Longtime Pullman optometrist wants to see profession do more for frontline health

About 50% of U.S. adults get an eye exam each year, yet optometrists can do more than prescribe contacts. Such providers check for eye health and can catch signs of diabetes, high blood pressure and cholesterol issues.

For patients – especially in rural areas – eye care often is a frontline health defense, said Pullman optometrist Dr. Jim DeVleming, who in July completed a 2014-2022 tenure on the board of the American Optometric Association.

Optometrists in annual exams check the health of eyes and can look for about 270 ocular and systemic diseases, DeVleming said. They can treat eye infections, apply glaucoma drops, care for eye injuries and remove a foreign body such as a wood speck, he said.

Optometrists can see signs of diabetes because of the blood vessels visible in the back of the eye. Diabetes causes blood vessels to be leaky, and hemorrhages to occur. The back of the human eye is the only place in the body where providers can see blood vessels as they truly exist without surgery, he said.

DeVleming added that if he sees tiny hemorrhages, he’ll ask the patient questions about frequent thirst and urination, then suggest a primary care physician visit.

“The three conditions – high blood pressure, high cholesterol and diabetes – are super easy to see in the back of an eye during an exam,” he said.

“High blood pressure causes the arteries and veins cruising around back there to be tortuous, like the lazy river going back and forth. High cholesterol causes these white blockages to reflect back as we’re looking at the arteries. You can see the blood vessel doesn’t look the right color; instead of being red, it’s more orange.”

DeVleming has advocated for optometrists’ scope of work to evolve by doing minor procedures, such as certain laser treatments, now allowed in 10 states. It’s called full-scope contemporary optometry, but Washington is yet to join.

“The next way to evolve is to use lasers to treat some things in the front of the eye – for glaucoma and secondary cataracts, these kinds of things,” said DeVleming, who trained two years ago in Kentucky, one of the 10 states, to do laser treatments he can’t provide to his patients until the state allows it.

“One option is using a laser to remove a secondary cataract, which is a clouding of the eye after cataract surgery. Basically, you’re punching a hole in a tissue that is not necessary to be in the eye after cataract surgery, because the eye has healed itself, and then this offending tissue starts to get cloudy. It’s 10 minutes in the office,” he said.

Other potential treatments include one for glaucoma – using a laser to open a natural drain for fluid – and procedures for lump removal in the eyelid area, he said.

Optometry professionals sought state legislation to do advanced scope work a year ago and gained Senate support, and now are working on it for the next session.

“This year, we hope to get the Senate and House on our side. We’re working with our legislators, making sure they understand what we’re doing and why this is important.”

DeVleming said that for complex cataract surgeries and retinal procedures, patients always are referred to ophthalmologists as the specialists who do surgeries on the back of the eye.

Ophthalmologists differ from optometrists and opticians in advanced medical training and do wider diagnoses and treatments, although many also prescribe for vision correction, says the American Academy of Ophthalmology.

He said anyone with health insurance typically can go see an optometrist, although optometry “lives in this strange world” of both vision insurance and medical insurance.

DeVleming bought his father’s optometrist practice in Pullman 32 years ago. His dad, Robert DeVleming, started there in 1959. Today, Pullman Vision Source sees patients from infants to those in their 90s. Convincing people to get an eye exam each year is a challenge, DeVleming said.

“The comprehensive eye exam should be a part of your regular health care. You get your physical, you get your eye exam, you get your teeth checked. The other thing is with kids, they don’t know they’re not seeing well, because a kid sees what he thinks is normal.”

He said the optometric association is furthering its work to improve diversity, both among providers and in serving underserved populations. U.S. optometry schools now are about 55-60% female to male, he said, and optometrists serve in community health and VA centers, he said.

About two years ago, the association started a scholarship program for minorities. DeVleming said there’s some concern today about provider shortages, particularly in rural areas .

The optometry association started an “Eyes Deserve More” campaign to help people understand what optometrists do, DeVleming said.

“People don’t know that we do foreign body removal, when you’re out working in the yard and get a piece of wood in the eye. Optometrists take care of that in every state. We deal with pediatric care and eye infections. You shouldn’t have to go to the emergency room.”

But DeVleming cautioned to seek immediate help at any hour for sudden vision changes such as floaters, darkness or swirly lights. A possible retinal detachment needs fast care to prevent vision loss. “We can’t treat that, but we know where to send you as quickly as possible,” he said.

“The most important sense people have is their vision. I get to talk to people and make sure their eyes are healthy and their vision is clear. It’s great that I get to see them for years and years.”