Optometrists, Ophthalmologists Announce First Collaborative Effort

Norra MacReady

December 10, 2013

The American Academy of Ophthalmology (AAO) and the American Academy of Optometry (AAOpt) have announced a joint initiative designed to foster greater support and sharing of resources among members of both organizations.

This marks the first large-scale, formal collaboration on educational initiatives between the 2 academies. Both organizations hope that by collaborating, they can better coordinate educational efforts and standards of care between optometrists and ophthalmologists.

The educational programs that will arise as a result of this collaboration are still under development and will not be formally launched until 2015. However, the academies are informing their members now to give them an opportunity to provide feedback as the programs take shape.

The initiative grew from a desire by the leaders of both organizations to find more common ground, said Bernard J. Dolan, OD, president of the AAOpt. "Our initial conversations were around the idea that ophthalmologists and optometrists work in a number of settings in different combinations and different ways: private practice, the Veterans Administration, the Indian Health Service, academic departments," he told Medscape Medical News. Dr. Dolan and David W. Parke II, MD, chief executive officer of the AAO, both "had the perception that within those settings, there were some great collaborative efforts for the betterment of patient care, and perhaps it was time we tried to talk to each other and identify areas within patient care and education where we could reach some common ground."

The collaboration will take into account the multifaceted nature of ophthalmology practice, said Dr. Parke, who participated in a joint telephone interview with Dr. Dolan. "As in other areas of medicine, our practices are very heterogeneous: 1-doctor shops in rural areas, large integrated systems, and multispecialty clinics," he explained. "[Dr. Dolan and I] both feel that trying to develop a single model will not apply to large portions of our membership. Our goal is to be very principle-based and to offer guidance to our members that will be focused on patient care."

The AAO distributed a press release stating that impetus for the collaboration arose in part from the aging of the American population and the commensurate increase in demand for optometric and ophthalmologic services. However, in their interview, Dr. Dolan and Dr. Parke downplayed this factor as a driver in the collaboration.

According to Dr. Parke, the primary driving factor was the desire to encourage the 2 academies to share information and educational opportunities. "From the perspectives of both academies, we treat the same patients with many of the same diseases, so it made good sense for us to be acting in a collaborative fashion because that was in the best interests of the patient," he told Medscape Medical News. "The [AAO] holds an annual meeting that attracts about 27,000 attendees each year, and one of the major foci of our activities is to provide continuing medical education for ophthalmologists. So we have a lot of educational resources, and it's always been our goal to optimize those resources in the best interests of the patients."

Both physicians emphasized that the process has just begun, so no specific goals have been identified as yet. One idea is to have a common symposium that would be offered at the annual meetings of both academies, with ophthalmologists and optometrists making presentations together, Dr. Dolan said.

Building Bridges

A question that arises when considering any joint efforts between optometrists and ophthalmologists concerns the risk of friction or turf battles. "We identified early on that there probably would be areas of disagreement," Dr. Dolan said. "We elected to put those aside and focus instead on areas where we could find common ground."

Dr. Parke acknowledged that there has been a history of friction between the 2 professions, particularly when it comes to defining the scope of practice. Similar to Dr. Dolan, he emphasized that the collaborative efforts would concentrate on more positive areas of interaction, at least for now. "I'm certain that at some point we will have to talk about [points of disagreement], but we have so many areas on which we can potentially interact in a positive fashion, that for now we will focus on issues of collaboration rather than competition."

IOMED: The Forerunner

At least in its basic outline, this collaboration is similar to an effort started by the American Society of Cataract and Refractive Surgery (ASCRS). In 2012, the ASCRS announced the formation of an Integrated Ophthalmic Managed Eyecare Delivery (IOMED) task force that was charged with developing a healthcare delivery model that integrated the strengths of optometrists and ophthalmologists who specialized in the treatment of cataracts. The 2013 annual meeting of the ASCRS featured an IOMED symposium with sessions on topics such as practice management, new technologies in an integrated practice, and dealing with challenging cases in an integrated practice setting.

IOMED essentially was developed as a way of expanding educational opportunities for ophthalmologists and optometrists alike, noted task force member Douglas D. Koch, MD. "Ophthalmologists and optometrists have worked together for a long time, but there have been relatively few educational efforts between them. There is a lot of material presented at ophthalmology meetings that could benefit the optometrists who provide primary care to ophthalmology patients."

Similarly, ophthalmologists could benefit from some of the information presented at optometry meetings, said Dr. Koch, professor of ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

The task force did run into some pushback from a few ophthalmologists and state academies of ophthalmology, which feared that some optometrists might try to gain surgical privileges, but so far that has not happened, Dr. Koch said. He urged general ophthalmologists to "reach out to your optometry colleagues. Find ways to bring them into your practice. They can be extraordinary practice extenders and free the ophthalmologists to concentrate on more specialized problems."

After all, he said, "I think collaborative care is here to stay."

Dr. Dolan, Dr. Parke, and Dr. Koch have disclosed no relevant financial relationships.

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