The evolving interface between ophthalmology and optometry

Abstract

Ophthalmologists and optometrists have a similar mission: the provision of high‐quality, cost‐effective ophthalmic healthcare to the population whom they serve. Each profession's respective focus of special expertise provides the basis for traditional pathways of patient referral, e.g. from optometrist to ophthalmologist (where surgery, such as that for cataract, will bestow most benefit) or from opthalmologist to optometrist (where low vision aids are the patient's only respite from degenerative macular disease). This interface (or common boundary) between these two ophthalmic specialties at the point of patient referral thus represents ‘an opportunity for positive interaction’. In the past, there was also evidence of that interface representing ‘a state of mutual interdependence’, whereby optometry undertook opportunistic population screening (or case finding) and provided a primary source of help for general practitioners (given the gross inadequacies of the HES), while ophthalmology constituted a major provider (after providence's bounty of myopia and presbyopia) of much good business by way of correction of aphakia. But waiting list initiatives, lens implants and refractive surgery threaten to change all that.Furthermore, the vacuum in eye care left by patients' primary healthcare providers, through their general practitioners' lack of confidence and competence in all matters ophthalmological, has created a basis for potential conflict between the professions‐‐a ‘negative interface’ of antagonism, if not hostility‐‐when considering community ophthalmology. Thus, as the NHS (and with it the HES) becomes progressively more commercialised and fragmented (‘much like the GOS’, some would say), will patients' best interests be served by interprofessional rivalry (with the potential to bring out the worst in College rhetoric and obfuscation) and by naked commercial competition instigated by healthcare commissioners? Is ‘shared care between HES and GOS’ a non‐starter, or do other areas of mutual interdependence‐‐especially research and teaching‐‐provide opportunities to bypass undesirable obstructions to sensible debate and the realisation of each profession's reasonable aspirations?