Article Date: 11/1/2003

o.d. to o.d.
A Look at Practice Guidelines
Guidelines should insure quality eye care but do some standards tie optometry to the past?
BY WALTER D. WEST, O.D., F.A.A.O., Chief Optometric Editor

It's no secret that the settings in which we provide optometric care and deliver optometric services vary greatly across the country and even within local market areas. We see optometrists providing care in private solo practice and private group practice, hospital settings, in association with ophthalmologists, commercial opticals, commercial optometric practices and also the side-by-side relationships with chain opticals.

Just as the business models of the different forms of delivering optometric care vary, so do the individual practices' approaches to marketing and patient management. The variations of laws that govern the optometric profession also vary significantly from state to state.

Recognize the patient's interest

Although great differences exist in the settings in which we provide optometric care, the demands of clinical expertise and quality patient care are critical in each. It is important that with so many variations in the delivery of optometric care that the eyecare provider consider the patient's interest of prime importance. To this end, some states and national organizations have set forth what I'll collectively refer to as "standards" -- that is, standards of care guidelines, state board rulings, opinion letters and even state laws.

Some states, for example, don't allow optometrists to delegate basic data gathering, such as keratometry, refraction and even visual acuities.

While I appreciate the standards set forth by any organization in an effort to ensure quality care to patients, I am concerned by standards that organizations write and then never revisit. I question what effect they have on the ability of optometrists to provide care in what is a continually more competitive marketplace.

Is "turf protection" an issue?

Whenever I'm made aware of a standard that seems unusually restrictive relative to an optometrist's ability to delegate data gathering or employ newer and more advanced technology, I have to ask, "Who is really being served?" I often get the impression that some of these standards are in place not for the best interest of the patients, but to protect the "turf" of optometry.

In other cases, it seems that well-intended entities put such standards in place so long ago that they have outlived their relevance for the practice of optometry and its scope of care in this day and time.

I recognize the benefits of other standards that are forward thinking and innovative. They're put in place to further expand the scope of care that optometrists provide and to improve our ability to better serve our patients.

Lead us into the future

As it seems standards are now and will ever be part of optometry, I'd like to encourage those individuals who are responsible for writing them to also get into the business of rewriting and updating them. Consider how the standards will affect the optometrist's ability to provide the finest patient care.

Let's see the "guidelines" for optometry lead us into the future, not tie us to the past.

Editor's note: Optometric Management invites you to share with us the standards (national or statewide) that you feel are out-of-date or of questionable benefit.

Please mail these questionable standards to us at: Optometric Management, Editorial Dept., 1300 Virginia Drive, Suite 400, Fort Washington, PA 19034 or e-mail them to thomasjj@boucher1.com. OM will report on these in a future issue.


Optometric Management, Issue: November 2003