It has been said “A specialist is a person who knows more and more about less and less….. Until he knows every thing about nothing.” It has been also said “A generalist is a person who knows less and less about more and more….. Until he knows nothing about every thing.”
Of course these definitions carry to the absurd the two polar end extremes in practice. However ODs seem to love the words “a specialist”. Look in any yellow pages or for more contemporary ODs, a web site and you will see the terms “Vision Care Specialist” or “Contact Lens Specialist” or “Specializing in Hard to Fit Contact Lens Patients” or any other Optometric Specialty where the practitioner feels there is superior knowledge or skill.
What do these terms mean? Who conferred this aura of expertise on these individuals? Have there been or are there now true specialists? There was a time not too long ago, from 1955-1975 when there were practices “Limited to Contact Lens Care”. True specialty offices that only accepted Contact Lens Patients.
These practices fell into two categories. The commercial practices were corporate entities that hired ODs and patients were solicited by advertising. These practices resembled the Refractive Surgery Centers of today. The only difference was that price advertising and mention of superiority was illegal then. No restrictions like that apply now.
The other category of “Contact Lens Specialists” were private practice ODs that could not advertise. The rules of ethical practice promulgated by the AOA in the 1950s and 1960s made it unethical, though not illegal to advertise or practice under an assumed name. The way to build your “Limited Practice” was by patient word of mouth referrals due to your expertise or professional referrals by ODs, OMDs and Opticians.
Most eyecare practitioners felt ill equipped to fit the Scleral and PMMA corneal lenses that were the only options in the early years. As a result if a “ Limited Practice” were not competing in services offered, they would refer these time consuming patients. There were some major specialty Contact Lens practices sprinkled throughout the larger cities in the United States, Canada and other parts of the world.
These “Contact lens Specialists” were the pioneers and made major contributions to the Art and Science of Contact Lens Care. Unfortunately some of these ODs have passed on but happily many are still active and contributing. Some are members of Seniordoc.org and perhaps they will share their experiences with us on the web site.
In the early days Contact Lens training in Optometry Colleges was minimal. Practitioners received their training on the job, either working in a commercial Contact Lens Establishment or taking an apprenticeship (before the word Residency came into vogue) with an experienced OD with a “Limited Contact Lens Practice” or at least someone with a significant number of Contact Lens patients.
When these younger ODs went out on their own some combined their “Limited Practice” with Contact Lens Manufacturing, before the FDA was involved in the process, forcing major investments in facilities. When their labs became successful some left private practice to manage the Laboratory. Others went into teaching to supplement their income and combined two careers of Education and Private Practice. Others were able to develop specialty practices that were Optometric showcases.
Until 1975, private “Limited Contact Lens” practices represented the very best in Optometry. What happened to them?
In a word, Hydrogel Lenses and the subsequent commercialization and trivialization of contact lens care. ODs and the less busy OMD s began fitting these lenses in their own practices. As a result the referral pool, which is the lifeblood of specialty practice, began to dry up.
A few fortunate Contact Lens Specialty Practices in the very large affluent cities with a large well to do patient base, not only survived but also thrived. The smaller practices began to practice primary care in addition to contact lens care, with the cash cow of designer eyeglasses showing a far greater profit margin than the devalued contact lens.
How could a limited practice that was the pride of Optometry 30 years ago be duplicated today? Are there areas in Optometry where ODs feel unqualified to offer a service? I believe so.
Our web site has had several discussions that many of the younger ODs are no longer doing the functional vision testing, that traditional ODs who offered a complete visual evaluation felt is so important. Is the rationale “Why test for it if I can’t do any thing about it?”
Suppose there was a Vision Therapy Center that offered care where your patients would be returned to your office for Primary Care after the treatment was completed. This Center would offer highly trained and Board Certified ODs combined with very competent Technical Assistants. Would there then be an increased desire on the part of the Primary Care OD to do functional testing?
Should this Vision Therapy Center also offer skills training for Athletes? How about increasing reading skills and speed for busy executives? Is there enough to do profitably for the Vision Therapy Specialist? You bet there is!
The same can be said for a Low Vision Specialty practice. With the influx of Baby boomers into the Low Vision Age Group there will be a market.
If the OD does not fill the void for these needed specialties there are other disciplines that are ready to step in. Shame on us as profession, if we allow that to happen.
This article is not meant to offer answers but to ask questions and begin a dialogue among our members who cover the spectrum of clinicians, educators, and editors. Many are organizationally active. The first part of the discussion is to determine if there is a need. As a web site administrator and occasional C/E speaker, I am no longer in a position to make that judgement.
If a need exists then we must look to the medical model of residency in a specialty, leading to Board eligibility and then to Board Certification. The specialist should be willing to devote most professional time to that specialty to maintain proficiency. The profession should be willing to refer patients, to be certain the specialist is financially remunerated for the additional time and training needed for the specialty.
When this is accomplished our profession will have taken the next logical step in the maturation process. This will benefit both the public and the profession.
I hope you will express your opinions on our State of Optometry Forum.”
Of course these definitions carry to the absurd the two polar end extremes in practice. However ODs seem to love the words “a specialist”. Look in any yellow pages or for more contemporary ODs, a web site and you will see the terms “Vision Care Specialist” or “Contact Lens Specialist” or “Specializing in Hard to Fit Contact Lens Patients” or any other Optometric Specialty where the practitioner feels there is superior knowledge or skill.
What do these terms mean? Who conferred this aura of expertise on these individuals? Have there been or are there now true specialists? There was a time not too long ago, from 1955-1975 when there were practices “Limited to Contact Lens Care”. True specialty offices that only accepted Contact Lens Patients.
These practices fell into two categories. The commercial practices were corporate entities that hired ODs and patients were solicited by advertising. These practices resembled the Refractive Surgery Centers of today. The only difference was that price advertising and mention of superiority was illegal then. No restrictions like that apply now.
The other category of “Contact Lens Specialists” were private practice ODs that could not advertise. The rules of ethical practice promulgated by the AOA in the 1950s and 1960s made it unethical, though not illegal to advertise or practice under an assumed name. The way to build your “Limited Practice” was by patient word of mouth referrals due to your expertise or professional referrals by ODs, OMDs and Opticians.
Most eyecare practitioners felt ill equipped to fit the Scleral and PMMA corneal lenses that were the only options in the early years. As a result if a “ Limited Practice” were not competing in services offered, they would refer these time consuming patients. There were some major specialty Contact Lens practices sprinkled throughout the larger cities in the United States, Canada and other parts of the world.
These “Contact lens Specialists” were the pioneers and made major contributions to the Art and Science of Contact Lens Care. Unfortunately some of these ODs have passed on but happily many are still active and contributing. Some are members of Seniordoc.org and perhaps they will share their experiences with us on the web site.
In the early days Contact Lens training in Optometry Colleges was minimal. Practitioners received their training on the job, either working in a commercial Contact Lens Establishment or taking an apprenticeship (before the word Residency came into vogue) with an experienced OD with a “Limited Contact Lens Practice” or at least someone with a significant number of Contact Lens patients.
When these younger ODs went out on their own some combined their “Limited Practice” with Contact Lens Manufacturing, before the FDA was involved in the process, forcing major investments in facilities. When their labs became successful some left private practice to manage the Laboratory. Others went into teaching to supplement their income and combined two careers of Education and Private Practice. Others were able to develop specialty practices that were Optometric showcases.
Until 1975, private “Limited Contact Lens” practices represented the very best in Optometry. What happened to them?
In a word, Hydrogel Lenses and the subsequent commercialization and trivialization of contact lens care. ODs and the less busy OMD s began fitting these lenses in their own practices. As a result the referral pool, which is the lifeblood of specialty practice, began to dry up.
A few fortunate Contact Lens Specialty Practices in the very large affluent cities with a large well to do patient base, not only survived but also thrived. The smaller practices began to practice primary care in addition to contact lens care, with the cash cow of designer eyeglasses showing a far greater profit margin than the devalued contact lens.
How could a limited practice that was the pride of Optometry 30 years ago be duplicated today? Are there areas in Optometry where ODs feel unqualified to offer a service? I believe so.
Our web site has had several discussions that many of the younger ODs are no longer doing the functional vision testing, that traditional ODs who offered a complete visual evaluation felt is so important. Is the rationale “Why test for it if I can’t do any thing about it?”
Suppose there was a Vision Therapy Center that offered care where your patients would be returned to your office for Primary Care after the treatment was completed. This Center would offer highly trained and Board Certified ODs combined with very competent Technical Assistants. Would there then be an increased desire on the part of the Primary Care OD to do functional testing?
Should this Vision Therapy Center also offer skills training for Athletes? How about increasing reading skills and speed for busy executives? Is there enough to do profitably for the Vision Therapy Specialist? You bet there is!
The same can be said for a Low Vision Specialty practice. With the influx of Baby boomers into the Low Vision Age Group there will be a market.
If the OD does not fill the void for these needed specialties there are other disciplines that are ready to step in. Shame on us as profession, if we allow that to happen.
This article is not meant to offer answers but to ask questions and begin a dialogue among our members who cover the spectrum of clinicians, educators, and editors. Many are organizationally active. The first part of the discussion is to determine if there is a need. As a web site administrator and occasional C/E speaker, I am no longer in a position to make that judgement.
If a need exists then we must look to the medical model of residency in a specialty, leading to Board eligibility and then to Board Certification. The specialist should be willing to devote most professional time to that specialty to maintain proficiency. The profession should be willing to refer patients, to be certain the specialist is financially remunerated for the additional time and training needed for the specialty.
When this is accomplished our profession will have taken the next logical step in the maturation process. This will benefit both the public and the profession.
I hope you will express your opinions on our State of Optometry Forum.”
Last edited by a moderator:
