Going further

Photography by Steve Craft

Excerpted from page 24 of the November/December 2020 edition of AOA Focus.

The rural Arkansas practice of Matthew Jones, O.D., made the decision some time ago to expand the care services it provides. Really it was out of necessity, if the practice was going to meet the needs of the patients who visit its Blytheville and Osceola offices. With its complex set of health circumstances, Arkansas ranks among the bottom of states in the country in terms of the overall health of its population (48th out of 50 states, according to a 2013 assessment by the Arkansas Department of Health). Diabetes, for instance, is among the leading causes of death in the state.

Ever since, the practice has invested in that crucial care.

“We were already seeing a high volume of medical eye care in our practice, due to our rural, Delta locations,” Dr. Jones says. “But that meant investing in the latest and greatest in diagnostic instrumentation.

“Our practice decided that if there was a piece of equipment available that allowed us to provide better care and we didn’t have it, then we better buy it,” he says. “Our mindset changed. We knew our patients entrust in us their vision, and it’s our duty to take care of them the best that we can.”

That’s just one of the adjustments the practice has made in recent years, as practices around the country, such as Dr. Jones’, embrace the opportunity to serve the essential needs of their patients.

Embracing change

Maybe it’s the aging population—and the chronic conditions that come with the seasons of life. Maybe it’s the shrinking numbers of ophthalmologists. Or perhaps doctors of optometry have diagnosed the future.

In 2019, in a landmark white paper by Avalon Health Economics called “Optometry’s Essential and Expanding Role in Health Care: Assured Quality and Greater Access for Healthier Communities,” the profession’s place and impact on the nation’s health care system came into focus. There were four key findings:

• Expanded scope of optometric practice nationally would result in an annual, system-wide savings of $4.6 billion.
• 91% of Americans support laws allowing doctors of optometry to provide a full range of care they are trained for.
• 96% of Americans see access to eye health and vision care as essential, second only to overall primary care (97%).
• 62% of Americans trust their doctor of optometry to provide their eye health and vision care.

“This report details the tremendous, beneficial impact across the health care system that doctors of optometry practicing at the full extent of their education and training will provide,” AOA Executive Director Jon Hymes said in unveiling the report last year. “We know the stakes are high and given how much this organization, the AOA and affiliates, have achieved in the past 20 years and more, now documented and spelled out in this report, we can see the profession’s future depends on our successes,” Hymes added.

Optometry’s essentialness during the COVID-19 pandemic was further underscored in a July 2020 report published by the AOA Health Policy Institute. In March, as the pandemic wreaked havoc across the country, doctors of optometry provided urgent/emergent care for more than 206,000 patients. That care diverted patients away from hospital emergency departments overtaxed by COVID-19 cases.

It comes as no surprise then that optometry, and its future, was the focus of the groundbreaking inaugural address given in June by AOA President William T. Reynolds, O.D., which he delivered virtually.

Doctors cannot move the practice of optometry forward without expanding advocacy efforts, Dr. Reynolds said. Or without expanding educational and professional development efforts.

“Contemporary optometry means expanding what we do to make ourselves more valuable to our patients,” he says. “It also makes our practices more viable in the future.”

So, what does that mean for doctors of optometry and paraoptometric staff?

Comprehensive eye examinations will always be the bread and butter of optometric practices, Dr. Reynolds says. “We’re better at doing that than anybody else,” he says. “The personalized care we give is always going to be there. But, if that’s all we do, we’re going to be really limited.”

A profession-forward, contemporary approach to care is required. It might resemble supporting AOA scope expansion efforts by getting to know your state lawmakers. Buying equipment that can advance the quality of care in practices. Supporting staff membership in the AOA, so they can access training and certification resources. Or specializing in the care of patients with diabetes or traumatic brain injuries.

“But it’s not just the way you practice,” Dr. Reynolds adds.

When he started practicing about 35 years ago, Dr. Reynolds recalls, he would sometimes help patients pick out a pair of frames. He’d even adjust them. Then his office was very eye exam and optical oriented. Today, he estimates that nearly 70% of his patients are medical.

“That is no longer a good use of the doctor’s time,” says Dr. Reynolds, who bought his practice, which had an older patient base with a lot of medical needs. “The doctors need to be using the skills they learned in school and let trained staff provide that service. If the profession is going to succeed in the future, we’re all going to have to up our game.”

But how do we get there?

There are three board-backed keys, Dr. Reynolds says: advocacy, continuing education and paraoptometric staff.

“It’s our responsibility as things evolve to make sure that the door is open for optometry to be successful,” he says. “Our practitioners have to take advantage of the opportunities, but it’s our job to make sure that pathway is open.”

Education

Nearly a year ago, the AOA launched its Future Practice Task Force, charged with developing 21st-century educational opportunities to help doctors of optometry to practice at their highest scope. It built on the AOA’s Future Practice Initiative, announced in 2018 to equip doctors for what lies ahead for the profession through scope expansion efforts and education opportunities, amid a changing health care landscape. COVID-19 slowed the task force’s work.

