I read with interest about your thoughts regarding this subject that will affect all of us. (More and More about Less and Less, August 2005, p. 19) I am an optometrist who was trained with and by ophthalmology, my residency was coordinated by two ophthalmologists. I have worked along with ophthalmology for my entire career, which spans 10 years. I have worked in large ophthalmology practices with many subspecialties. I can say that I only have positive experiences with ophthalmology over my career.
Currently, I work in association/partnership with a extremely talented comprehensive ophthalmologist whose primary areas of interest are glaucoma, cataracts and oculoplastics. We seem to have a synergistic relationship in which each of us has our specific role in patient care. Most of my day (about 85 percent) is involved with what some might classify as traditional general ophthalmology. My partner concentrates exclusively on complex medical/ surgical cases thus utilizing his talents to maximize our resources.
From your [editorial] it appears that the general ophthalmologist is becoming more and more difficult to find, and from my experience optometry seems be filling in this void. Depending on which side of the fence you sit on this situation is either good or bad. I can appreciate that if I was a general ophthalmologist I would not want to see these developments. I am vaguely familiar with the RAND study, which looked at the supply of eye-care providers in some far-off future. Unfortunately, the study had some built-in flaws. One, utilization of eye-care services was underestimated; also the change in ophthalmology towards sub-specialization was not accounted for in the study. You are completely correct in your assertion that ophthalmology and optometry must meet and work out a framework for the future. I have written to both academies, AAO and AOA, attempting to bridge the divide that separates us. In each case I have received only lip service. I am passionate about eye care and would like to see a working relationship with both bodies regarding training, scope of practice, insurance reimbursements, etc. I have advocated a six-year optometry program which involves ophthalmology input in every aspect of the program. My belief is a well-trained optometrist is a tremendous asset to eye care. I don't see any reason why such a program could not occur other than our leaders not wanting it to happen for their own reasons.
Peter M. Rogaski, OD