Optometrists may usher in real preventive medicine in eye care. For the most part prevention in modern medicine consists of early detection and treatment of measurable pre-disease states (cholesterol, blood sugar, etc.) or symptomatic disease (in this case, visual decline). The primary objective of modern medicine is to seek out and find more disease to treat, not prevent disease from occurring in the first place. There are no financial rewards for real disease prevention.
A recently published report reveals optometrists are on par with ophthalmologists in regard to accurate diagnosis of macular degeneration. The number of sight-threatening errors made by optometrists and ophthalmologists was virtually indistinguishable from ophthalmologists, with each group making such an error in approximately 6% of cases. [Medscape Oct 6, 2016; British Medical Journal Open 2016] However, another published study came up with less favorable results. [Journal Royal Society Medicine Aug 2011]
Whether optometrists will be licensed to inject medicines in the eye to treat the most advanced stage of this disease is unknown. In some other countries, nurses safely inject medicine into the eye. [Eye 2014] So why not optometrists?
But this is treatment of disease when the field of eye care may be headed toward averting the progression of this disease altogether, before visual decline is symptomatically experienced by the patient or aging changes can be detected in the eyes.
Optometrists have opportunity to usher in real preventive medicine and will have incentive to do that if their license is NOT expanded to perform invasive injections, given that clinicians gravitate towards tests and treatment that are the most rewarding financially.
A testing device is now available that can predict macular degeneration 3 years prior to visual disturbances or observable disease changes at the back of the eyes. As eyes age, the inability to refill visual chemicals (rhodopsin) at the back of the eyes after they have been bleached out by a flash of bright light is predictive for macular degeneration. Typically health eyes regain their ability to see in dark environments within 5 minutes after a bright flash of light.
Subjects who will develop macular degeneration require a longer adaptation time. [EyeTubeOD] This dark-adaptation test is performed by a device called ADAPT-Dx. It is a 20-minute eye test. [Journal Ocular Biology Diseases Informatics March 2008]
However, this test is like knowing being told when you will die. What can you do to delay or altogether avert the onset of macular degeneration before it becomes macular degeneration? The race is on to develop a dietary, sun-filtering and nutraceutical intervention to waylay the disease.