How to train an eye surgeon

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It seems obvious to me that the only people who should be performing eye surgery, using lasers, or performing intraocular injections are people who have completed ophthalmology residencies. No one else has the training to safely provide this care and handle all of the complications that may arise.

The question I have is what is the best pathway to ophthalmology residency? Is medical school the best, in which students acquire a broad overview of the entire field of medicine? Or is optometry school more appropriate, in which the education is heavily focused on the eye? Both seem to have their advantages. Any thoughts?

Also, why is there a preliminary year for ophthalmology residencies? It seems like a huge waste of time. Having a year of ophthalmology research or spending that year learning more in-depth knowledge about the eyes seems like it would be much better spent.

Optometrists can get residencies? Don't they have to go to medical school as well, and then apply for one, or is there a different system for their post-graduate training?

I, for one, think the broad overview that one gets from medical school is critical- not so much for the information that you learn, but for the critical thinking abilities that you develop along the way. Those are what's going to be useful when you come up with your differential diagnoses as a physician.

inb4 that shrekky fellow comes in here and starts spouting nonsense...

Yes optometrists can get additional training beyond their Optometry program however it does not confer them a greater scope of practice.

The dead horse has politely requested that the beatings stop.

To practice as a Doctor of Optometry in states that allow Optometrists to do injections and/or laser surgery you have to pass specific state licensing exams that are usually much harder than states with a more restrictive scope of practice. Example: In North Carolina you need to not just pass all 3 parts of the national board exam but you need to have gotten at least in the 80th percentile in each section. And you need to have passed the TMOD supplementary exam as well.

Originally Posted by Shnurek

To practice as a Doctor of Optometry in states that allow Optometrists to do injections and/or laser surgery you have to pass specific state licensing exams that are usually much harder than states with a more restrictive scope of practice. Example: In North Carolina you need to not just pass all 3 parts of the national board exam but you need to have gotten at least in the 80th percentile in each section. And you need to have passed the TMOD supplementary exam as well.

Passing tests are no substitute for clinical experience.

I am just a rising fourth year medical student so forgive me. However, I really don't understand why people have such a hard time grasping this concept. Ophthalmologists are medical doctors that specialize in the eye. Just like pulmonologists are doctors that specialize in the lungs, anesthesiologists are doctors that specialize in anesthesia, and radiologists, yes even radiologists are medical doctors that specialize in radiologic imaging. Why is this concept so hard to grasp for so many people???

Originally Posted by mydodger

Why in the world do we not ban posts like this? The Ophtho sub-forum is constantly trashed by posters like this guy. Why in the world do we allow this?

This poster is a member since some time in 2011 with 10 total posts all of which involve Ophthalmology's "take over" by Optometry or how ODs should be doing eye surgery. Lets just indulge you some: Here's the kicker little fella - it's not going to happen. Heck most ODs don't want it happen! If they continue the political warfare now that this seems to be an actual "fight," the current field of Optometry will die. If Optometrists can do cataracts then there is little to no defense of the current rent-seeking that is refraction. If without medical training and residency you argue that it is safe for you to perform surgery you start to lose all of your arguments about how it's only safe if you do refractions because you're trained and that makes it safe for patients. You can't argue on both sides of the fence for too long before even the densest of politicians and regulators start seeing the absurdity. So if ODs start doing cataracts then a high schooler can do basic refractions after a week of training. That will be the next step of this feud, that's the end game of this escalation, and that's where the OD field would die. That's why most ODs will even tell you they only want to do "some" procedures, like YAG lasers. I don't agree with that, but even the pushiest ODs know it isn't in their best interest to push this fight too far.

However the SDN Optometry students don't seem to be getting that message. If the fight continues Optometry as it currently stands will die, and most Optometrists don't want that to happen. If you want to do eye surgery you go to medical school and do a residency in Ophthalmology. So stay the heck off of the Ophtho forums with this BS.

That's right. Let's ban ideas that make you uncomfortable. Btw your argument lacks substance. The only reason optoms shouldn't do cataracts is because then they won't be able to refract? Maybe opticians will take over the optom role and optoms will take over the ophtho role. Professions are not static throughout history.

Originally Posted by mydodger

Almost every thread gets derailed by an Optom wanting to talk about how their turf should expand. We're all sick of talking about this.

Wow, don't typecast all of us due to the actions of one or two. Besides, the OP is calling him/herself a medical student - for all we know they could be an uneducated, jobless 30yo schizo living in their mom's basement.

I think this thread should be locked.
Next time don't feed the troll and the thread will just disappear into the depths of SDN.

Originally Posted by MKE2STL

Passing tests are no substitute for clinical experience.

