The dog days of summer are an odd time to think about the perennial Christmas staple It’s a Wonderful Life, but that classic movie has been on my mind lately. More than once this year I’ve wondered what the healthcare system would look like if optometry, like George Bailey, had never existed. 

Because, remember, optometry wasn’t a sure thing. The profession’s history is more erratic and idiosyncratic than most. What came to be called optometry grew out of the disciplines of opticianry and ophthalmology, blending aspects of both but not really sanctioned by either. Optometry owes its existence to many forward-thinking pioneers, most notably Charles Prentice and Andrew Cross, who swam against the tide to create it. 

As a result, optometry has been in a defensive posture since its inception. Ophthalmology has been accusing ODs of practicing medicine without a license literally since 1892, when Prentice had the temerity to charge a fee for an eye exam (shocking!) and incurred the wrath of local “oculists,” as physicians specializing in the eye were then called. It’s no surprise, then, to see the “not a doctor” bills introduced in Florida and elsewhere this year to discredit optometry’s standing. The proponents of those bills are spiritual successors to Prentice’s detractors from 130 years ago. 

Anti-optometry acrimony may ebb and flow but never really dies down. With optometric scope of practice expansion happening on multiple fronts right now, the OD-MD fault lines within the wider world of eye care have been more prominent this year than most.

You can see this all over our news section this month, with stories on a scope expansion bill in Ohio and dueling narratives about optometry’s efficacy (touted by the AOA) or lack thereof (naturally, from an ophthalmology analysis) in the delivery of laser procedures.

So, let’s ponder: Prentice and Cross (and countless other agents of change over the last century) never went about the business of creating optometry. Fine, we’ve just reduced the US workforce of eye doctors by two-thirds. The eyecare needs of the 330,000,000 Americans now rest on the shoulders of fewer than 20,000 ophthalmologists. Good luck scheduling grandma’s cataract surgery in under six months with ophthalmologists mired in routine care all day! And what of uniquely optometric endeavors like specialty contact lenses, vision therapy, low vision and now myopia management? Kiss those goodbye. How could the overburdened ranks of ophthalmologists fit those in? They would have needed to cultivate a robust team of midlevel eyecare providers to keep their practices from bursting at the seams.

In other words, if optometry had never existed, ophthalmology would have had to invent it just to keep from drowning in routine care. That’s why I and so many others greet ophthalmology’s many anti-optometry salvos with such indignation. 

I’m not so naïve as to expect a Hollywood ending. The entrenched interests in organized medicine won’t give up ground—even when it’s in their own long-term interests to do so.  Instead of holding back the optometry profession, why not offer constructive support—or at least tacit approval by staying out of the fray—so that better OD-MD integration could flourish, to the benefit of literally everyone involved? That’s a world that looks a lot more like Bedford Falls than Pottersville.