Article Date: 4/1/2001

o.d. to o.d.
Why the Push to Stop Co-Management?
The real reason isn't that complicated.
Chief Optometric Editor

Optometry and ophthalmology have successfully co-managed patients for decades -- long before it was even called co-management.

We know the drill: We diagnose an ocular disorder that's best treated by surgery. We refer the patient to an ophthalmologist who confirms the diagnosis and performs the procedure. When the surgeon feels the time is right, she returns the patient to us for continuing care.

It's a mystery to me why some ophthalmologists want to stop this practice -- especially now when we're at our highest level of expertise in treating eye disease, and all 50 states permit us to prescribe meds.

Trouble in the Sunshine State

Last month, the most recent attempt occurred in Florida, where a few powerful ophthalmologists gained backing from medical societies to persuade legislators to sponsor bills. The legislation seeks to prohibit M.D.s from referring patients to O.D.s for ocular post-op care.

Ironically, many ophthalmologists employ O.D.s, and the legislation would prevent even these optometrists from doing post-op care for their M.D. colleagues. Of course, many ophthalmologists in Florida, and nationally, wouldn't support this movement.

Florida optometrists were working hard to educate state lawmakers that:

We'll soon know the outcome, but I'm concerned that we'll have to continue to fight this battle, which we already fought during the '80s and '90s for the right to prescribe.

In other states, a few attempts have been made to restrict optometric co-management. So far, none has had success. Good judgment and common sense have prevailed.

Interprofessional harmony

It's also a shame we have to fight these political battles at a time when our two professions are working closer together than ever before.

Ophthalmologists are on the faculty of every optometry school in the nation, and optometrists often teach in ophthalmology residencies. Many O.D.s and M.D.s work together in the same practices. And in separate practices, we actually see patient referrals going both ways!

Our patients are doing better than ever with regard to eye health, which is the main point.

So what's the real reason to try to stop co-management? The only one I can come up with is economics.

You may contact Dr. Gailmard at

Optometric Management, Issue: April 2001