Optometry used to have one, and only one, specialty: vision correction. In the profession’s earliest years, the precision and attention to detail practitioners brought to the task of refracting patients and fitting glasses was a mark of pride, and indeed a defining trait. It elevated the nascent field and created for its practitioners a distinct identity head and shoulders above the dubious reputation of the “spectacle peddlers” who came before them. Any huckster with a trunk full of wares could sell you a pair of glasses—only an optometrist had truly mastered the art.

But no sooner had optometry created a clearly defined public persona than it began diluting it. The push for the legal authority to use diagnostic agents, then therapeutics and, lately, minor surgical procedures confused the public, creating ambiguity about what defines an optometrist. (This magazine deserves a share of the credit or blame for that—we started publishing articles on disease diagnosis back in the 1930s.)

Optometry’s transition from vision specialists to primary eye care providers may have been a messy one, but it was necessary. There’s simply too many people in need of eye health services for ophthalmologists to shoulder it all. The current working relationship between optometry and ophthalmology allows ODs to provide the lion’s share of primary eye care while feeding surgical patients to high-volume MD practices. 

The optometry profession once again has a pretty clear conception of itself and its public face. 

But is another schism coming? Where once optometry’s scope of practice was limited by legislatures, now it may well be limited by its own practitioners, as a strategic choice. 

Responding to both clinical need and business opportunity, ODs are increasingly looking to carve out a niche for their practices rather than aspiring to be the generalists of the eye. That’s the model in ophthalmology, where retina specialists limit their practice to the posterior segment, glaucoma specialists confine their interests to that field, and so on. The Subspecialty Day events at the Academy of Ophthalmology annual meeting are among the most popular—and the most segregated. Will optometry splinter in the same manner? Should it?

Some ODs may well prefer to narrow their scope with such conviction that they turn away patients outside their purview. For most, however, the best course is to augment a general optometry practice with a special interest that adds to it without redefining it. 

That balancing act is the focus of this issue’s series on specialties in optometry. We invited six ODs who were able to create these dual identities to describe the clinical and practice management changes they had to make. Each presents a model of specialty practice for you to ponder. The choice is yours—including the choice to contentedly remain a generalist.