The Health Care Future 18 Years Ago

BauerNow that everyone has gone home early, and it’s just me and the plow guy at the office, I have the chance to reflect on a book that I found browsing nearly 18 years ago at the Strand Bookstore.  It was written by medical economist and health futurist Jeffrey Bauer, Ph.D., and he caught my eye when he wrote:  “Regarding the related insinuation that optometrists simply do not know as much as ophthalmologists, I have from first-hand experience developed considerable skepticism about the scientific base of many things done by physicians.  Several years ago, which means things should have improved in the meantime, I served as an expert witness in a case involving the scientific validity of optometrists’ use of vision training to correct strabismus (misalignment of the eyes).  Ophthalmologists had charged that the optometric research on vision training did not prove that vision training worked.  They were right; some optometric literature on the subject was scientifically flawed.  However, I also evaluated the research that ophthalmologists used to defend their surgical approach to correcting strabsismus.  The literature on surgical correction was no more scientifically valid than the comparable studies on vision training. Physicians living in glass houses should not throw stones.”

You can pick up the second edition of the book, published in 1998, at a very reasonable price through  I’d like to tell you that Jeff’s blueprint for improving relationships between optometry and ophthalmology has come to fruition.  Perhaps to some extent, but there is much room for further improvement.  If you’re a regular reader of the blog, you may recall that some ophthalmologists are still aiming stones from glass houses. Bauer makes another prescient observation (2nd ed. p. 140):  “Nearly all eye care services can be safely provided by optometrists because they are as well educated – arguably even better educated – within their scope of practice as ophthalmologists.” [emphasis added – LJP]

That last point should be emphasized because there are ophthalmologists, particularly select pediatric ophthalmologists, who seem to have a great deal of difficulty acknowledging that optometrists are better educated than they regarding therapy for the developing visual system.  This was reflected in a lengthy exchange that I had with Dr. David Granet contained in this blog post.  Nor is this merely a matter of casual disagreement.  It in fact perpetuates the monopolistic fallacy that Dr. Bauer was addressing in his now classic book.

Forecasting the future in health care is risky business, but Dr Bauer does it with aplomb.

Perhaps Bauer’s suggestion is on the verge of becoming reality, and greater synergy can be forged between our two professions to help patients in need of therapy.


I’m looking forward to hearing the joint presentation at this year’s Annual COVD Meeting by VHG developmental optometrist Nancy Torgerson, O.D., FCOVD, and Thomas Lenart, M.D., Ph.D., on the Collaboration Between Developmental Optometry and Pediatric Ophthalmology.

4 thoughts on “The Health Care Future 18 Years Ago

  1. Len,
    A 9 year old girl recently seen at my office was first seen by a ped’s Ophthalmologist who recommended strabismus surgery for a left esotropia.
    I pushed the plus, added the bifocal, added nasal occlusion at the inner limbus, added base out prism and we shall see.
    Her eyes looked straight at follow-up. You taught me right.
    But, a fellow Optometrist here after seeing a little boy with alternating estropia sent the patient to a general Opthalmologist who prescribed, guess what; bifocals with split the pupil. There you go, an Opththalmologist who gets it and an Optometrist who does not get it. There are good and not so good in both professions.

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