Opticians Refracting Indepently

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Should opticians have the right to refract and dispense a Rx indepently?


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You can keep trying to put words in my mouth, but it's not working. I never once said this was not a public health issue. What I said was, the law is not rooted in the public health issue; it's rooted in ODs and ophthalmologists wanting revenue. The public health issue is there, but it's not the driving force. My OTC example proves that.

what words am i putting in your mouth?

you said "risky"
you said "irresponsible"
you said "stupid"

and you are right about that, it is stupid. So I dont know how you can say stand alone refraction is stupid, bad for public health and then turn around and say "but we only do it for the money"......sorry, but have to admit that sounds a little schizo. You really think ODs/MDs want to somehow make more money by limiting who can provide refractions to the public? As in a conspiracy? cause if there's anything I like its a good conspiracy theory. :rolleyes::rolleyes::rolleyes:

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...you will have to do me a favor and stop saying its not a public health concern, because that is exactly what it is and is ENTIRELY about that.

Now, for about the fourth time, I never once said the issue was not a public health concern. Please read my posts. What I said, was, the requirement for patients to have an exam along with their refraction is not driven primarily by public health concern, it's driven by reimbursements. Again, the availability of otc readers demonstrates that.

You really think ODs/MDs want to somehow make more money by limiting who can provide refractions to the public?

Yes, I do. That you don't see that is amazing to me. What do you think would happen to optometry if patients could get Rxs at the mall, from an auto refractor? You don't think there's some concern there? If you don't, you're crazy. If you don't think ODs are worried about other providers, such as opticians, being able to provide independent Rx's, you're on another planet - perhaps it's the planet upon which Obama will actually do anything constructive in a second term.
 
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If you don't want ophthalmic tech's doing your refractions, then you can't argue for optometrists to perform surgeries (I don't know what your opinion is on this, but just saying). It's the same principle.
 
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Now, for about the fourth time, I never once said the issue was not a public health concern. Please read my posts. What I said, was, the requirement for patients to have an exam along with their refraction is not driven primarily by public health concern, it's driven by reimbursements. Again, the availability of otc readers demonstrates that.



Yes, I do. That you don't see that is amazing to me. What do you think would happen to optometry if patients could get Rxs at the mall, from an auto refractor? You don't think there's some concern there? If you don't, you're crazy. If you don't think ODs are worried about other providers, such as opticians, being able to provide independent Rx's, you're on another planet - perhaps it's the planet upon which Obama will actually do anything constructive in a second term.

I charge $35 for a refraction and its the lowest fee compared to any other service I offer. I'd bet that pattern is consistent amongst virtually ALL OD and MD practices. So I disagree that limiting refraction to ODs/MDs serves to increase my (or anybody elses) bottomline in any great fashion. If I perform refraction, a script is made available for pts to purchase glasses anywhere they choose. So in just considering refraction alone its hardly the huge economic incentive you claim it is, and as such I fail to see how this would be of any great benefit to the stand alone refractionist either. Although in the abscence of any ethical concerns, and being driven solely by profit motive, I can easily see this type of service being abused. Those who don't know better taking advantage of those who also don't know better. The blind leading the blind.
 
If you don't want ophthalmic tech's doing your refractions, then you can't argue for optometrists to perform surgeries (I don't know what your opinion is on this, but just saying). It's the same principle.

I've stated before that I don't think ODs have any business doing surgery. We don't have the training in our OD programs to support it.

I also never said I don't think ophthalmic techs should be allowed to refract independently. I think it would be terrible for optometry, which is the reason it's opposed so highly in the field, but as my previous posts argue, there is nothing about refraction of normal, healthy individuals that can't be done by someone with a few months training. The reason refraction is limited to ODs/MDs is not because it's some terribly difficult skill that can only be done by a doctor, it's because we want patients to be funneled into our offices.
 
I charge $35 for a refraction and its the lowest fee compared to any other service I offer. I'd bet that pattern is consistent amongst virtually ALL OD and MD practices. So I disagree that limiting refraction to ODs/MDs serves to increase my (or anybody elses) bottomline in any great fashion. If I perform refraction, a script is made available for pts to purchase glasses anywhere they choose. So in just considering refraction alone its hardly the huge economic incentive you claim it is, and as such I fail to see how this would be of any great benefit to the stand alone refractionist either. Although in the abscence of any ethical concerns, and being driven solely by profit motive, I can easily see this type of service being abused. Those who don't know better taking advantage of those who also don't know better. The blind leading the blind.

