I read a lot of journal articles. As I mentioned in my January column, we publish about 750 news stories every year, and nearly all are reports on research papers. Every one of those is selected by me. My morning routine is to scan more than 40 eyecare journals for new research that contains some clinical relevance to everyday practice or a better understanding of the finer points of pathophysiology. So, trust me when I tell you that I’m well-travelled in the world of ophthalmic research.

One thing that I find increasingly galling is the conspicuous lack of representation of optometry. I don’t mean on the bylines of journal articles, though I would love to see more of that, too. I recognize that research is still predominantly conducted in ophthalmology practices for all sorts of reasons. It’s easier to access a sizable patient base of subjects for the condition in question by going to a retina subspecialist, for instance, rather than a primary care optometrist. MDs also have big staffs capable of running a study, proficiency working with institutional review boards and name recognition with funding sources. There’s also just a lot of inertia that keeps an established system humming along as is.

No, what I mean is the persistent blind spot the ophthalmologist authors of these journal articles have toward the very existence of optometry. The discussion section of a paper is where the researchers put their findings into context. Time and time again, they describe the significance of their work not for eyecare providers or eye doctors or physicians but for ophthalmologists. End of story.

Ophthalmologists overall and the research community in particular pride themselves on adhering to evidence-based principles. And yet, here’s some evidence that seems to escape them:

• Optometrists provide 34% of all medically focused eye exams and 76% of all comprehensive exams when combining routine and medical services.
• ODs outnumber ophthalmologists in the US by more than two to one. In fact, the ratio is fast approaching three to one. Current workforce estimates put the number of ophthalmologists at 17,246 and optometrists at 48,792. That means there are 2.83 practicing ODs for every ophthalmologist right now.
• All the growth in eyecare capacity for decades to come will happen within optometry. A study published last year in Ophthalmology projected a 12% decrease in the ophthalmology workforce by 2035 and the second-lowest rate of workforce adequacy among all medical specialties. Optometry, if anything, may have the opposite problem, as some worry that there’s a glut of optometry colleges.

All this capacity and potential requires diligence from ODs to pursue education and training on medical eyecare. But the ophthalmology profession remains a walled garden that gives ODs the cold shoulder in both practical and symbolic ways. Acknowledging the reality of optometry’s significance in medical care, and being more open to educate the profession, would be in the best interests of both MDs and the patients they serve. 

Many thanks to Richard Edlow, OD, “the Eyeconomist,” for assistance with the statistics mentioned here.