END THE CRAZY SEPARATION BETWEEN MEDICAL AND VISION CARE
ONE OF the greatest challenges I see, hear, and feel in our profession is this crazy separation between medical and vision care. Some optometrists say, “I don’t treat medical” or “I don’t know how to treat medical.” People! It’s all medical!
All medical conditions share four major components: symptoms, clinical signs, a clinical diagnosis (as defined by ICD-10) and some form of a management plan. So, essentially, short of the true emmetrope, who has perfect binocular function, visual perception and a perfectly quiet, white eye and just wants to use either his or her prepaid managed vision benefits, or the individual who truly believes in well care and wants to self-pay for his or her well health exam — everyone else is medical. (By the way, if you find one of those perfect people, please let me know. They are rare!)
NOT IN SIGHT
I often hear, “I just don’t see medical.” Let’s put this in perspective. The six most common diseases we see clinically are myopia, astigmatism, presbyopia, dry eye disease, allergy and hyperopia. In other words, most disease is visual in our world. The other two in the top six also primarily affect vision by their assorted effects on the tear film. And, if you already treat visual disease, then you know the basics of how to treat all ocular disease. Who pays for any given exam really has nothing to do with the care that we provide.
Every one of the top six has symptoms — blurred vision at some distance with some frequency being one of them, if not the main symptoms. Every one of the top six has clinical signs. Some of the signs need to or may require diagnostic testing to ascertain the severity or depth of the diagnosis. Diagnostic testing may include a photograph, an OCT, topography or a refraction. Yes, refraction is no more or less of a diagnostic test than any of the others.
Each of the top six diseases has one or more diagnoses that may closely match the true description of what is going on. In fact, the top six comprise more than two dozen different ICD-10 diagnoses. Most have multiple diagnoses. Each of the diagnoses should have pertinent and relevant treatment plans.
STOP SEGREGATING CARE
My point with all this: We need to stop segregating our care into either vision care or medical care. I repeat: It is all medical care. Eye disease affects each consumer in unique ways. Our job is to listen for the symptoms of individual diseases, examine for the relevant clinical signs, define all the pertinent diagnoses and devise and discuss with each patient his or her individual management. Not all disease could or should be treated in the same exam.
In essence, changing our philosophy as an industry to “it’s all medical” might just lead to better care. OM.