Has any patient who came into your office ever spent money on anything other than the refraction? Refraction is what gets people to your office. No one says, "I think I'm going to get my eyes dilated next week." They say "I think I'm going to get new glasses next week." And in order to do that, they need to see you for a refraction and eye exam. If you don't see that refraction is at the core of what optometry is, as a profession, you're kidding yourself. Take refraction away from us by opening it up to opticians, and we'll collapse in on ourselves under our own weight.
 
I've stated before that I don't think ODs have any business doing surgery. We don't have the training in our OD programs to support it.

I also never said I don't think ophthalmic techs should be allowed to refract independently. I think it would be terrible for optometry, which is the reason it's opposed so highly in the field, but as my previous posts argue, there is nothing about refraction of normal, healthy individuals that can't be done by someone with a few months training. The reason refraction is limited to ODs/MDs is not because it's some terribly difficult skill that can only be done by a doctor, it's because we want patients to be funneled into our offices.

how does an ophthalmic tech determine that a pt is "normal and healthy"? Are you expecting that they will be taking HPI, medical/ocular/family history, and providing physical exam to establish this? or do they just guess? :rolleyes:
 
Has any patient who came into your office ever spent money on anything other than the refraction? Refraction is what gets people to your office. No one says, "I think I'm going to get my eyes dilated next week." They say "I think I'm going to get new glasses next week." And in order to do that, they need to see you for a refraction and eye exam. If you don't see that refraction is at the core of what optometry is, as a profession, you're kidding yourself. Take refraction away from us by opening it up to opticians, and we'll collapse in on ourselves under our own weight.

refraction is very often why people come to my office, and very often these people are told they dont need refraction, a refraction isnt performed, and the real reason for their underlying complaint (which is usually blur, headache, etc) is dealt with. Based on my experience the need to even perform a refraction on most people is WAYYYY overstated (as well as the need for new glasses), and the public are the ones that are drving this misconception. Many complaints of blur I see may have a secondary refractive component, but the overwhelming majority are driven by some other issue. cataract, cornea, retina, etc these are FAR more common. It took quite a few years to get to this point, but my practice base is built on those pts, whereas routine refractive care is only one of many revenue streams. Even in my small town office I feel I have ample room to adjust for the loss of that revenue, as my model is different then the more traditional OD model. Mine is a primary care practice.

I agree tho that many ODs who do practice primarily as vision care and ignore or refer everything else could be affected, altho even in that case I'm not sure it would matter. Those ODs are already in the mall, they already are dirt cheap, they will do a better job at the refraction AND they will at least provide some limited battery of screening tests. I dont really see stand alone refraction being able to compete with that.
 
how does an ophthalmic tech determine that a pt is "normal and healthy"?

That's the point - they don't. Do you think anyone in a Walmart, VisionMart, Cohen's, Target, Sam's, Costco, Walgreens, America's Best, etc, etc, etc....actually gives a Cleveland Steamer about their ocular health assessment? No, it's viewed as an inconvenience that they must get through in order to get their piece of cheese, the Rx.


Are you expecting that they will be taking HPI, medical/ocular/family history, and providing physical exam to establish this? or do they just guess? :rolleyes:

No, I'm not, because they'll be doing independent refractions, not independent health assessments. That's the point - they won't be doing health assessments. I'm puzzled as to why this is so difficult to understand. As an objective observer, I don't personally subscribe to the idea that someone should be forced into a medical exam, in order to get a prescription for glasses. However, as an optometrist, I recognize that refractions are the life blood of the the profession, and taking away our turf would spell disaster for a large portion of us. Why are you unable to separate yourself from the "sphere" in which you sit? Look at things from the outside and you might see them differently.

The rules are inconsistent, and that inconsistency demonstrates that my standpoint is valid. Ask an OD why an Rx is required for a pair of glasses, and he/she will likely tell you it has to do with public safety. Then ask the same OD why a person can buy otc readers right next to the light bulbs in Walgreens, and you'll likely hear crickets chirping. Why the inconsistency? Are emmetropes or low hyperopes not worthy of the same protection as myopes and high hyperopes, who need prescription glasses to see clearly? It proves, quite nicely, that the driving force behind the Rx requirement is in the interest of prescribing doctors, not the public. The public might benefit indirectly from the rule, there's no question about that, but it's not in place because of public safety. If you don't see that, you're not looking at the issue objectively.
 
That's the point - they don't. Do you think anyone in a Walmart, VisionMart, Cohen's, Target, Sam's, Costco, Walgreens, America's Best, etc, etc, etc....actually gives a Cleveland Steamer about their ocular health assessment? No, it's viewed as an inconvenience that they must get through in order to get their piece of cheese, the Rx.




