EyeNet Magazine

Guest Opinion

Comanagement: What Is Optometry's Goal?
By John M. Haley, MD
Patient Initiatives
Task Force Chairman

The profession of ophthalmology and its patients could certainly benefit from a hard look at recent trends in optometric comanagement of ophthalmic surgical patients. Where is optometry going with comanagement, and what is their real goal? I will tell you: It is all about control. And optometry is advancing its agenda with assaults in three important areas.

Legislation. Optometry continues to carry their scope of practice ventures through legislative halls, extolling the trust ophthalmologists have in their postoperative comanagement arrangements and the education therein gained.

Education. Comanagement is driving the move by optometry schools to incorporate ambulatory surgery centers within their walls. These are essentially training sites for perioperative surgical care for optometry students. That, coupled with the optometric refractive surgery residencies sponsored by ophthalmologists (essentially comanagement mills), truly tells you the state of affairs.

Philosophy. Comanagement trivializes medical and surgical ophthalmic education by implying that anybody can “push the button,” “do the procedures” or “care for postop patients,” even optometrists with little clinical education. So why all the hubbub about the need for medical school internships and ophthalmic residencies?

Where will this lead? For a disturbing look at where optometry is headed, read “Maximizing Your Involvement in Comanagement” (Optometric Management, January 2005, pages 44–45.)

The article urges optometrists to use the power of referral to ensure their full involvement in comanagement of the patient, and it outlines several strategies to accomplish this.

For example, it reminds optometrists that they can perform an A-scan, saying, “The instrument isn’t expensive and the medical reimbursements are terrific.” Notably, the article mentions that if the ophthalmologist doesn’t want to use the OD’s A-scan results, then he or she can do it again but won’t be reimbursed when this diagnostic test has already been performed by the optometrist.

It advises the optometrist to provide all the postoperative care (if allowable in his or her state) in order to receive the full Medicare reimbursement, and for another reason, as well: To establish himself or herself as the “real doctor” in the patient’s mind, which, the article says, is accomplished by writing prescriptions.

And last, but not least, this article sounds the call to optometrists: “This is your patient. Therefore, you (the optometrist) must plot the course of pre- and postoperative care—not the ophthalmologist!”

That’s how optometry perceives comanagement . . . as a way to exert control over ophthalmologists.

Their control even extends to OphthPAC contributions. Optometrists’ refusal to refer to ophthalmologists who donate to our PAC at the Leadership Level—or sometimes at all—is a means to control our future. And what about the comanagement dollars transferred to optometry? Ironically, a significant portion is likely to end up in the optometric PAC to fund their legislative initiatives.

The Surgical Scope Fund is the Academy’s best state-level weapon against optometry’s surgical initiatives. Contributions are confidential. Donate to the Surgical Scope Fund, AAO, P.O. Box 45568, San Francisco, CA 94145, or at www.aao.org/advocacy.


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