Ophthalmologists once were placed firmly at the top of the eye care “ladder,” many rungs above optometrists, dispensing opticians, and all others in the vision field, members of the American Academy of Ophthalmology and Otolaryngology (the study of the ears, nose, and throat) were told at their October 1976 annual meeting. But because eye surgeons were “legislatively asleep”, non-physician practitioners, primarily optometrists, have been able to fight for and win increasingly larger shares of the eye care domain.
“Ophthalmology has been overtaken and it is now in the process of being taken over,” warned Whitney G. Sampson, M.D., a Houston eye surgeon.
Legislative “battles have not been lost by ophthalmology; they have been forfeited,” said Byron H. Demorest, M.D., a Sacramento, California eye physician.
Particularly under the prospect of national health insurance, “all practitioners in the ophthalmic field are now scurrying for a position as close to the top of the ladder as possible in order to assure their own professional eminence in the future,” Dr. Demorest said.
“The future of ophthalmology rests in the hands hearts, and minds of our legislators. Supporting and working with local legislators is a high priority item for each doctor who is concerned about the future of his practice and of eye care for his patients. As state and national laws defining the boundaries for eye cad practitioners are changed, all of us must carefully monitor such actions,” urged Dr. Demorest.
Kenneth J. Myers, O.D., director of optometry for the Veterans Administration (VA), which does not authorize optometrists to use drugs, agreed. Dr. Myers said, “I feel equitable relations can more easily be developed [between optometrists and ophthalmologists] if it is clearly stated VA optometry will not practice therapeutic medical or surgical eye care … VA clinical procedures are now and will continue to be dictated by this basic division of responsibility: Ophthalmology staff definitely diagnoses all medical and surgical ocular conditions and provides any required medical or surgical ocular therapy. Optometry staff provides optometric diagnosis and therapy of vision dysfunction with referral to VA physicians of patients having signs and/or symptoms of ocular disease or injury. “It is not our intent to expand the practice of optometry into medical or surgical areas, for we believe these areas are the correct and historically established domain of the physician, and it is best for patient care that optometry and ophthalmology continue centered in their respective disciplines,” Dr. Myers said.
Calling himself “middle of the road” in the ophthalmology-optometry dispute, David M. Worthen, M.D.J head of ophthalmology at the University of California, San Diego, said, “In my opinion, the present optometrist ii over-trained for what he can do, yet doesn’t receive an education of high enough quality to allow him to give complete care.” The prescribing of medicines, especially, he said “just like the performance of surgery, must be founded on a broad-based medical curriculum,” which optometrists generally do not receive.
To allow any health care provider to prescribe therapeutic medicines or operate on the basis of limited classroom experience is the practice of medicine without a license and should be stopped, regardless of legislative changes. In my opinion, such erosion will lower the quality of medical care in all areas,” said Dr. Worthen.
Of course, another area of dispute exists between optometrists and ophthalmologists–the area of eye surgery for refractive problems. Optometrists don’t perform surgery but just prescribe corrective lenses. Ophthalmologists do both. Optometrists have been accused of discouraging people from engaging in surgical corrections strictly because surgery competes directly with the prescribing of lenses by them. Such discouragement of people from undertaking permanent correction by operative means to eliminate eyeglasses and contacts is considered unethical and an exploitation of trusting individuals.
Ophthalmologists additionally suggest that optometrists sometimes overprescribe eyeglasses for minimal refractive errors. They say that the total cost of examination and glasses by an optometrist could exceed that given by an ophthalmologist. If lessened expense is the object, refractive care delivered by trained ophthalmic assistants working under the direct supervision of ophthalmologists costs less and supposedly gives the patient equivalent care.
Frequently a patient with a serious eye problem first consults an optometrist for examination. Many individuals have been conditioned to believe that lenses are able to accommodate most eye difficulties, which is untrue. Finding at the problem consists of more than the simple need for a lens correction, the honest optometrist will likely refer his visitor to the patient’s physician for a re-examination. With a serious eye disorder present, the average family doctor probably won’t feel qualified to treat it. Finally the patient is referred, in turn, to the ophthalmologist who should have been consulted in the first place.
This situation, or a similar set of circumstances, is what may bring someone to seek eye surgery such as radial keratotomy (RK) or another of the operative refractive corrections. Indeed, controversy prevails within the ophthalmology profession about these various refractive surgeries.
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