You are right. You have to prove your clinical competence as well in states such as these by a practical. I don't know all the details but google is your friend. ODs have been doing surgery in Oklahoma for 20 years. I'm sure if people were going blind left and right it wouldn't be the case presently. Its not a matter of if ODs can be trained to do invasive procedures. Its more about protecting the Ophthalmology turf that they worked so hard to attain by doing not so relevant coursework for 9 years before they began their ophtho residency (4 years college, 4 years med school, 1 year internship). Can't you see? We must protect inefficient educational pathways! How dare a 4 year graduate program be only focused on the eye! Who do they think they are?

:P

Originally Posted by Shnurek

You are right. You have to prove your clinical competence as well in states such as these by a practical. I don't know all the details but google is your friend. ODs have been doing surgery in Oklahoma for 20 years. I'm sure if people were going blind left and right it wouldn't be the case presently. Its not a matter of if ODs can be trained to do invasive procedures. Its more about protecting the Ophthalmology turf that they worked so hard to attain by doing not so relevant coursework for 9 years before they began their ophtho residency (4 years college, 4 years med school, 1 year internship). Can't you see? We must protect inefficient educational pathways! How dare a 4 year graduate program be only focused on the eye! Who do they think they are?

:P

Why doesn't anyone challenge this statement with a rational fact-based argument? The only thing I've seen so far is name calling (troll), claiming this is not the correct sub-forum for this content, pleading for the ban-hammer, or pulling the old "you're beatin' a dead horse" gambit. It seems a bit desperate.

Originally Posted by MiBicicleta

Why doesn't anyone challenge this statement with a rational fact-based argument? The only thing I've seen so far is name calling (troll), claiming this is not the correct sub-forum for this content, pleading for the ban-hammer, or pulling the old "you're beatin' a dead horse" gambit. It seems a bit desperate.

They challenge it in congress and they lose more often than they win. That's where it matters. SDN is just a playground when it comes to politics.

lol @ visionary, great picture to describe what is going on

Originally Posted by MKE2STL

Is medical school the best, in which students acquire a broad overview of the entire field of medicine? Or is optometry school more appropriate, in which the education is heavily focused on the eye? Both seem to have their advantages. Any thoughts?

Also, why is there a preliminary year for ophthalmology residencies? It seems like a huge waste of time. Having a year of ophthalmology research or spending that year learning more in-depth knowledge about the eyes seems like it would be much better spent.

I think as a physician, no matter what specialty, it's your duty to have a basic grasp of medicine in general. Also, having an understanding of the pathophysiology, manifestations, and treatment principles of the numerous systemic diseases with ophthalmic manifestations will help us be better physicians for our patients. After looking at the fundus, seeing a high A1c and recognizing the guy's diabetes isn't being adequately managed is important, even as an ophthalmologist. Also, if a patient's other medical problem flares up in the office, we have to act our roles as general physicians once in a while.

Originally Posted by MKE2STL

Also, why is there a preliminary year for ophthalmology residencies? It seems like a huge waste of time. Having a year of ophthalmology research or spending that year learning more in-depth knowledge about the eyes seems like it would be much better spent.

This statement is clearly why you're not qualified to comment on this subject.

Originally Posted by TheLesPaul

This statement is clearly why you're not qualified to comment on this subject.

No, you're right. I see the light now. Physicians need to be well rounded. That's why I think ophthalmologists should complete a 3-year internal medicine residency first, just like cardiology, endocrinology, rheumatology, etc.

The SDN ophthalmology forum is starting to feel like a 3 am discussion on your psychiatry rotation with a perseverating demented patient crossed with that Star Trek episode where Cap'n Picard and Dr. Crusher are stuck in an endless time loop on the shuttlecraft watching everything blow up over and over... Or was it Janeway and Neelix, I forget.

Originally Posted by The Doctor

The SDN ophthalmology forum is starting to feel like a 3 am discussion on your psychiatry rotation with a perseverating demented patient crossed with that Star Trek episode where Cap'n Picard and Dr. Crusher are stuck in an endless time loop on the shuttlecraft watching everything blow up over and over... Or was it Janeway and Neelix, I forget.

A real Trekkie would know the answer to that.

Originally Posted by KHE

A real Trekkie would know the answer to that.

They like to be called Trekkers now.

Originally Posted by MiBicicleta

Why doesn't anyone challenge this statement with a rational fact-based argument? The only thing I've seen so far is name calling (troll), claiming this is not the correct sub-forum for this content, pleading for the ban-hammer, or pulling the old "you're beatin' a dead horse" gambit. It seems a bit desperate.

Because, there have already been ten billion gagillion threads that either started as or devolved into this topic. There's nothing to argue. Both sides are immovable, sort of like a pro-life vs. pro-choice "argument." Pointless. Neither side will convince the other of anything. It always ends up as name-calling and such. How about we discuss something worthwhile?

Originally Posted by KHE

A real Trekkie would know the answer to that.

Dr. Elder you are back??? Welcome back.

Originally Posted by mydodger

If Optometry school was training Ophthalmology-level practitioners I wouldn't be seeing referrals from Optometrists like I am in my rotations. You'd send them to OMDs for use as you seem to see OMDs - cataract technicians.

