A good deal of my career has been spent working closely with ophthalmologists. In NY, at the peak of my practice, we received ongoing referrals from more than 60 area ophthalmology practices for specialty contact lens care. For well over a decade, I served as a voluntary unpaid attending in the North Shore University Hospital Department of Ophthalmology. I devoted a full day a week to teaching residents and seeing patients with them. I practiced with Drs. Eric Donnenfeld and Hank Perry for many years, learning much and occasionally enlightening these brilliant clinicians and incredible human beings. Now in Phoenix, our practice is well integrated into the medical community. We have wonderful relationships with many area ophthalmology practices, receiving referrals for dry eye and referring for surgical management. We work closely with many primary care practices.

Despite this, I am a realist and life with ophthalmology has not always been a bed of roses. Like many of you, I have experienced instances of enmity and discrimination, but I have always put patient care, mutual respect and personal relationships first. While I have been vocal and critical of arrogance, small-mindedness and blatant discrimination, I have always believed that optometry and ophthalmology must ultimately work together as close allies—now more than ever. My strong desire to find a path for reconciliation between our two professions led to an ongoing dialog with Dunbar Hoskins, then the EVP of the American Academy of Ophthalmology. My goal was to create an independent, non-political, working group of leading ODs and MDs to craft recommendations for a path forward. The project was eventually scuttled by politics, but I did learn much from the endeavor.

A lot has changed since that failed attempt. Optometry has grown in numbers, has dramatically enhanced education and training, and developed far greater clinical expertise in many areas. Optometry has reinforced its position as the primary provider of eye care in the US, and we continue to evolve as an independent skilled and learned profession. Many ophthalmologists, especially the younger and more secure surgeons and subspecialists, work closely with ODs collegially and with mutual respect. Yet, optometrists are still banned from the Academy of Ophthalmology meetings, and on a state level, significant acrimony still exists. Hopefully that will soon change.

Writing in this month’s Academy of Ophthalmology Eyenet Magazine Current Perspective column, current Academy EVP David Parke addresses the ongoing changes in the professional landscape and ponders the question of where do we go from here. I’ve spoken with Dr. Parke only once, shortly after he succeeded Dr. Hoskins, but from the more balanced tone of his editorial, it seems he has evolved somewhat from his stridently anti-optometry days in Oklahoma.

The AAO will be conducting a survey of its entire membership on the issue of the Academy’s relationship with optometry. This is a bold and long-overdue move, but as Dr. Parke poignantly states, “For many ophthalmologists, there are very few professional issues that elicit such a strong emotional reaction as our relationship with optometry.” While I welcome any attempt to improve relationships, recognizing that this is an emotional issue rather than a rational one will likely be key to its success or failure.

Ophthalmology has long placed itself at the head of the eye care team, blind to the advances optometry has made, typically taking a parental and usually judgmental position regarding optometric practice under the guise of patient protection. The unpleasant truth is that most of the animus derives from economic competition, turf issues and ego. Stunning competence and terrifying incompetence can be found equally in both professions, and despite the ostensibly honest belief that patients would be dying in the streets from topical mydriatics or blinded by ODs wielding YAG lasers, no one has died and no one has been blinded.

In completing the Academy survey, I urge our ophthalmologist colleagues to keep in mind that optometry is an independent profession, rapidly growing in stature and influence. We are not inferior beings, just different in background, training and even outlook regarding patient care. The overwhelming majority of us know our limitations as well as our abilities, and we welcome the opportunity to work collegially and cooperatively with ophthalmology in an environment of mutual respect, shared knowledge and dedication to collaborative patient care. Continued acrimony serves no purpose and only harms our professions and our patients. It is my sincere hope that this small crack in the wall separating us opens wider, and that this is the start of a breakthrough that many of us on both sides have long been waiting for.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com