Editor’s note: In December’s “Chairside” column, Montgomery Vickers, OD, shared his experiences working with a traveling nursing home practice. You can read his column at www.reviewofoptometry.com/content/c/58445/.

The topic Dr. Vickers selected for his December column, in my view, touched on a huge unmet need and a horribly underserved population: eye care in skilled care facilities. My practice was limited to providing the full scope of eye care for patients in skilled care facilities and, for more than 15 years, I tried to stimulate optometrists to be more involved with this population. Dr. Vickers’ personal experience in skilled care facilities has clearly brought into focus (pardon the optometric pun) his appreciation of the problem.

According to 2009 demographic data, approximately 80% of patients in skilled care facilities nationwide were receiving no eye care. We have the most advanced technology in our practices, most of which can be miniaturized and mobilized, but our practices today are driven by chair time and cost effective measures that discourage us from much dialog with our patients and showing them the compassion they so desperately need and deserve. The highest endemic vision problems reported in skilled care facilities can be treated; however, the the medical staff in these facilities simply does not have the skills to provide the care. Eye care is not mandated in skilled care facilities, so most do not offer the service in-house, and patients that have been managed effectively for their entire ambulatory life for diabetic retinopathy, glaucoma, macular degeneration or even cataracts are lost to follow up and are unnecessarily exposed to catastrophic vision loss.

For 15 years I tried to make a difference one patient at a time, like most eye care providers, and managed to make an impact in my community. However, the problem can only be solved through a public health policy approach that mandates eye care in all skilled care facilities.

We are trying to make a difference now through our Public Health and PhD programs at Salus University, and maybe I will see this change in my professional lifetime—but it will take a broad collaborative approach and professionals like Dr. Vickers, who makes a unique contribution through his humor and insights.

We will keep the fires burning and hopefully, with enough motivated people like Dr. Vickers voicing concern, we will get the attention necessary to help these people before they lose all useful vision.

Thank you, Dr. Vickers, for making our fellow optometrists a little more aware of how important these wonderful patients are and what a difference optometry can make in helping them with the dignity they deserve.

—William A. Monaco, OD, MSEd, PhD, associate dean of Biomedical Sciences PhD Program and MPH Programs at Salus University.

Dr. Vickers responds: 
I have gained so much as a clinician and healer by joining Dan Shropshire, OD, and his wonderful nursing home mobile practice here in the Dallas/Fort Worth area. As you have said, this is a growing and grossly underserved population. I have a new-found respect for the doctors who dedicate themselves to this mode of practice, and I challenge each of you to find the time to ask these doctors how you can help at least to fill in from time to time. You will be amazed what you learn that you can take back to your own mode of practice.