Defining Scope and Utility of Practice by What is Positive Rather than the Inverse


Ingrid Nelson, a very thoughtful and discerning parent who took the time to comment on the exchange that Dr. Granet and I had  last week, prompted a thought:  We will continue to benefit the public by defining the scope and utility of practice by the positive elements of our respective professions rather than the inverse.  We can start with a very basic illustration.  What is Optometry?  We define ourselves through the AOA as follows:  Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye.

In contrast, take a look at the description of  Optometry on the website of the AAO.  It begins:

The distinction between ophthalmology and optometry is a frequent source of confusion. In addition to the fact that both are concerned with eye care, several other factors contribute to this misunderstanding. One source of confusion stems from the fact that optometrists are often referred to as eye doctors although, unlike ophthalmologists, they do not have medical degrees.

Look again at the discussion that Dr. Granet and I had, or through his Audio-Digest comments through the lens of limitations as opposed to the cost utility or relative value to the patient.  Doing so would lead you to focus solely on the cost of vision therapy, the necessity of prescribed glasses, and so forth, without acknowledging any of the benefits.  Conversely one could focus on the limitations of Ophthalmology training, narrow scope of education in the visual system as related to geometric and physiological optics, vision as related to behavior and performance, and their lack of exposure to patients who have had success through vision therapy beyond orthoptics.

When the patient receives unfiltered and unbiased information about vision therapy, our professions work together to achieve the best possible outcomes.  Is the position of those who focus on the limitations of Optometry a position based on arrogance and ego?  You be the judge.

“Arrogance and ego are real problems in the medical profession,” but good docs welcome involved patients, says Richard Klein, M.D., author of Surviving Your Doctors.  After all, we don’t want to survive despite our doctors’ advice and guidance.  We want to thrive because of it.  That is precisely what Ingrid Nelson and the legions of parents like her will be doing.

– Leonard J. Press, O.D., FCOVD, FAAO

2 thoughts on “Defining Scope and Utility of Practice by What is Positive Rather than the Inverse

  1. Perhaps part of the problem lies in the fact that Americans are health care consumers. When we consumers assume the role of patient, we often forget our duty: caveat emptor, “buyer beware”. It is a cultural assumption that Americans have, to presume that doctors know best and can fix our problems. This is a poor mix when patients are actually shoppers, influenced by our insurance coverage and the services doctors, clinics, and hospitals offer us for sale.

    In contrast with my experiences as an opthalmology and optometry patient, I cannot help but think of my experiences as a dental patient. There was no ego or confusion on behalf of my dentist, when I was a teenager and he referred me to an orthodontist for braces. There was no resentment or hesitation for my dentist, when he referred me to an oral and maxillofacial surgeon to remove impacted wisdom teeth. Clearly there are a variety of “teeth doctors” and they offer different services. No one service will fit every patients’ needs every time.

    From my own experience, the dental community seems clear on the different skill sets they offer, and the dental health benefits for the patient when that patient seeks care commensurate with a particular practitioner’s scope of practice. Maybe it’s because dental patients/consumers would instantly recognize the fallacy of “fixing” a cavity by going to an oral surgeon and having the tooth extracted. Dental patients know that surgery is invasive, expensive, and can fix a lot of things, but not a cavity.

    Ultimately, it’s hard to be an empowered consumer when you don’t know what shops are available. I am certain my father would have investigated vision therapy for me when I was a child, but he didn’t know it existed. I would have chosen it for myself years ago. I am grateful I recently read Sue Barry’s book so I can make that choice for my eye health now.

  2. Excellent points, Sally. There is one significant difference however between the dental field and eyecare field. The specialists you’re referring to all have the same core training in dental school before they go on to specialize. Some hold the DDS degree, some the DMD degree, but none are MDs. Why, then, is the “lack of an MD degree” not raised as an issue as noted above by the AAO? Because there is no practitioner with an MD degree who feels there is overlap with the dental field. I daresay that were there MDs trained as oral surgeons, they would declare the same dominion over the field as Dr. Granet does regarding vision development.

    You hit the nail on the head, Sally, about health care consumers being given informed choices. I’ll visit this again in another blog piece, but suffice it to say that ophthalmologists in general not only withhold the recommendation to see a developmental optometrist, but when the issue is raised by you as a patient they will actively discourage you from pursuing a consult. It’s unconscionable, and patients like you will go back to their MDs at some point after experiencing success through VT and say: “I’m disappointed (if not peeved) that you didn’t suggest I consider vision therapy”.

    Regarding the influence of Sue Barry’s book, I couldn’t agree with you more. It is as inspirational as it is credible. Yet look what Dr. Granet wrote in his comments when I raised the issue of how pediatric ophthalmology lets down patients like Sue:

    “The book you reference is really a discussion for another day. However I have a practice that has a very large adult component. We use orthoptic intervention all the time as well as surgical and have recovered stereo acuity in some that were told they’d never have it. They just don’t write books. We carefully investigate all options before intervening.”

    In other words, he’s hinting that he has a problem with Sue’s book, and I would really love to hear from him as to what that problem is. Otherwise I’m left to speculate that his primary concern is that it inspires patients like you to seek the services of developmental optometry.

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