Rural Eye Healthcare: Optometrist Explains the Benefits of the Medical Model of Optometry

by Kay Miller Temple, MD

Back to: Eye Health Needs: Preserving the Eyesight of Rural and Underserved Populations

Optometrist Dr. Kristin White explained how the medical model of optometry brings value to rural clinics and health centers.

"It's probably not well understood how optometrists can serve to actually engage patients into our community health systems," White said. Currently using that model in a northern California Federally Qualified Health Center (FQHC) look-alike, she further explained how it works.

"A lot of rural patients haven't been able to get healthcare, much less vision care," White said. "Even when medical care is available, patients sometimes feel intimidated about seeing a medical provider. They're fearful about what might be found or the instructions they might be given. I know sometimes they say to themselves, 'But I can at least get my eyes checked and maybe get glasses if I need them.' When we determine their glasses prescription, we also do a dilated fundus exam. If we see signs of diabetes, we can check their blood sugar and get them in to see the primary care provider. Or if there are signs of high blood pressure, we can check that and explain how uncontrolled blood pressure affects their eyes. We can share what might happen to their vision if they don't get care. Sometimes we're the first provider to make that important connection between their vision and their overall health."

Sometimes we're the first provider to make that important connection between their vision and their overall health.

White shared more about the basics of this optometry care model.

"Optometrists are primary eye care doctors," she said. "You don't go to a cardiologist for your yearly physical and you shouldn't have to go to an ophthalmologist for a yearly eye check. It's really important that ophthalmologists have time to do surgery and specialty evaluations, rather than routine primary eye care. As rural optometrists, we need to be part of the strategic use of these eye care workforce resources. The medical model of optometry fits this need. Eyes are as important as hearts, lungs, and kidneys, organs that are so carefully monitored by our medical providers. In the medical model of optometry, we carefully monitor the eyes, do complete eye exams by using drops to dilate so we can see into the eyes. Think about the eye as being the only organ where you can actually look inside the body and see what's happening. You can see blood vessels that give you information about undiagnosed diabetes or signs of high blood pressure or even brain tumors. Looking into the eye, we can see findings that are smaller than a millimeter in size and measure them to the micrometer with tools like the OCT, or optical coherence tomographer.

White said although all recent optometry graduates are capable of practicing this type of optometry, if others like her desire more in-depth training within a particular area, they can do an optional one-year residency with a special focus. She chose a residency in community health optometry, but said that other programs, like ocular disease residencies, fit the need. If an optometrist wants to serve in FQHCs or the Veteran's Administration (VA), she mentioned this extra training is usually required. White, who lived on New Mexico's Zuni and Jicarilla Apache Nation reservations while working at the Gallup Indian Medical Center that primarily serves the Navajo Nation, shared that the Indian Health Service (IHS) also offers special residencies for optometrists.

White said she appreciates the community health setting where she knows and refers her patients to colleagues in primary care, behavioral health, and other specialties. For her – and her husband, also an optometrist – working with underserved populations in a rural setting is a "dream job."

Our patients can come in, be respected, get great service and the kind of care they most certainly deserve. And for me? I love being able to pour out great care on them.

"It's so satisfying to discover the changes people make in their life because of the education you've shared about what's going on in their eyes," White said. "We get to do not just eye care, but we can help patients access total care. It's been my experience that underserved patients are super grateful about the care they receive at their community health center. Where I'm working now, I have the latest equipment in a new building in a gorgeous setting. I love being able to serve people who often have complicated health conditions, sometimes complicated even more by their life situation. Our patients can come in, be respected, get great service and the kind of care they most certainly deserve. And for me? I love being able to pour out great care on them."