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: Determining optometry's role in health care reform

Optometry is a legislated profession, and our scope of practice varies from state to state. There are a few important consistencies, however, that should be considered in determining our role in health care reform.

We are licensed in all 50 states as independent health care providers that are educated and trained to provide medical care. This includes the use of medications to treat disease. We are also large in number and well distributed through the country, including rural and underserved areas.

The nuances, however, in the medical care that we are licensed to provide are quite varied. More important is the fact that the legislative efforts in many states are not moving us to a more consistent primary health care profession. Some states are working on defensive legislation to protect old turf while others are trying to chase ophthalmology for low volume-low reward procedures.

Optometric leaders that are involved with legislative efforts at the state and national level need to know two things to craft the future of our profession. First and foremost, they need to look to the public health needs of our citizens. Second, leaders must look to the future direction of the profession of optometry. This includes our ability to leverage technology combined with our optometric medical training. They must then craft legislation that will allow us to use our talents to improve the health of our people. Legislative efforts that support the use of optometric resources to meet the needs of the public are almost always successful. Those that are self-serving, greedy and protective are less so.

Technology has made the traditional practice of optometry, as in my dad’s generation, quite simple. Auto lensometry, keratometry, retinoscopy and refraction have made prescribing glasses fast and easy. Automated visual field testing, fundus photography and tomography have made the eye examination faster and more effective. This, however is just data collection. The assimilation of this data combined with the health history, vital signs, the patient’s symptoms, visual needs and lifestyle is the next step. Synthesizing all of this into a comprehensive management plan that not only includes ophthalmic materials but also addresses risk factors, eye health, systemic health and wellness is the optometry of the new millennium.

To be more specific, the optometric legislation that was recently enacted in California had a couple of very important landmark issues that make it a progressive step. The ability to provide immunizations for flu, shingles and pneumonia is a huge step for primary care optometry. The optometrist is often the only health care profession of record for citizens in need of these preventive measures. The addition of tramadol, a non-opium narcotic, is a welcome addition and much better choice to treat pain considering the rising opioid epidemic.

Recent legislation in the states of Kentucky and Louisiana also merit some attention, but not for the obvious reason. Much lauded as “laser legislation,” this is not the aspect of the legislation that meets an important public health need. Many forms of laser treatments are being replaced by injections and other less invasive procedures. The real importance of these new laws is that they increase the scope of practice for the management of chronic medical problems that affect the eyes and vision. In particular, these diseases include diabetes and hypertension, which often result in vision loss.

There are a number of states where optometric leaders feel threatened by telemedicine. Some states are even looking to craft legislation that will prevent an optometrist from performing a remote eye examination. This is, again, a myopic attempt to protect traditional optometry. The fact is that some of these systems are very effective in leveraging technology and providing effective care in areas of need. Enacting laws that prevent optometrists from providing these services will only allow others to fill this void.

Another popular item of optometric legislation is known as vision plan reform or lab choice legislation. These bills are attempting to protect the optical aspect of traditional optometric practice. Although this type of legislation has enjoyed success in a number of states, the long-term effectiveness of these programs is questionable. The net effect of these bills often drive up the cost of care for the traditional optometric practice and may move both the vision plan industry and the consumer to seek other sources of eye care. This includes both the retail locations of the vision plans and online options. Ironically, progressive optometrists may be blocked from participating in the online alternatives by their own protectionism efforts.

Optometric legislation is a critical part of our future in every state. The opportunity to have the issues of optometry introduced in the form of a piece of legislation is no small effort. Mustering support and the lobbying effort involved in moving a bill through the many steps to end up as a law is expensive and time-consuming. With this is mind, optometric leaders must carefully consider all options.

Remember the two most important axioms before working with your legislative sponsor. Is this piece of legislation good for the public’s health and is consistent with the future of our profession? If not, you might want to reconsider.