Eye Care Services

Organization of Care

Three types of medical practitioners provide eye care services in the nation: ophthalmologists, optometrists, and opticians. Ophthalmologists are physicians who specialize in the medical and surgical management of the eyes and the visual system. They provide a spectrum of care, including the examination of the visual system to prescribe eyeglasses and contact lenses, as well as the diagnosis and medical or surgical management of eye disorders and diseases. In addition, many ophthalmologists further specialize in a particular section of the eye or disease. Ophthalmologists are medical doctors (MD) or doctors of osteopathy (DO).

Optometrists, also called doctors of optometry (OD), diagnose and treat vision problems, [Page 391]prescribe eyeglasses and contact lenses, diagnose and treat eye diseases, and prescribe medications to treat eye disorders. They do not perform surgery, but they often provide patients with pre- and postsurgical care. Sometimes ophthalmologists and optometrists work in the same practice and comanage patients.

An optician manufactures and fits eyeglasses and, in some states, contact lenses. Many states require opticians to be licensed to deliver these services. Some opticians manufacture eyeglass lenses and contact lenses from raw materials in the laboratory. Office-based opticians cut the laboratory-created lenses to fit into the eyeglass frame. Opticians then take eye measurements to ensure proper lens placement in the eyeglass frame and verify accuracy.

Since there is some overlap in the scope of care offered by ophthalmologists and optometrists, there is no defined organization of eye care delivery. An efficient and effective model is a vertically integrated system with optometrists being the primary entry point into the system with referral to ophthalmologists for more advanced medical care or surgical treatment. This design is widely recognized in studies as showing an enhancement in both eye care delivery and cost-effectiveness of care.

There are an estimated 17,000 practicing ophthalmologists and 33,000 practicing optometrists in the nation. Eye care services provided by them represents more than 5% of the total Medicare Part B payments, or $4.5 billion in 2005. The National Ambulatory Medical Care Survey (NAMCS), conducted by the National Center for Health Statistics (NCHS), reported an estimated 47.3 million outpatient visits to ophthalmologists in 2004. This number does not include hospitalized patients or visits to optometrists. The current supply of eye care providers meets the patient demand; however, the demand for eye care services is artificially low. The demand significantly increases when the number of patients in whom eye care is indicated but not requested is considered. Of the population that is determined to be at high risk of serious vision loss, and which should have yearly eye examinations, less than half have had a complete eye examination in the past year. This shortfall in the provision of eye care services highlights the lack of access to needed care.

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