Lee et al1 succinctly described the distribution of the supply and need for subspecialty ophthalmologists in the optometry-first model: all care that optometrists are "legally entitled to perform" should be provided by optometrists, and ophthalmologists should provide "only care that optometrists could not perform, mainly laser and incisional surgery." The supply of neuroophthalmology subspecialists reported was 279 fulltime equivalents (FTEs) and the need was 248 FTEs. In the optometry-first model for neuro-ophthalmology, the FTE supply is 34 and the need is 14 FTEs! I wonder if the authors could comment on the validity of an optometry-first model meeting the special needs of the unique, complex, and difficult case mix of neuro-ophthalmology. It does not seem valid to equate the legal definition of optometric care with high-quality neuro-ophthalmic diagnosis, treatment, and management. Could the authors comment on the basis for such an equation? Is it realistic or valid to assume that neurologists, neurosurgeons, and other medical specialists treating neuroophthalmic patients would use an optometry-first model for neuro-ophthalmology? Is there evidence to support the optometry-first model for neuro-opthalmology at all? While I applaud the work of the authors in providing this analysis for future planning of the desirable characteristics of an eye care system, I am concerned that the data may be misconstrued or misapplied without further clarification and discussion regarding the assumptions for neuro-ophthalmic care in an optometry-first model.
Lee AG. Subspecialties in Ophthalmology. Arch Ophthalmol. 1999;117(2):287-288. doi: