Well KHE this is where "what is primary care" becomes very gray and there is not much of a "black" or "white".
My optometric frame of reference is very limited compared to yours KHE. Based on my own research I feel that optometric primary eye care should be the state of oklahoma's scope of practice for OD's. combined with Tennessee's prescribing scope (any drug deemed necessary for the treatment of ocular disease.)---to me that is the "ideal definition of optometric primary eye care". That still leaves all invasive ocular surgery beyond the PRK, trabs, iridotomies, SLT's, etc....that Oklahoma OD's do in the realm of ophthalmology. For god sakes, family practice doctors can do some invasive "in office" procedures but they are NOT surgeons. Oklahoma's scope of practice in my eyes is the model for the future.
Oklahoma Association of Optometric Physicians
Optometry Scope of Practice
- Optometric physicians detect, diagnose and treat eye diseases. These diseases include infections (viral and bacterial), ocular allergies and ocular inflammations. They manage and treat diseases of the eye and eyelids. They also manage cataracts, glaucoma and diabetic retinopathy.
- Optometric physicians treat eye diseases with any indicated systemic and/or topical medications and prescribe supportive pain medications schedule III, IV & V to improve overall health and vision capabilities
- Optometric physicians treat eye injuries including foreign objects in the eye and eyelid. They routinely treat cysts, chalazia, trichiasis, disorders of the lacrimal system and dry eye.
- In Oklahoma, optometric physicians utilize laser technology to treat eye conditions with capsulotomies and iridotomies. They provide pre-operative and post-operative treatment for many eye surgeries in coordination with ophthalmologists.
- Optometric physicians specialize in comprehensive eye examinations with dilation to improve visual disorders through prescriptions for corrective spectacle lenses and contact lenses, this also includes rehabilitative therapy for ocular motor dysfunction (amblyopia, eye coordination & strabismus). Optometric physicians are trained in prescribing specialized adaptive vision aids for subnormal vision, or loss of vision from diseases such as macular degeneration and stroke.
- Developing and maintaining professional referral relationships with family practitioners, internists, endocrinologists, neurologists, ophthalmologists and other physician specialties to ensure that eye health is maintained in concert with overall physical health and wellness.
http://oaop.org/index.php?option=com_content&task=view&id=16&Itemid=31
NONE OF THIS MAKES OPTOMETRIC PHYSICIANS IN OKLAHOMA "EYE SURGEONS" (contrary to the Ophthalmology propaganda)
I really believe in my heart that this is what the nationwide optometry scope of practice should be. I am not going to be "PC" about it. If they can do it in Oklahoma then it can be done everywhere else too. I really don't care what organized ophthalmology thinks about this because after I have done my own extensive research of the last 38 years of optometry's growth the conclusion I have come to is that
organized ophthalmology---1) does not respect optometry 2) would wipe OD's off the planet if they could and 3) will put its turf protection over patient care (i.e the nonsense of 5 states still not having oral drugs, a couple of states not having glaucoma treatment, and trying to block things like HR 1983 from going through). I am really tired of being P.C. about this stuff.
Let the onslaught of---"you're just a lowly student, you should just go to medical school, why not just close down all the ophthalmology residencies, go refract and be happy, ophthalmologists have 24 years of training (k-12 + 4 yr BS + 1 yr + Ophtho residency), surgery by surgeons, your going to be very unhappy as an optometrist if you think that, you have an inferiority complex, -----------begin! 
