• AAO Hoskins Center for Quality Eye Care
    Comprehensive Ophthalmology

    Policy

    The American Academy of Ophthalmology believes that the public’s interests are served when patients have access to primary eye care services that meet their needs for healthy eyes and best possible vision. Ophthalmologists are specifically trained to provide these services because their medical school education provides a thorough understanding of pathology and disease processes, systemic disorders with ocular manifestations, as well as skills and experience in medical decision-making. Primary eye care provides an entry point for patients to receive refractions and glasses or contact lenses, screenings for asymptomatic eye diseases, diagnosis and treatment of most eye conditions, referral to specialists, and coordination with other aspects of medical care. While it is the ophthalmologist’s responsibility to perform the comprehensive medical eye evaluation, certain aspects of data collection may be conducted by trained individuals under the supervision of the ophthalmologist.

    Background

    In the past several years, significant attention has been paid to establishing primary care as the foundation of the U.S. health care system. In the effort to organize and finance health care, the shift toward an emphasis on primary care is intended to achieve better health through increased accessibility to needed services, reduced cost, and improved coordination of care. Health care reform proposals have called for greater numbers of primary care physicians to address a need for care in rural and disadvantaged populations. A clear understanding of primary eye care will help guide policymakers, organizations, and the public to plan, evaluate, and develop eye care delivery systems.

    Evaluation

    Primary Eye Care
    Primary eye care is the provision of appropriate, accessible, and affordable care that meets patients’ eye care needs in a comprehensive and competent manner. Primary eye care provides the patient with the first contact for eye care as well as a lifetime of continuing care. Primary eye care services are integrated to meet the needs of patients from a single source so patients receive quality, efficient eye care that is coordinated with general health care services. Competent and expert management and decision-making are critical in promoting the quality and efficiency of primary eye care.

     Primary eye care services include:

    1. Educating patients about maintaining and promoting healthy vision.
    2. Performing a comprehensive examination of the visual system.
    3. Screening for eye diseases and conditions affecting vision that may be asymptomatic.
    4. Recognizing ocular manifestations of systemic diseases and systemic effects of ocular medications.
    5. Making a differential diagnosis and definitive diagnosis for any detected abnormalities.
    6. Performing refractions.
    7. Fitting and prescribing optical aids, such as glasses and contact lenses.
    8. Deciding on a treatment plan and treating patients' eye care needs with appropriate therapies.
    9. Counseling and educating patients about their eye disease conditions.
    10. Recognizing and managing local and systemic effects of drug therapy.
    11. Determining when to triage patients for more specialized care and referring to specialists as needed and appropriate.
    12. Coordinating care with other physicians involved in the patient's overall medical management.
    13. Performing surgery when necessary.

    Primary Eye Care Physician 
    A primary eye care physician’s role is to observe and assess visual signs, symptoms, or concerns that patients present, unrestricted by problem origin. The physician must have the appropriate education and training to manage a large majority of those problems.

    Primary eye care should be provided by, or supervised by, qualified physicians who have the following competencies: 

    1. To discover and discern abnormal states from normal.
    2. To diagnose disease conditions.
    3. To relate general medical conditions and symptoms to possible eye diseases.
    4. To triage and manage effectively eye diseases and conditions, or refer patients for specialized treatment.
    5. To coordinate with other physicians and health care professionals to meet general health care needs.
    6. To develop a treatment plan and take care of the large majority of eye care needs encountered in the general population.
    7. To perform surgery when necessary.

    Primary eye care physicians generally assume responsibility for coordinating eye care services to optimize a patient’s visual function. Coordination involves interacting with, referring to, and consulting with other physicians and health professionals, specialists, and community programs.

    The ophthalmologist is an appropriate and cost-effective provider of primary eye care. He or she is not only accountable and committed to the patient’s best interests in preserving healthy vision, but can also perform surgery when necessary. Ophthalmologists have extensive education and training that includes four years of medical school education, one year of a general surgical or medical internship, and three or more years of intensive training devoted solely to all aspects of medical and surgical care of the eyes and visual system. They can diagnose and manage the large majority of eye conditions that present, and can efficiently triage patients for timely management. Patients’ interests are best served when they can visit an ophthalmologist and have all their ocular problems efficiently managed from the time of first contact without going through unnecessary referrals, testing, or therapies, which incur additional cost and delay in receiving care.

    Approvals


    American Academy of Ophthalmology,
    Board of Trustees, 1995

    Reaffirmed and Approved by:

    American Academy of Ophthalmology, 
    Board of Trustees, September 1999 

    Revised and Approved by:

    American Academy of Ophthalmology, 
    Board of Trustees, February 2005
    American Academy of Ophthalmology, 
    Board of Trustees, April 2009

    Reaffirmed and Approved by:

    American Academy of Ophthalmology, 
    Board of Trustees, April 2014

    ©2014 American Academy of Ophthalmology®
    P.O. Box 7424 / San Francisco, CA 94120 / 415.561.8500