain risk factors. This is a logical expansion to the supplements that you may already offer for dry eye or age-related macular degeneration. As with these disorders, the correct recommendation is risk based. You may also want to offer fitness trackers or other wearable technology. Some of these trackers and monitors are spectacle based and may be integrated with Rx lenses. There are also contact lenses that can monitor IOP for glaucoma patients. Other contact lenses are in development to monitor blood sugar and may also become part of the optometric management of insulin resistance and diabetes.