“We had plans but now we’re reworking the plans,” says Rich Castillo, O.D., D.O., assistant dean for surgical training and education at Northeastern State University Oklahoma College of Optometry, who chairs the task force with AOA Secretary-Treasurer Ronald L. Benner, O.D.

“The item we were working on before everything shut down due to the pandemic was an educator summit at Optometry’s Meeting,” Dr. Castillo says. “We were planning a half-day of lectures, workshops and breakout sessions. Things have been pushed back a bit, but I expect we will begin to regain our traction now that the challenges of pulling off a virtual event have been successfully met. I imagine we will begin to push forward again very soon, perhaps in our new online reality.”

The time has not been wasted though. The pandemic has shone a bright and important spotlight on optometry, Dr. Castillo says, giving renewed impetus to the work of the task force.

“It has highlighted and reaffirmed the important contribution optometry makes in the nation’s health care chain,” Dr. Castillo says. “The importance of optometric physicians providing comprehensive eye care within the primary care space has gone a long way toward providing relief for our hospitals and emergency departments, which have been overwhelmed with the present COVID-19 pandemic.

“Today, we’re not just looking for ocular pathology,” he says. “We’re also looking for the systemic correlates whether it’s, for instance, hypertension or diabetes. The optometric physician of the 21st century is more a true primary care provider than at any point in the past. Today’s successful practitioner needs to incorporate a diversity of services. You can’t rely on just one.”

Paraoptometrics

About 435 paraoptometrics registered for the 2020 Virtual Learning Livecast—that’s more than typically attend the annual Optometry’s Meeting. Further, for the first time, paraoptometrics were invited to attend the first-ever Virtual AOA on Capitol Hill in September. Both engagements were meant to expand the role of paraoptometrics in the AOA.

The paraoptometric attendance at the AOA Virtual Learning Livecast goes to show that they’re receptive to their changing roles, says Linda Rodriguez, CPO, committee chair of the AOA Paraoptometric Resource Center (PRC).

“It is apparent that paraoptometrics are eager and ready to embrace contemporary optometry and support the scope expansion of optometry in their states. The overwhelmingly positive response of paraoptometrics to the Livecast courses revealed that paraoptometrics want to have access to great education, which expands their knowledge to best assist doctors of optometry in areas such as the diagnosis and treatment of eye diseases, the ocular manifestations of medical conditions, patient education and future treatments on the horizon, just to mention a few areas,” Rodriguez says.

“Change will demand a better skilled, trained and knowledgeable paraoptometric staff. Doctors of optometry will need greater assistance from paraoptometric technicians who are committed to their professional growth and prepared to increase their knowledge as the profession of optometry expands.”

Toward that end, the AOA is growing its continuing education offerings through EyeLearn Professional Development Hub, the member-exclusive centralized education platform. Further, the PRC offers education and training for paraoptometrics.

“The PRC is ready to offer AOA paraoptometric associate members essential professional development education, training and skill sets to meet the current and future health care demands and will continue to promote certification in all levels to further enhance their professional commitment,” Rodriguez says.

Advocacy

Beyond investing in equipment, Dr. Jones’ practice recognized that training staff for this new normal was key.

“The questions our schedulers and technicians asked also changed,” he says. “That involved greater training for them, in which also came greater responsibility. The doctor dialogue changed as well in talking with the patient about every aspect of the eye. That involved showing photos, describing structures and their function, and discussing treatment options for minor issues that we may have ignored in the past.

“Over the past year we have invested more in the biological corneal bandage arena and punctal plugs arena,” he adds. “We also have purchased the latest equipment for detecting and diagnosing macular degeneration, diabetic retinopathy and glaucoma. We are certainly able to offer more than we could one year ago, but we will continue to evolve as technology and innovation changes.”

Yet, for Arkansas’ doctors of optometry, practicing at the highest level of their education and training requires a scope change, too.

Signed into law March 27, 2019, the bipartisan Act 579 amended Arkansas’ optometric scope of practice act to permit ophthalmic procedures in keeping with optometric education, including selective laser trabeculoplasty and YAG laser capsulotomy, certain injections (excluding intravenous and intraocular), removal of lid lesions, and chalazion incision and curettage.

A well-oiled and well-funded opposition, “Safe Surgery Arkansas,” by ophthalmologists, rose. And in June 2020, opponents challenged the scope law and started collecting signatures to place the law on the November 2020 general election ballot. However, on Sept. 17, the Arkansas Supreme Court ruled that “Safe Surgery Arkansas” failed to follow requirements for collecting signatures—specifically, that the group failed to certify that its paid canvassers had passed criminal background checks, as noted in a recent special master’s report—thus invalidating the majority of the signatures collected. The ruling paves the way for doctors of optometry across the state to begin to provide dramatically expanded eye health care to their patients.

“I know that I want to take care of my patients in every way that I know how. Whether that includes an injection for a cyst or investing in a laser to aid in the treatment of glaucoma, we have to continue to evolve our practices.”

With the definition of scope varying across the nation, communicating the different nuances can be just as complicated as the legislation. The AOA provides tools and resources to help states navigate the current political and legislative landscape, as well as engage with lawmakers, the media and other key audiences.