While eye “exams” have been part of the vernacular of patient visits over the decades, we believe the time has now come to abandon this very limiting, antiquated terminology. 

As technology and the Internet continue to evolve, optometric dispensary revenues will continue to be reduced. To wit, we have a friend who just recently obtained four pairs of single-vision glasses from Zenni Optical for about $125. These types of consumer-focused deals will become more common going forward and will negatively impact optometric and ophthalmological optical services, as well as that of stand-alone optical stores. No OD needs to be reminded of what retailers like Warby Parker and 1-800-CONTACTS have done to the profits from sales of optical goods. Furthermore, optometrists need to be aware that ophthalmic technicians and opticians are eagerly pursuing training in refraction techniques as they—like us, we must admit—pursue an expansion of their professional scope.

What does all this have to do with the eye “exam”? If we want to maintain our traditional standard of living, we need to portray ourselves as more than just “exam” providers, for many reasons, including our optical revenues being at risk. A major way to do this is to let the public know we do more—a lot more—than just eye “exams.” 

We suggest two key ways to do this: 

First, immediately stop referring out patients for medical eye care to surgeons if it is within your purview. They don’t want to see these patients, but they do so to keep your goodwill for the surgical referrals you also make! 

Second, immediately start to tell every one of your patients that, in addition to routine eye care, you provide comprehensive medical eye services. Most people still think optometrists only “examine” eyes for glasses and contacts, and that if you have an eye problem, you need to see an ophthalmologist. It is important that the public learns more about what we actually do, and you are the best one to explain it to them! 

Since most people who present to you are likely there for traditional eye exams, they passively assume that is what you do. While this assumption is logical, it is incorrect. Tell each of your patients, “If you ever have any eye or vision problem, call me first!” 

We have seen hundreds of new patients over the years who have trichiasis, vitreous detachments, dry eye, blepharitis, ocular allergy and a wide variety of red eyes (including a huge number of subconjunctival hemorrhages); the list goes on and on. We notice that most have nice eyeglasses and are new patients to us because they felt they needed to see an ophthalmologist but were worked into our schedules. Again, eye surgeons have little or no passion for seeing patients with these routine medical eye problems. We always ask these patients for the name of their previous eye doctor; almost invariably, they give us the name of their optometrist, whom they hold in high regard. 

In trying to always advocate for our profession, we tell these patients that their optometrist could have provided care for their current problem. The patient’s typical answer is, “Oh, no! They just do eye exams.” This is an erroneous supposition that needs to be corrected immediately. If we genuinely care for our patients, it is our duty to let them know that we are comprehensive eye doctors. If we do not promote our services, no one else will. 

Do note that while routine eye examinations are a significant portion of comprehensive eye care, the two terms are not exclusively synonymous!

For example, it is increasingly common for companies that tout “telehealth” services to claim such efforts provide a comprehensive eye exam. They do no such thing, even when administered in person by a technician while an OD observes remotely. Unless that tech knows their way around a condensing lens, an ophthalmoscope and any number of other instruments, the patient is not receiving comprehensive care. If people want to take advantage of remote medical services, that’s their right, but they should only do so with a clear understanding that they are sacrificing thoroughness for convenience.

Fortunately, we noted with some relief that the American Optometric Association recently began using the phrase “all patients deserve comprehensive eye care” in its most recent public education outreach (the current campaign geared toward video game enthusiasts). That’s a step in the right direction—let’s all be sure to stay on message, too.

To end with a cautionary tale, be aware of a recent incident we learned of at a hospital emergency department. An ophthalmologist taking call in the emergency department over the weekend filed a complaint against five optometrists. She indicated she was called in on five patients under different optometrists’ care with mundane concerns such as renewal of medications, contact lens issues and similar run-of-the-mill stuff. All the optometrists in question had voicemail messages instructing their patients, “If you have an eye emergency, go to the nearest ER.” The ophthalmologist filed a complaint to the Board alleging these optometrists were not taking care of their patients. The Board addressed this with an immediate call to action that the ODs should take call for their practices and answer their patients’ inquiries.

Such incidents do a disservice to the public and the medical community. It’s time for us to stop being reactive to circumstances like those discussed throughout this missive and instead take control of our own destinies, as individuals and as a profession.

—Randall Thomas, OD, MPH, Ron Melton, OD, and Patrick Vollmer, OD

Drs. Thomas, Melton and Vollmer all practice in North Carolina and have been tireless advocates for optometric adoption of comprehensive eye care in their lectures and publications, including the annual supplement Clinical Perspectives on Patient Care, published this month. 

Don’t Overlook Diet

It seems that every article I read concerns eye diseases and what drug to use on them. Too little attention is given to the patient’s physical condition, their medical history, the drugs they are presently using or even their age. These all play a huge role. I also like to know the diet of the patient. Jack LaLanne—the guru who advocated for Americans to take control of their health through a good diet and regular exercise—always stressed the effects of a person’s diet on their physical and mental health.

I like to know the reason for a patient’s eye conditions, and that includes their history of diet and exercise (if any). In other words, I want to know the cause of their condition rather than just how to treat it with a drug.

I ask my patients what they eat for breakfast, lunch and dinner. When what they describe amounts to a junk food diet, I tell them to do their best to stop the coffee, soda, alcohol and processed foods, and just eat mostly fruits, green veggies, fish and whole grains.

Of course, I realize that patients want a quick fix. Likewise, most doctors are only interested in treating the problems rather than finding the cause of it. So, doctors never seem to ask the patient what they eat or drink—or even care.

I heard a lecture recently where the MD said he tried all these different drugs, which didn’t improve the condition, and he didn’t know what to do now. I asked him about the patient’s diet and he said that’s a good question but he doesn’t do that. 

I am 82 years old, still in practice, take no drugs, follow my own advice—and am in great health. I tell my patients to do what I do. Healthy, organic food is the medicine I tell my patients to take. They listen to me, but most probably just continue to eat and drink the same.

Good, sustainable, long-term health requires effort and attention, from doctors and patients alike.

—Edward Soss, OD

San Francisco

Clearing Up Hallucinations

I appreciated the article “Visual Hallucinations in the Dementia Spectrum” in the May 2022 issue. In the past, I have had patients complain about visual hallucinations, and I now feel better equipped with some of the science and research explained in the article.

—Katrina Tomsen, OD

Norfolk, NE

An Injection of Facts

I am a neurointerventionalist and director of two comprehensive stroke programs. I recently came across a news story in your publication from late last year entitled, “CRAO Rare But Possible After Cosmetic Procedure.” The article describes a case report of a patient who experienced ophthalmic artery occlusion following a cosmetic dermal filler injection to the glabellar region.

 The doctor’s explanation of how it could have happened—injection into the anterior communicating artery—is impossible and wrong. The likely mechanism by which this could happen is injection into the veins and the patient, by bad luck, having a patent foramen ovale (right to left shunt). Injection into the artery would never get into the cerebral circulation or the ophthalmic artery. 

—Reza Malek, MD

San Jose, CA

To comment on these discussions, or start your own, write to editor@reviewofoptometry.com.