True, but the scope of practice of optometry varies from state to state. So in some states ODs can treat certain things while in others they cannot do so, so they must refer by law. As KHE stated in the past I also agree that ODs are in fact over trained for what they actually do so if the scope of practice followed the training then there wouldn't be so many referrals. Also, I do not see OMDs as any kind of technicians. Presently, they are better trained than ODs but I believe the traditional training system can be augmented by having a more direct path to eye care.

Let me show you a parallel:

1) MD graduate --> General surgery residency (5 years) --> Vascular surgery fellowship (2 years)
2) MD graduate --> Vascular surgery residency (5 years)

Both come to the same end point but one route is more direct and saves taxpayers two years of training along with gaining 2 years of time practicing (theoretically) so it is better for society in the end.

Shnurek... what year optometry student are you?

Originally Posted by JMK2005

Shnurek... what year optometry student are you?

He's a first year, but he's at one of the top optometry schools in the world, don't you know? That means he know more than the rest of us.

Originally Posted by Visionary

He's a first year, but he's at one of the top optometry schools in the world, don't you know? That means he know more than the rest of us.

Wow I didn't realize that... first year in opto school? At that point you don't even know what you're not going to learn in your education.

I did hear about a current lawsuit in Oklahoma about an OD who did 8-10 repeat ALTs on a patients eye..the patients eye pressure trickled up to 30 over several years and went blind..not sure why he didnt refer it out...Not to mention,, why he would try to do repeat ALTs on the same eye...idiot...

Originally Posted by mclem222

I did hear about a current lawsuit in Oklahoma about an OD who did 8-10 repeat ALTs on a patients eye..the patients eye pressure trickled up to 30 over several years and went blind..not sure why he didnt refer it out...Not to mention,, why he would try to do repeat ALTs on the same eye...idiot...

Source?

I heard about this one really stupid optometrist once...man he was so stupid...what an idiot. It just goes to show how stupid all optometrists are.

Originally Posted by mclem222

I did hear about a current lawsuit in Oklahoma about an OD who did 8-10 repeat ALTs on a patients eye..the patients eye pressure trickled up to 30 over several years and went blind..not sure why he didnt refer it out...Not to mention,, why he would try to do repeat ALTs on the same eye...idiot...

$$$$$ makes you do dumb things... oh, and ego too

Ya, I heard about this one stupid ophthalmologist that exploded an eyeball. I guess that means that every ophthalmologist doesn't know what they are doing and will eventually explode an eyeball. O ya, and another one that did cataract surgery on a 20/25 eye that suffered a detached retina post-op and went to hand motion. I guess its all about $$$$ and ego

O ya and optometrists are really stupid. They can Rx orals in 47 states, Rx pain medications in 43 states and do injections in 36 and yet their average malpractice insurance is ~$500. Man they must be such a huge liability since they do not know what they are doing.

Originally Posted by Shnurek

Ya, I heard about this one stupid ophthalmologist that exploded an eyeball. I guess that means that every ophthalmologist doesn't know what they are doing and will eventually explode an eyeball. O ya, and another one that did cataract surgery on a 20/25 eye that suffered a detached retina post-op and went to hand motion. I guess its all about $$$$ and ego

O ya and optometrists are really stupid. They can Rx orals in 47 states, Rx pain medications in 43 states and do injections in 36 and yet their average malpractice insurance is ~$500. Man they must be such a huge liability since they do not know what they are doing.

You aren't exactly representing your profession well. Maybe spend a bit less time on the forums?

Originally Posted by LightBox

You aren't exactly representing your profession well. Maybe spend a bit less time on the forums?

It won't change your opinion or any other OMDs. I frankly don't care if you haven't noticed already.

Originally Posted by Shnurek

Ya, I heard about this one stupid ophthalmologist that exploded an eyeball. I guess that means that every ophthalmologist doesn't know what they are doing and will eventually explode an eyeball. O ya, and another one that did cataract surgery on a 20/25 eye that suffered a detached retina post-op and went to hand motion. I guess its all about $$$$ and ego

O ya and optometrists are really stupid. They can Rx orals in 47 states, Rx pain medications in 43 states and do injections in 36 and yet their average malpractice insurance is ~$500. Man they must be such a huge liability since they do not know what they are doing.

I love your stats

How many of those numbers are because you can prescribe oral agents such as NSAIDS/Tylenol and you can give injectables like epinephrine during an anaphlyactic crisis?

The 47 states for orals ODs can Rx legend drugs such as acyclovir, tetracycline etc. Here is an example list for Pennsylvania: http://www.pacode.com/secure/data/02.../chap6toc.html

And yes I'll agree with you on the injections. Only 13 states allow "true" injections: http://www.revoptom.com/content/c/31908/ scroll to the bottom of the page.