Overview of starting your own Medical Optometry Practice:

  • Joint Management of Cataract Surgery by Ophthalmologists (MD) and Optometrists (OD) in the U.S. 2012 and 1013. Can we do better?

An article was published recently examining cataract extraction (CE) co-management rates between Optometrists (ODs) and Ophthalmologists (MDs) for the 27 million medicare beneficiaries in the U.S., Puerto Rico and the District of Columbia. (It does not  include the 28% of Americans > 65 years old in Medicare Advantage programs or the 19% of cataract extractions (CE) performed on Americans < 65 yo). This is a very large patient base. This article was published in the journal “Ophthalmology” (Erie JC, Hodge DO, et al. Joint Management of Cataract Surgery by Ophthalmologists and Optometrists. Ophthalmology 2016; 123: 505-513). I asked for copyright privileges to reprint the whole article here but they wanted a fee for it.

  • Approximately 1 in 10 patients nationwide had their CE surgery co-managed in this study. Prior estimates were between 15% to 24%.

[1) Eye Care Workforce Study: Supply and Demand Projections. Prepared by the American Optometric Association and the Association of Schools and Colleges of Optometry. St. Louis, MO: The Lewin Group, Inc. April 25, 2014. 2) Bass EB, Sharkey PD, Luthra R, et al. Postoperative management of cataract surgery patients by ophthalmologists and Optometrists. Arch Ophthalmol 1996;114:1121–7].

20% of co-management ODs did 10 or more co-management patients per year with male ODs having a higher rate than female ODs (P < 0.001. I don’t know why this was singled out for analysis). 81% of ODs in a 2012 survey reported co-managing CE.

[Report on the 2012 National Eye Care Workforce Survey of Optometrists. Prepared by the American Optometric Association and the Association of Schools and Colleges of Optometry. St. Louis, MO: The Lewin Group, Inc. March 24, 2014

But, in this study only 24% of co-managing ODs did 10 or more per year. I am not too surprised by this low rate of > 10 per year knowing how much the average Optometrist’s income is derived from routine eye exams and glasses sales. Can Optometry do better? Do they want to? Isn’t co-management of CE an easy foray into medical services by ODs? What about devoting your whole practice to performing medical services only? The responce from Optometrists wanting to build their own medical only practice has been slower than I had anticipated. I realize the “out of the box” thinking this requires from both the OD and MD, but I haven’t given up yet. I’ll have to rethink how to get more ODs involved in medical services. My book should be coming out soon from Lulu covering the medical knowledge an OD needs to master in order to build their own Medical Optometry Practice. Don’t forget, an Ophthalmology consultant will be sued for any medical services malpractice you, the OD, does which is why few, if any, Ophthalmologists consult medical patient care with Optometrists and why a baseline, Ophthalmology based medical knowledge book is necessary (IMHO).

Interesting facts in this study; of the 17,214 Ophthalmologists submitting Medicare claims in 2013, 55% submitted claims for > 10 CE per year. Of the 26,282 Medicare participating ODs, 20% co-managed CE for > 10 per year. (The vast majority of Ophthalmologists are participating in Medicare). Approximately 6,000 ODs work in Ophthalmology practices [United States Department of Labor, Bureau of Labor Statistics. Occupational Handbook, 2012 Edition Optometrists. Available at:]. I’ve attached the excel spread sheet for this here with line #22 having the 6,100 figure: 

Here are some projections on the supply and demand for Ophthalmology (their data, my graph) until 2020 by the Department of Health and Human Services (DHHS).


There are fewer full-time equivalent (FTE) Ophthalmologists than supply of Ophthalmologists since some Ophthalmologists don’t work full time. Here is the complete document.

Here is a graph of the projected US population growth as predicted by DHHS.


You can see that the aging population > 65 years old is growing increasingly faster than the general population and hence the demand for Ophthalmology services will not keep up with projected demand. This is where a Medical Optometry Practice can step in. An Ophthalmology consultant, which has to be licensed in your state and is open to malpractice lawsuits from what you do, can help you fill this void. I’ve included the need for support staff per full-time equivalent (FTE) Ophthalmology projections as well


Preferred Practice Patterns by the American Academy of Ophthalmology:

(All Articles are Copyrighted from the American Academy of Ophthalmology or Elsevier)

Most Recent Articles are on the Bottom


Here are some interesting articles covering the marketing of a practice:

Here is an article that addresses billing:

Here are some articles addressing malpractice issues:

Just for Fun:

It's been said, "Great minds discuss ideas; average minds discuss events; and small minds discuss people." -Eleanor Roosevelt

Here are some interesting clinical scenarios, click to view:

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