The Academy believes that the public’s interests are served when patients have access to primary eye care services that meet their needs for healthy eyes and best possible vision. Ophthalmologists are specifically trained to provide these services, because their medical school education provides a thorough understanding of pathology and disease processes, systemic disorders with ocular manifestations, as well as skills and experience in medical decision making. Primary eye care provides an entry point for patients to receive refractions and glasses or contact lenses, screenings for asymptomatic eye diseases, diagnosis and treatment of most eye conditions, referral to specialists, and coordination with other aspects of medical care. While it is the ophthalmologist’s responsibility to perform the comprehensive medical eye evaluation, certain aspects of data collection may be conducted by trained individuals under the supervision of the ophthalmologist.

In the past several years, significant attention has been paid to establishing primary care as the foundation of the U.S. health care system. In the effort to organize and finance health care, the shift toward an emphasis on primary care is intended to achieve better health through increased accessibility to needed services, reduced cost, and improved coordination of care. Health care reform proposals have called for greater numbers of primary care physicians to address a need for care for rural and disadvantaged populations. In the realm of eye care, patients can self-refer accurately and readily discern symptoms that are related to their eyes and vision. A clearer understanding of the attributes of primary eye care will help guide policymakers, organizations, and the public to plan, evaluate, and develop eye care delivery systems.

Primary Eye Care:
Primary eye care is the provision of appropriate, accessible, and affordable care that meets patients' eye care needs in a comprehensive and competent manner. Primary eye care provides the patient with both the first contact with eye care as well as a lifetime of continuing care. Primary eye care services are integrated to meet the needs of patients from a single source, and patients receive quality, efficient eye care that is coordinated with general health care services. Competent and expert management and decision-making are critical to promoting the quality and efficiency of primary eye care.

 Primary eye care services include the following:

1. Educating patients about maintaining and promoting healthy vision.
2. Performing a comprehensive examination of the visual system. 
3. Screening for eye diseases and conditions affecting vision that may be asymptomatic. 
4. Recognizing ocular manifestations of systemic diseases and systemic effects of ocular medications.
5. Making a differential diagnosis and definitive diagnosis for any abnormalities that are detected.
6. Performing refractions.
7. Fitting and prescribing optical aids such as glasses and contact lenses.
8. Deciding on a treatment plan and treating patients' eye care needs with appropriate therapies.  
9. Counseling and educating patients about their eye disease conditions.
10. Recognizing and managing local and systemic effects of drug therapy.
11. Determining when to triage patients for more specialized care and referring to specialists as needed and appropriate.
12. Coordinating care with other physicians involved in the patient's overall medical management.

Primary Eye Care Physician: 
The key characteristic of a primary eye care physician is to observe and assess visual signs, symptoms, or concerns that patients present, unrestricted by problem origin. The physician must also have the appropriate education and training to manage a large majority of those problems.

Primary eye care should be provided by or supervised by qualified physicians who have the following competencies: 

1. To discover and discern abnormal states from normal.
2. To diagnose the presence of disease conditions.
3. To relate general medical conditions and symptoms to possible eye diseases.
4. To triage and manage effectively or refer for more specialized treatment.
5. To coordinate with other physicians and health care professionals to meet general health care needs.
6. To develop a treatment plan and take care of the large majority of eye care needs encountered in the general population.

Primary eye care physicians generally assume responsibility for coordinating eye care services necessary to optimize a patient's visual function. This coordination involves interacting with, referring to, and consulting with other physicians and health professionals, specialists, and community programs.

The ophthalmologist is an appropriate and cost-effective provider of primary eye care, because he or she is accountable and committed to the patient's best interests in preserving healthy vision. Ophthalmologists also have extensive education and training that includes four years of medical school education, one year of a general surgical or medical internship, and three or more years of intensive training devoted solely to all aspects of medical and surgical care of the eyes and visual system. They can diagnose and manage the large majority of eye conditions that present, and they can efficiently triage patients for timely management. The patients' interests are best served when they can visit an ophthalmologist and have all their ocular problems efficiently managed from the time of first contact, without having to go through unnecessary referrals, testing, or therapies, which incur additional costs and delays in receiving care.