Optometrists should be available to health plan patients.

Byline: GUEST VIEWPOINT By Jeffrey Morey For The Register-Guard

Oregon optometric physicians have seen a steady broadening in the scope of their practice and services over the past two decades. It's time insurance practices caught up with this trend.

Doctors of optometry are the main providers of primary vision care. They examine, diagnose, treat and manage diseases and injuries of the eye and visual system. Optometric physicians have their own professional education system separate from medical schools, similar to dentists: four years at an accredited college of optometry, which concentrates on studies of the eye, the visual system, optics, biochemistry, systemic disease and pharmacology. Graduates attain a doctor of optometry degree, or O.D.

The Oregon Board of Optometry, established in 1905, is the state agency responsible for licensure and for the enforcement of optometric statutes and administrative rules. Every Oregon doctor of optometry must complete 18 hours of continuing education each year for license renewal, a requirement not matched even for general medical physicians in our state.

Board-certified optometric physicians use any means of eye treatment other than laser or invasive surgery, deep injections or general anesthesia. They have been prescribing topical medications since 1991. In 2001, Oregon joined most other states in expanding this to include oral and certain injectable medications as well.

Doctors of optometry work closely with primary care providers and specialists to help patients with systemic conditions that can affect the eyes. Many also co-manage patients with ophthalmologists (medical physicians who specialize in eye and vision care, including surgery) in order to provide eye care before and after eye surgeries. Doctors of optometry also provide exams for glasses or contact lenses.

Optometric services for routine eye exams are covered by most vision benefit plans. Optometric services for non-routine medical eye care are covered by most major medical eye care insurance plans. Most optometric physicians are providers for the larger insurance companies, as well as Medicare and many other plans. Most have also been providing both routine and medical eye care for Oregon Health Plan patients.

The situation is somewhat different in Lane County, where the Lane Individual Practice Association administers the Oregon Health Plan for approximately 28,000 enrollees. Due to a long-standing LIPA policy, opto- metric physicians are tightly restricted in their abilities to provide medical eye care for their health plan patients. Despite pleas for change, LIPA's position is that local health plan patients should see ophthalmologists exclusively for anything other than routine vision exams and glasses.

Many Eugene-Springfield ophthalmologists have repeatedly asked LIPA to change the way it restricts the care of optometric patients. In a letter to LIPA, one ophthalmology group said: "We would like to express our concerns regarding LIPA's blocking of optometry in seeing and treating medical patients within the scope of their licensure. We request that LIPA apply the same standards of professional access to all non-physician health care providers ... in addressing the eye care needs for the whole community."

Another ophthalmologist wrote: "Personally, I feel it is a waste of my skills and time spending it doing primary eye care for the general public when optometrists are capably trained to do so."

In the current precarious health insurance climate, our state and nation have a vital need for a fair and uniform system of providing care for all persons. As both taxpayers and health care providers, Eugene-Springfield optometric physicians feel it is unfortunate that LIPA restricts Oregon Health Plan patients who require medical eye care to seeing eye specialists exclusively rather than optometric physicians, who in many cases could have provided more convenient, less costly care.

Optometric physicians believe that patients with medical insurance or a vision benefit should have the freedom to be treated by the eye care provider of their choice.

Optometric physicians also believe that covered eye benefits and procedures should be reimbursed at equal rates with ophthalmology for all services that fall under the scope of optometric licensure and training. Many progressive insurance carriers and administrators have recognized this and have ended past policies that prevented patients from exercising their freedom of choice. As managed care contracts have become less common over the last year, the situation has indeed improved locally. But the LIPA-administered state contract demonstrates that there is yet room for improvement.

Jeffrey Morey, O.D., is a member of the Lane County Optometric Society. Twenty-nine of his colleagues co-signed this column.