Optometrists and ophthalmologists alike look to the American Academy of Ophthalmology as perhaps the most influential arbiter of clinical practice patterns for most patient care responsibilities (at least those outside of traditional optometric strengths like vision therapy and specialty contact lenses). It has earned that reputation and deserves it. The Academy’s data registry, called Intelligent Research in Sight (IRIS), collects patient care results from thousands of practices and allows researchers to tap into that rich database. It’s innovative, commendable—and incomplete.

Why? Because IRIS excludes optometry. Only ODs who work at ophthalmology practices are eligible to participate, but that’s hardly adequate to capture the sizable amount of eye care provided by the profession. 

To reiterate a few statistics I cited in my May 2024 editorial on a similar theme, optometrists provide 34% of all medically focused eye exams and 76% of all comprehensive exams when routine and medical services are combined. Two growth trends will continue to accelerate the profession’s contribution: (1) more optometrists than ophthalmologists are entering the field, and (2) ODs, both new and established, are taking on more medical care.

The Academy uses IRIS participation as a member benefit, helping MDs to fulfill their obligations to Medicare’s Merit-based Incentive Payment System. So, I get it: optometry is not its top priority. That’s fine. But research studies generated from IRIS data will become increasingly inaccurate representations of the state of eye disease in the US if optometry continues to be shut out—maybe not on things like complications of an ILM peel or an intravitreal injection, but disease prevalence and routine eye care will suffer for sure.

IRIS was launched in 2014. Ten years on, it has amassed data on more than 490 million patient visits. Again, that’s a monumental achievement to celebrate, but imagine what it would be if all eyecare providers were included. In another 10 years, where will we be? The optometric contribution to eye care cannot be ignored forever.

There are some signs of progress elsewhere, fortunately. A study recently published in Translational Vision Science & Technology describes an effort to collect real-world data from optometric practices in order to improve the accuracy of an OCT reference database. Nearly 5,000 scans performed at OD practices were included. This is exactly what optometry brings to the table: lots of data, and likely the best source of information on healthier individuals, given that ophthalmology practices are so heavily weighted toward those with various ailments.

It would be counterproductive for the Academy of Optometry to attempt to set up a system comparable to IRIS, and even that would keep OD and MD data siloed away from each other. So, I would like to see the Academy of Ophthalmology eventually work out a mechanism that allows optometric data to be incorporated. It serves the organization’s goal of  “continual improvement in the delivery of eye care,” as stated right there on the IRIS Registry homepage. 

Come on, Academy. Repair that self-inflicted iridotomy.