SECO Presentation Advocates for Medical Approach to Optometry

Ron Melton, OD, and Randall Thomas, OD, are not your average optometrists. They’re nationally known for their envelope-pushing lectures and comprehensive publications. They are ambassadors of the profession and longtime advocates for its growth. Expanding optometry’s reach has always been their raison d’être, and even now, decades into their careers, the pair has not lost a step. 

Their presentation to the annual meeting of the Southeastern Educational Congress of Optometry (SECO) 2021, held in Atlanta from April 28 to May 2, started with a discussion, not of the traditional but of the technological.¹ They offered prognostications about the coming applications of artificial intelligence, how optometrists could actually benefit from (not be threatened by) digital refraction, and the improvements in care devices such as at-home intraocular pressure monitoring can bring. 

They also delved into the philosophical, calling on optometrists to see beyond refraction and use their position to enhance public health through medical eye treatment. “If someone broke into our practices one night and stole our phoropter, we should still be able to see most patients” said Dr Thomas. “You need to start shaping your practice to be the medical practitioner of the eye.” 

What we need is the will and the determination to keep patients in our practice. 

Glaucoma. The presenters discussed several areas where optometry can improve its treatments and offer patients a broader range of care. The first area where Dr Melton thinks optometrists need to improve is in glaucoma care. “Eighty percent of glaucoma scripts in optometry are written by 20% of ODs, and the other 80% of ODs are managing very few glaucoma patients therapeutically. Obviously, dry eye and glaucoma are 2 areas where the patients are there for us.” 

Dr Melton explained that because glaucoma patients require such frequent monitoring and glaucoma specialists are frequently overbooked, “There’s a big need for optometrists to step in and fill this role.” That’s where technologies such as at-home tonometry readings come into play. “Two-thirds of patients experienced peak IOP outside of regular clinic hours, with peak IOP most frequently occurring at night.” 

“We recommend obtaining multiple IOP measurements outside of office hours,” Dr Thomas added. In fact, the team suggested, pressure measurements in optometrists’ offices need an update altogether. “The only place where a puff tonometer belongs is in the Smithsonian,” Dr Thomas said, instead opting for a handheld noncontact tonometer. “Your contact lens technician can easily teach most patients how to perform this technique,” according to the optometrists.

To Refer or Not to Refer. Decades ago, optometry may have been considered a detect-and-refer discipline. Today, Dr Thomas said, “refer is a 4-letter word.” He advocated for optometrists to not only practice to the highest level they are permitted by state regulations, but also to communicate with other clinicians and offer their opinions. 

The crux of optometric care today is medical treatment, the speakers suggested. And many presentations now can be treated therapeutically. For instance, a new drug, teprotumumab, has demonstrated an approximately 2.5-mm reduction in proptosis for more than 75% of patients who used it, creating a new prescribing opportunity for optometrists.²

Medical oversight, too, is within optometry’s wheelhouse. For instance, Dr Melton said, approximately half of patients prescribed hydroxychloroquine are overdosed. The recommended dosage for this increasingly-applied drug is 5 mg/kg a day. But, “new data using modern retinal imaging techniques identify the prevalence of hydroxychloroquine retinopathy at around 7.5% in patients taking the drug for more than 5 years, increasing to 20% to 50% after 20 years.”³ 

Clinicians in optometry need to take the reins in assuring the health of the retina for these patients, the presenters suggested. In addition to providing long-term monitoring, optometrists can sometimes treat patients having acute emergencies. 

Dr Thomas advised, “If you want to really care for your patients, let them know ‘if you ever have a medical eye problem, call my office.’ You don’t want patients to go to an emergency room. Have them call you. Be available. If you have a dental emergency or a painful tooth, you’re going to call your dentist with the expectation of receiving care in a timely manner. Why should our patients have any less expectations from their eye doctor?”

“I saw a patient who went to an emergency room with a foreign body sensation and the ER doctor was trying to remove what turned out to be an iris nevus. That’s why, if you love your patients, you see them,” Dr Thomas added. “The American population needs to know, if you have an eye problem, you go to an optometrist, not the emergency department.”

As they do each year at SECO, Drs Melton and Thomas offered both their deep knowledge of the latest drug information available and their views on how to apply that to better serve patients.

References

1. Melton R, Thomas R. Special session: clinical perspectives in patient care. Presented at: Southeastern Educational Congress of Optometry (SECO) 2021 Annual Meeting; April 28-May 2, 2021; Atlanta, GA. Course 61.

2. Douglas RS, Kahaly GJ, Patel A, et al. Teprotumumab for the treatment of active thyroid eye disease. New Eng J Med. 2020;382(1):341-352. doi:10.1056/NEJMoa1910434. doi:10.1056/NEJMoa1910434 

3. Marshall E, Robertson M, Kam S, Penwarden A, Riga P, Davies N. Prevalence of hydroxychloroquine retinopathy using 2018 Royal College of Ophthalmologists diagnostic criteria. Eye (Lond). 2021;35(1):343-348. doi:10.1038/s41433-020-1038-2