Article Date: 3/1/2010

The Changing Optometric Model

The Changing Optometric Model

As an industry, we've been told we need to shift our focus. But maybe the focus shouldn't be medical; maybe the best solution to vision care is vision wear.


By Ian Ben Gaddie, OD, and Scot Morris, OD

If you had to define what it means to be an optometrist to a lay person, what would your answer be? What is our purpose? We perform comprehensive eye examinations, prescribe eyeglasses and contact lenses, and help prevent and treat ocular disease. Undoubtedly, there's an increasing trend in optometry to focus on the so-called medical model. The majority of continuing education courses, magazine articles and even much of the curricula taught in U.S. optometry schools are focusing on this model of care.

It's true that treating ocular surface diseases, glaucoma and retinal conditions add to the challenges we face in clincial practice. But we must remember that our primary responsibility is to enhance the vision of our patients. In many instances, the primary way this is accomplished is to prescribe the optimal vision solution for our patients.

Providing optical solutions also impacts the business of optometry. Industry-specific data indicate that our primary source of income is still the sale of optical materials and contact lenses. In most independent practice models, vision plan benefits for contact lenses and/or eyeglasses make up more than 60% of revenue while professional vision services compose an additional 15% to 30% of revenue. This means a successful comprehensive optometric practice only derives 10%to 20% of revenue from the medical management of eye disease. Even in the most "aggressive" medical model practices, such as our own, we strive for 35%.

Consider it from a different prespective: 3-4% of the population will develop glaucoma; ocular surface disease affects an estimated 20%. However, more than 65% of the population have some form of ametropia. Ametropia is almost 100% "curable" with corrective lenses. In 2008, there were approximately 15 million prescriptions written for anti-infectives while about 150 million pairs of eyeglasses were dispensed.

Maybe it's our profession that should "re-focus" on our real goals and responsibilities—to protect and enhance visual performance. We must ensure that our professional image encompasses what patients really want: our vision expertise. Simply put, the best solution to vision care is still vision wear.

Optometrists are extremely fortunate to have the privilege and responsibility of being the doctors who provide a professional service and the retailers who provide material eye wear. It's our RESPONSIBILITY as optometrists to protect and enhance our patients' vision through medical management, nutraceuticals and most of all, corrective eye wear, all of which grant us the opportunity to prevent disease and enhance visual performance.

Performance Enhancement

Using your web site as a repository of information, instead of a simple e-brochure, can even save you time. If a known “tire-kicker” says to you, “I've heard about these plug things you can use for dry eyes. Do you know about them?” Your response can be similar to the staff's: “If you give me your e-mail address I'd be happy to send you information.” In this case, CC the message to your staff so they can follow-up with the patient to book a return visit.

A Vision Council of America study found that about 25% of people surveyed purchase new eyeglasses based on doctor recommendations. This should be 100%. Of greater concern is the 2.2-year average repurchase cycle for individuals in the study. Most people have 25 or more pairs of shoes, three or more watches, and in many cases, more than one vehicle, yet they own only one pair of eyeglasses. These statistics are telling. The push for expanded scope has been successful, but at the expense of traditional optometry. Young optometrists should recognize that medical eyecare is synergistic with traditional refraction-oriented eyecare. Instead, we've focused so heavily on medical eye care that we've overlooked the fact that eyewear is one of the primary forms of eye protection. Proper eyewear can help restore or improve vision in people with glaucoma, macular degeneration, diabetes and a whole host of other conditions — not to mention ametropia. Through optical prescribing, optometists can correct basic ametropia and higher-order aberrations and enhance contrast sensitivity. We also have the ability to significantly improve vocational vision or sports performance. All of these measures can lead to enhanced visual performance for our patients.

Protection and Prevention

In essence, vision care is the ultimate formofmedicalmanagement. We have the opportunity to write a prescription that can "cure" a disease, prevent a whole host of others and restore or even enhance visual performance every waking moment of the day. The best form of prevention is protection. Polycarbonate or Trivex™ lenses in a wrap frame provide the best form of eye protection from trauma and should be prescribed for many occupations. Eyewear technology allows us to protect the eyes from UV damage that can cause a host of diseases including cataracts, macular degeneration and many forms of dry eye disease. Patients deserve the very best protection. Would you prescribe a first-generation antibiotic for a corneal ulcer or pilocarpine for glaucoma? No. So why would you prescribe CR-39 or a first-generation progressive addition lens?

Doctor-driven Dispensing

It all starts in the exam lane. Optometrists prescribe vision solutions. We're paid to be our consumers' vision consultant. How do we optimize their vision for the various activities in life? Just as with a medical prescription, we need to provide detailed instructions when we write our optical prescriptions. Designate the type of progressive lens and the material, as well as other performance enhancement options, such as anti-reflective coatings, Transitions lenses, polarized lenses and so on. Be specific. This may even include writing exactly what the prescription is intended for, such as computer use or sportswear (Figure 1).


Figure 1. Be specific when writing prescriptions. Details (right) make all the difference.

The Power of the Prescription

The high-impact sale is more than just a high pricetag. Consumers generally feel better about the worth of a product based on how much they pay for it. Perception is reality in our business. But there's also a key mental step that must occur. The consumer (the patient in our case) has to "buy into" the need for your proposed vision solution and feel confident that your optical team has the ability to fulfill that solution. To really convince your patient, it's advisable to prescribe the ideal lens for each pair of eyeglasses. Then transfer the patient to the optician for additional patient education and frame selection.

There are many combinations of prescriptions, lens types, lens materials and lens options. No one is better equipped than you are to suggest the best options for each patient. They're paying for you to be their consultant. Never sell patients short. Many times, only a small or negligible change in manifest refraction is demonstrated during the eye examination, but that doesn't mean patients don't want or need new eyeglasses. They may want new frames to better represent their image. They may want multiple frames to wear with different outfits or for different uses (at home, in the office or out on the town). Some patients want to try the newest technology, such as free-form lenses.

Finally, our duty to warn and protect against UV damage has gone unfulfilled. Every human being should have a pair of sunglasses that protect against 100% of UVA and UVB. Period.

Reclaiming Our Role

The bottom line is this: vision care starts with vision wear. Give your patients what they want, need and expect from you: an examination and a recommendation. Remember that you don't have the right to decide what patients can afford, so always recommend the very best. If they ask for a less expensive option, you can modify your recommendation accordingly. But as with all things in life, never assume. nOD

Dr. Gaddie is owner and director of Gaddie Eye Centers, a multi-location, full service practice in Louisville, Ky., founded by his father more than 40 years ago. Contact him at Dr. Morris opened his private practice, Eye Consultants of Colorado (, in 2004. He's operating partner of Morris Education and Consulting Associates ( and Ocular Technology Solutions, Inc. ( E-mail him at Both doctors develop and host the Student Practice Management Symposium.

Optometric Management, Issue: March 2010