The professions of ophthalmology and optometry deliver the vast majority of eye care in the United States. While separate disciplines, members of the two professions frequently work together in the same practice or same clinical department or unit.
Ophthalmologists are medical doctors by training, and they all complete medical school and residencies for a combined minimum of eight years in duration. In addition, most now also complete full-time clinical fellowship programs of between one and three years in duration. Current training in optometry involves four years of optometry school, and some graduates complete one additional year of post-graduate training.
Ophthalmologists earn licenses to practice medicine and surgery. They generally restrict their practice to the eye (and some specialize in the surrounding eyelids, orbit, and midface). Many choose to restrict their practice scope further, depending on professional interest and training. Optometrists’ practice scope varies by state regulations with regard to therapy but generally involves eye examination and care of a limited range of less severe eye conditions not requiring systemic therapy or surgery.
Ophthalmology and optometry have been in conflict for generations over scope of practice. Ophthalmologists characterize their objection to optometric expanded scope of practice as one of patient safety and quality of care wherein scope of practice should be determined by training and evidence-based competence analytics. Optometrists characterize their training as appropriate to clinical needs and ophthalmologic opposition as a “turf war.”
Regardless of their scope of practice battles, the two professions overlap in many areas. They both provide general eye care and provide glasses and contact lenses. They see many of the same patients with some of the same diseases. They confront some of the same public health problems. They find themselves on the same didactic educational programs—although teaching different things. They collaborate on funded research. And about half of all ophthalmologists work in practices that employ optometrists. Surveys indicate that ophthalmologists welcome this collaboration as it permits them to focus on more-severe clinical problems. Surveys also indicate that working with an ophthalmologist is a professionally and economically rewarding career path popular with many young optometrists.
It is a common aphorism among ophthalmologists that “I work collaboratively and collegially with optometrists in my community in patient care, but not at the state and national level when it comes to scope of practice issues.” Many optometrists feel similarly.
The mission statement of the American Academy of Ophthalmology reads, “The mission of the American Academy of Ophthalmology is to protect sight and empower lives by serving as an advocate for patients and the public, leading ophthalmic education, and advancing the profession of ophthalmology.” In the pursuance of this mission, the Academy has worked with the profession of optometry in a number of areas including public health initiatives, National Eye Institute support, federal professional payment policy and patient benefit structures, U.S. Food and Drug Administration regulations, and many others. It has also opposed some optometric initiatives, particularly pertaining to scope of practice.
Over the past decade, the Academy and its principal national counterpart optometric organization, the American Academy of Optometry, have intentionally developed relationships at the leadership level intended to serve patients in areas of common ground. These have included joint symposia by a combined ophthalmologic-optometric faculty at each other’s annual meetings and periodic leadership meetings. The societies and their representatives have worked together on policy statements, clinical guidelines, and on quality of care initiatives.
In 2018, spurred in part by growing evidence of member interest and by evolving national health policy, the American Academy of Ophthalmology Board of Trustees began a focused study of the interprofessional relationship. Consistent with its mission to lead the profession and advocate for patients, the Academy Board of Trustees began exploring potential other relationships between optometrists and the Academy that might advance patient care without compromising professional principles.
After considerable study among selected committees and the Board of Trustees, two questions emerged:
- Should the annual meeting of the American Academy of Ophthalmology be open to a greater subset (or all) of optometry?
- Should the American Academy of Ophthalmology consider establishing a “membership opportunity” (affiliate class or optometric organization under the Academy organization) especially for optometrists who work in practices with ophthalmologists?
Beginning in early spring 2019, discussion of these two concepts was extended to the general Academy membership. Over the ensuing eight months, there were numerous meetings, webinars, online chat forums, and web posts pertaining to the subject. The issues were considered at local, state, regional, and national levels.
In January 2020, for the first time in the history of the Academy, the entire membership was surveyed on a policy issue of professional importance. The survey process was conducted by an independent third party, and the survey instrument was primarily focused to address the two questions of annual meeting and membership option.
Over 20,000 surveys were distributed electronically to U.S. Academy members and members-in-training with a resultant 18% participation rate. The statistical confidence interval was 95% +/- 1.5%. Survey responses were analyzed to be representative with regard to many important factors, including age, length in practice, gender, practice type and focus, geography and optometrist employment in practice.
The topline survey results were as follows:
- With regard to attendance at the Academy’s annual meeting, a preponderance of members felt that the annual meeting should remain principally a meeting of ophthalmologists and not be open generally to optometrists (58%). 33% felt optometrists should be able to attend, and the remainder were undecided.
- Considerable heterogeneity in opinion was manifested with regard to optometrist inclusion in the Academy in a category of membership. About one-third favored no inclusion, one-third favored inclusion in a separate “suborganization,” about 20% were open to inclusion within the general membership and 15% were undecided.
Extensive subgroup analysis was performed. Of note, substantial differences in response to the above questions did not occur by geography or by age of the respondent (two commonly posed questions). And four in five respondents overall agreed that “optometrists are an important component to the eye care team.”
The entire detailed results were posted for members in May 2020, and substantive member commentary ensued. The Academy Board of Trustees then considered the survey and its results on several occasions, leading to this statement.
The Board values the engagement of its membership in this discussion. Few subjects have been as sustained a policy focus for over so many generations. And few relate as keenly to the core of professionalism, education, credentialing, patient safety, access to care, and quality of care. Concomitantly, the Board also recognizes that the delivery of optimal health care, more than ever, is a team-based process. The Board and the Academy membership understand that ophthalmology and optometry are both integral to the team.
The Board believes that any fundamental change in American Academy of Ophthalmology structure and operation to incorporate another profession into the core of its activities should be supported by a large percentage of its membership—a situation that does not currently exist. Accordingly, the Board will not at this time initiate a process to either open its annual meeting for ophthalmologic continuing education to the general optometric community or to create a membership opportunity for optometrists within the Academy.
The Board notes, however, that the relationship among the two professions, their two leading professional education organizations, patients, and the American healthcare system is important and is increasingly a dynamic one. It also acknowledges that, particularly at the community level, strong and patient-centric inter-professional relationships frequently exist and are desirable. The Academy recognizes that some members seek appropriate educational opportunities developed by ophthalmology organizations for optometrists in their practices. The Academy supports individual practices and other ophthalmologic organizations at the community or state level that interface effectively with optometrists and optometric organizations in a fashion consistent with professional principles and always keeping paramount the interests of patients and communities. Likewise, consistent with those principles, the Academy will seek out opportunities to innovate and elevate eye care, building relationships with all involved in its delivery.
Approved by: Board of Trustees, September 28, 2020