The numbers tell the story this month. “Ophthalmology Workforce Expected to Decline 12% by 2035,” declares one of our news articles, which details a study that pairs a drop in the number of practitioners with an increase in need for eye care and concludes that ophthalmology will fall short by 30% relative to patient demand just 12 years from now. That’s based on status quo patterns of access to eye care. If future policy changes succeed in reducing barriers to healthcare access, the gap between supply and demand in ophthalmology widens to 36%.

The same report projects a future shortage of optometrists of 11% under the reduced-barriers scenario (none in the status quo), though it doesn’t detail how it arrives at that or explain whether the MD shortage in any way causes the OD one in their projections. Either way, we all know where the spillover from unmet ophthalmology demand shows up: in your chair. When they get there, more and more patients will need a level of care that goes beyond the routine. An aging population and a shrinking ophthalmology profession all but guarantees it. How, then, to both train optometrists for advanced expertise and communicate to patients as well as other doctors who’s capable of what? 

Also this month, we share highlights from a new survey conducted by Jobson Optical Research on opinions about creating a process of subspecialization within optometry. It’s a contentious topic in some circles, but the survey found widespread openness to the idea. According to the data, 70% of practicing optometrists—and a whopping 92% of students—said they would value the opportunity to earn a subspecialty credential of some kind. The point is all the more intriguing when you consider that just 28.3% of respondents identify as “primary care providers with subspecialty skills” (26.1%) or as bona fide subspecialists (2.2%). 

Crucially, 82.4% of respondents would be more inclined to refer to another OD if that doctor had a subspecialty credential. Intraprofessional referral is an untapped area where optometrists can collectively pick up the slack in eyecare delivery. With ophthalmologists up to their eyeballs in, well, eyeballs, ODs can cut down on the overwhelming demand and get patients seen more quickly by building a much more robust OD-to-OD network than what exists now. “I think it would more greatly set optometrists apart from each other so that employers, other healthcare specialists, politicians and the public know who to trust and turn to in certain situations or with specific issues,” wrote a student at Ohio State College of Optometry in their survey response.

Subspecialization seems inevitable, and it sounds desirable, but there are obviously plenty of hurdles to overcome. How should subspecialties be defined, and by whom? What would a credentialing process be like? Do established ODs need to undergo formal training or can “time in the field” qualify them? Would it foster discontent and rivalry within the profession? Optometrists have excelled as generalists of the eye. The trick is to maintain that while adding another layer of skill—and, importantly, transparency—for anyone inclined to pursue it. Subspecialties would make optometry less of a black box, a critical evolutionary step as its numbers grow and ophthalmology’s drop.