U.S. Senate roundtable spotlights battle to preserve ‘one standard of care’ for veterans

July 14, 2017
AOA, leading lawmakers and national veteran service organizations highlight threat of experimental TECS program for veterans’ vision and eye health.

The AOA is an unrelenting advocate against a U.S. Department of Veterans Affairs (VA) experimental eye and vision screening program, which violates the department's own "one standard of care" principle.

Last year, the VA began piloting Technology-based Eye Services (TECS) at the VA Medical Center in Atlanta, Georgia, in a supposed effort to better serve the eye care and vision needs of veterans living in rural areas, or some distance from full-service VA facilities.

Under the pilot, an ophthalmic technician performs unproven vision and eye health screenings on veterans and sends that information to an off-site eye doctor for analysis and possible prescription, rather than an in-person eye examination performed by an eye doctor. Plans call for the pilot to expand to other VA medical facilities across the country.

"Trying to shortcut the care provided by doctors of optometry to more than 1.5 million veterans a year places their eye health and vision care at risk," says Christopher J. Quinn, O.D., AOA president. "Our veterans have earned and deserve dedicated and quality vision care—and the AOA will fight for them."

The June 21 briefing was held on the U.S. Capitol grounds and was hosted by the AOA, the Armed Forces Optometry Society, the Association of Schools and Colleges of Optometry, AMVETS, the Blinded Veterans Association, the Vietnam Veterans of America, Sen. John Boozman, O.D, (R-Ark.) and Rep. Julia Brownley (D-Calif.).

Immediately after co-hosting the June 21 roundtable, Sen. Boozman attended a hearing of the Senate's VA appropriations subcommittee and raised questions regarding the TECS program with VA Secretary David Shulkin, M.D. Watch the hearing.

Sen. Boozman raised concerns that the TECs program was providing a "Third World experience" to veterans based upon his understanding of how the program operates.

"Eye care is growing tremendously because people are doing a good job and veterans are seeking you out," said Sen. Boozman, who graduated from Southern College of Optometry in 1977. "I think the idea that we're using technology is excellent—you and your team are coming up with out-of-the-box thinking.

"But I really think you ought to look at the way eye care is being delivered and put the technology in the hands of the optometrists, the ophthalmologists," Sen. Boozman added at the hearing. "They're in place, and again, give them the support staff and then they will be able to see more patients in an effective manner and cut out all this other stuff. Because we really do have some problems in that area."

Shulkin noted the VA's desire to leverage technology for better, more timely care for veterans.

"But I will look into the TECS program and the eye care model," Shulkin responded.

Fighting for vets who sacrificed for us

At the June 21 roundtable, Veteran Vision: A Discussion on The Importance of Eye Health Care for America's Veterans, thought leaders and advocates spoke in support of making sure veterans received the care they had earned. Among its attendees were Sen. Boozman, roundtable co-host Rep. Julia Brownley, (D-Calif.); and Sen. Jerry Moran, (R-Kan.), who chairs the Senate VA appropriations subcommittee.

Dr. Quinn participated in the roundtable, as well as other doctors of optometry, including Christopher Wroten, O.D., of Louisiana.

"The VA guarantees one standard of care (at all VA facilities) and its core values include 'striving for the highest quality,' but it's concerning to see that the TECS program seems to fall short of both goals and instead offers a disparate and—in our opinion—reduced level of care for some veterans, which does not conform with existing VA policies," Dr. Wroten said. "Our vets deserve better."

Retired Rear Admiral Michael H. Mittelman, O.D., MPH, president of Salus University, also spoke at the roundtable. In an interview, Dr. Mittlelman thanked the Veterans' Administration for providing the largest clinical training ground for doctors of optometry at the intern and residency levels.

"Optometric training, within an integrated health care system such as the VA, assures that optometrists not only see a myriad of patients and clinical conditions, but also learn how to effectively interact in today's complex health care environment," Dr. Mittelman says.

"Practicing in an integrated system is not only cost effective but also ensures that patients are appropriately triaged and referred in a timely fashion for many chronic diseases, including diabetes and hypertension, that are identified during routine eye examinations."

Yet, Dr. Mittelman expressed concerns over the TECS program,

"I believe that a system such as TECS cannot be used as a surrogate for a comprehensive eye examination," he says. "The VA is being extremely short-sighted in its current approach to the program, which should only be employed as a very basic screening tool with clear doctor supervision. There are other, more efficacious methods of screening patients currently available that help to ensure patients are appropriately cared for without compromising their eye and overall health.

Advocating for veterans' eye care

Eye care clinics staffed by VA doctors of optometry—and residents—are among the busiest primary care settings in the veterans' health care system. The VA Optometry Service last year provided primary eye care services for about 1.8 million veteran visits.

The AOA has long supported measures that expand veterans' access to timely, quality eye and vision care services offered by in-person, comprehensive eye examinations, including legislation in this current Congressional session.

Passage of the bipartisan Veterans Access, Choice and Accountability Act of 2014 (Choice Act) created the Veterans Choice Program, a way for eligible veterans to access care via non-VA providers should the veteran face an extended wait time or geographical hindrances. But an AOA-backed provision effectively made it easier for veterans to qualify for this care. Through the Choice Act, non-VA doctors of optometry can provide care to America's veterans when needed.

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