Optometry’s medical eye care opportunity a boon for patients, coordinated care

Volatility, uncertainty, disruption—all economists’ buzzwords describing the emerging U.S. and global market environment for 2023. But for the ‘eyeconomist,’ the key word for optometry is opportunity.

“This is the greatest opportunity that optometry has ever had as a profession—right now. This is it,” says Richard Edlow, O.D., the Eyeconomist author and industry lecturer.

“There could never be a greater time to be an optometrist.”

Leveraging an economics degree prior to optometry school, Dr. Edlow chaired the AOA’s Information & Data Committee for 15 years and only recently retired from clinical care. Yet that retirement hasn’t slowed a special interest in business and market issues surrounding the eye care profession; it’s only ignited it like a trendline on an exponential growth chart.

In authoring an annual Economic Overview of the Ophthalmic Industry report, Dr. Edlow’s workforce and market analysis of the three O’s—optometry, ophthalmology and opticianry—describes an inflection point many years in the making for optometry.

“Medical eye care is the opportunity,” Dr. Edlow says. “With where the office-based medical eye care is heading, the AOA and state associations have done a phenomenal job of creating a scenario where 98% of doctors of optometry can provide 98% of the care.”

Those estimations are a linchpin to Dr. Edlow’s market analysis, and it’s largely due to a confluence of industry factors that have driven conversations about medical eye care for over a decade; namely: 

1. Supply of eye care providers.
   Where optometry is growing at an annual rate of about 1% with some 48,000 full-time equivalent (FTE) doctors, ophthalmology remains virtually stagnant at nearly 16,000 FTE doctors and near-equal entrants versus departures year-over-year from that profession. By Dr. Edlow’s estimation, the total number of all eye care provider FTEs should grow by about 6,700 providers to nearly 71,000 by 2030.
   
   
2. Demand for medical eye care services.
   Likewise, the overall demand for medical eye care services is expected to balloon, corresponding to the increasing size of the over-65 age group. Whereas this group represented 15% of the total U.S. population in 2016, it is projected to account for 21% by 2030 with 73.1 million people and 23% by 2060. As Dr. Edlow notes, data shows over 93% annual utilization rates for medical eye care services among that 65 and older population as compared to a 53% annual utilization rate among 16-to-64-year-olds. He posits that demand for medical eye exams will increase over 25% between 2020 and 2030, or about 15 million additional medical eye exams in 2030 than were provided in 2020.
   
   “There’s a huge gap in being available to meet that increasing demand,” Dr. Edlow says. “So, who are you going to call? Optometry.”
   
   
3. Leaning into providers’ strengths.
   Further diving into the data, Dr. Edlow notes how demand for common, often age-related ophthalmology procedures will increase commensurate to trends in the aging population while FTE ophthalmology numbers remain virtually stable. For example, about 4.2 million cataract surgeries were provided in 2020 with an estimated 16,042 FTE ophthalmologists available whereas by 2023 those figures increase to 5.6 million procedures and 16,518 FTE ophthalmologists. While not nearly as profound, similar trends appear for other age-related conditions, such as glaucoma, age-related macular degeneration and diabetic retinopathy, through the current decade.
   
   “The average ophthalmologist performs 400 cataracts a year, so that would mean we need 3,500 additional ophthalmologists just for cataract surgery—forget everything else—and we’re only going to have 500,” Dr. Edlow says. “So, ophthalmologists will be spending more and more time in their surgical facilities, and less and less time providing all that medical, chronic eye care.
   
   “There’s this huge increase in demand for age-related medical eye care and ophthalmology isn’t there,” he adds.

Simple supply and demand indicates ophthalmology’s workforce will not be able to meet the spike in demand for age-related medical eye care services, yet optometry stands ready to fill the gap in providing this primary eye health and vision care.

In referencing the Centers for Medicare & Medicaid Services’ (CMS’) 2019 Physician Utilization and Payment data—as opposed to 2020 data as an outlier—Dr. Edlow posits that while about two-thirds of optometrists billed Medicare fee-for-service (FFS) that year, only about a third of optometrists billed Medicare FFS for at least one diagnostic test, such as visual field, optical coherence tomography or fundus photography. In Dr. Edlow’s view, this indicates an opportunity for the profession to grow further in not only diagnosing but treating medical eye conditions.

“I encourage doctors to envision their practices providing at least 50% medical eye care services,” he says. “Start thinking about what do you need—what equipment, facilities or technicians—and do that sooner rather than later.”

Studying the workforce

In 2014, the AOA partnered with the Association of Schools and Colleges of Optometry (ASCO) in producing a National Eye Care Workforce Study to quantify the profession’s supply and demand for eye care through 2025. Updated in 2017, that workforce study looked at the impact of the aging population with particular attention to rates of Type 2 diabetes, as well as the impact of coverage expansion under the Affordable Care Act.

While that study concluded there was an adequate supply of eye care providers, inclusive of projections of new eye doctors, to meet projected demand for eye care through 2025, it also served to make a case for optometry’s involvement in medical eye care.

“What does this [data] mean? It means greater opportunity for ODs to provide full-scope care, not at the exclusion of comprehensive, routine vision care, but to the inclusion of the medical side as well,” noted Randolph Brooks, O.D., AOA past-president and AOA-ASCO Workforce Study Project Team chair, during Optometry’s Meeting® 2014 in Philadelphia.

Dr. Brookes added that optometry wouldn’t realize that increased demand without doctors of optometry practicing full-scope, medical eye care.

Ultimately, patients stand to benefit the most from optometry providing this level of care. Per the AOA Health Policy Institute, doctors of optometry practiced in more than 10,176 communities and counties that account for 99% of the U.S. population—and optometry is the sole provider of eye care in a whopping 39% of U.S. counties. Such data reinforces another truth: for many Americans, doctors of optometry are not only the sole provider of eye care but also the only health care provider many will see in any given year.

Even as states currently look to expand and further validate optometry’s scope of practice nationwide, the profession continues to deliver an outsized impact in Americans’ primary eye health and vision care.

“We’re truly in a great profession,” Dr. Edlow says.