In the last fifteen or twenty years, advanced technology to assess the integrity of the retina and optic nerve head has literally transformed the ability of the optometrist to manage many chronic eye conditions at a level never before. Optometrists who have the inclination, interest and education can now equal the detection of many, if not all, ophthalmologists for many of these conditions.
On a philosophical level, does advanced technology “make” an optometrist “equal” in diagnostics as an ophthalmologist? To many optometrist who use or have this technology their answer is “yes”. These new technologies can now speed the training necessary to be comfortable and confident in detecting and even managing these conditions with little or no additional assistance. Of course, this kind of ability isn’t often shared by ophthalmology, especially comprehensive ophthalmology.
First, ophthalmology procures patients different from optometry, there really isn’t that much overlap in that respect. If a patient intended to go to the optometrist, they weren’t intending to go to the ophthalmologist. Second, most optometrist don’t have the infrastructure that an ophthalmologist has and can concentrate on more personalized care. Lastly, I believe that ophthalmologists are so focused on “problem” patients that the vast majority of “well eyes” don’t necessarily engender enthsiasm or interest as it does with an optometrist.
Armed with this technology, an optometrist can now be a “partner” or “extender” with any “forward thinking” ophthalmolgist. By forging respectful relationships with one another, I don’t believe that the insular fights on turf need occur. There are plenty of patients out there.
The following comments were copied from original submission dates and posted as a journal follow-up article in preparation for changing to DISQUS for future commenting on my blog.)
12Apr2010 my comment:
Great posting and surprised that this has not been overloaded with comments yet. I've been refraining to throw in my two cents but will provide a posting later this week about a patient-centered approach to helping those with glaucoma. I spoke with a group of 70 optometrists yesterday on this very subject and there was a lot of useful feedback. Watch this space for more in the days ahead and let's keep this discussion going.
Robert M Schertzer, MD, MEd, FRCSC
On 30Apr2010 I wrote:
In response to Patrick Lo's comment that was submitted but awaits Richard to approve as author of this article, I would like to add the following:
At least among glaucoma specialists, none of us see the technology as more than ancillary tests to complement the clinical assessment and probably malpractice to pin diagnostic and treatment recommendations based on any test results. Even the mighty HRT nerve scan is often plain wrong if you compare it to the clinical picture. Blood vessels get interpreted as healthy neuroretinal rim. Gently near totally cupped out optic nerves can be flagged as normal. Physiological cupping can be marked as completely abnormal. One would be doing harm to the patient if they relied on that technology and deceiving themselves if they thought this made ODs and EyeMDs equal (unless they mean equally ignorant!) Would an eye care professional give patients a glasses prescription based solely on an auto-refraction? Technology can give us some clues and starting points but not the complete answer.
Robert M Schertzer, MD, MEd, FRCSC
30Apr2010 Dr Hom's response:
Thank you for your posting.
I believe that glaucoma relies on the doctor's brain more than the technology and if the doctor doesn't have the brain, then the technology will not make that kind of doctor better than before their use of high technology.
In the case of collaboration, a provisional clinical impression of glaucoma can occur where the referring doctor can relay technology findings, retinal photographs, intraocular pressures and descriptions of the optic nerve to a glaucoma specialist for confirmation or non concurrence of a glaucoma diagnosis.
Having been involved with glaucoma care for 6.5 years (over 500) I concur with Dr. Schertzer that such collaboration is possible. I will have to say that in my experience, the comprehensive ophthalmologist generally has the edge over any single optometrist because of the number of cases that are required to be proficient just like any learned profession.
Optometrists who have compiled a similar level of experience and can leverage technology can approach or even be equivalent to comprehensive ophthalmology in the detection and medical management of many kinds of glaucoma. In the United States, there are hundreds of optometrists who do that now.
In summary, I think that a collaborative link should be established between optometry and ophthalmology and that glaucoma care is frequently not an exact science. In those cases a collaborative relationship is essential that is built upon bilateral respect. In the US, comprehensive ophthalmology on occasion shows that respect, but not nearly enough as I believe that it could.
Richard Hom, OD, FAAO