No, I'm not, because they'll be doing independent refractions, not independent health assessments. That's the point - they won't be doing health assessments. I'm puzzled as to why this is so difficult to understand. As an objective observer, I don't personally subscribe to the idea that someone should be forced into a medical exam, in order to get a prescription for glasses. However, as an optometrist, I recognize that refractions are the life blood of the the profession, and taking away our turf would spell disaster for a large portion of us. Why are you unable to separate yourself from the "sphere" in which you sit? Look at things from the outside and you might see them differently.

The rules are inconsistent, and that inconsistency demonstrates that my standpoint is valid. Ask an OD why an Rx is required for a pair of glasses, and he/she will likely tell you it has to do with public safety. Then ask the same OD why a person can buy otc readers right next to the light bulbs in Walgreens, and you'll likely hear crickets chirping. Why the inconsistency? Are emmetropes or low hyperopes not worthy of the same protection as myopes and high hyperopes, who need prescription glasses to see clearly? It proves, quite nicely, that the driving force behind the Rx requirement is in the interest of prescribing doctors, not the public. The public might benefit indirectly from the rule, there's no question about that, but it's not in place because of public safety. If you don't see that, you're not looking at the issue objectively.

the reason otc readers are allowed is because the manufacturers have succesfully convinced the legislure that there is no risk in the self diagnosis and treatment with otc readers. Nothing more conspiratorial then that. Just good ole american lobbying. But of course we know better...there IS risk. Thus this "inconsistency" you think is so telling of a conspiracy to defraud the public of refraction fees (gasp!). Do you also believe in UFO's? Do you think optometrists killed JFK? Are you prepared for the mayan apocalypse?
 
That's the point - they don't. Do you think anyone in a Walmart, VisionMart, Cohen's, Target, Sam's, Costco, Walgreens, America's Best, etc, etc, etc....actually gives a Cleveland Steamer about their ocular health assessment? No, it's viewed as an inconvenience that they must get through in order to get their piece of cheese, the Rx.
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you keep saying that its ok for a healthy, normal to have a stand alone refraction. But how does a "healthy, normal" know they are a "healthy normal"? Don't they have to see an eye doctor to find out if they are a "healthy normal"? Well of course they do. Are they going to go there after they go to the eye doctor to first rule out anything of significance? If thats what you propose then I could definitely get on board with that, altho I think is still kind of pointless.
 
I've stated before that I don't think ODs have any business doing surgery. We don't have the training in our OD programs to support it.

I also never said I don't think ophthalmic techs should be allowed to refract independently. I think it would be terrible for optometry, which is the reason it's opposed so highly in the field, but as my previous posts argue, there is nothing about refraction of normal, healthy individuals that can't be done by someone with a few months training. The reason refraction is limited to ODs/MDs is not because it's some terribly difficult skill that can only be done by a doctor, it's because we want patients to be funneled into our offices.

My comment was more of a response to the original poster. I agree, almost anyone can perform a refraction on a normal patient after a few weeks of training. That's essentially what a 2nd year optometry student is anyway.
 
the reason otc readers are allowed is because the manufacturers have succesfully convinced the legislure that there is no risk in the self diagnosis and treatment with otc readers. Nothing more conspiratorial then that. Just good ole american lobbying. But of course we know better...there IS risk. Thus this "inconsistency" you think is so telling of a conspiracy to defraud the public of refraction fees (gasp!). Do you also believe in UFO's? Do you think optometrists killed JFK? Are you prepared for the mayan apocalypse?

I'm doing a literature review and came across an old article from the American Academy of Ophthalmology. In it, they claim that those who use OTC readers are no less likely to avoid eye exams than the regular population. This is extremely old data. Would be interesting to see if it has changed.

Ready-to-wear reading glasses. American Academy of Ophthalmology. (1989). Ophthalmology, Suppl, 35-36.
 
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I'm doing a literature review and came across an old article from the American Academy of Ophthalmology. In it, they claim that those who use OTC readers are no less likely to avoid eye exams than the regular population. This is extremely old data. Would be interesting to see if it has changed.

Ready-to-wear reading glasses. American Academy of Ophthalmology. (1989). Ophthalmology, Suppl, 35-36.

I havent seen that article, but I wonder about the conclusion. If its comparing utilization by OTC users to the "general population" I'd say that isn't saying much. Utilization by the population at large is low from what I recall. The rates are probably identical:rolleyes:
 
Of those using OTC the percentage seeking regular eye care is similar to the percentage of those who do not use OTC but seek eye care. You are likely correct that the number of people seeking eye care in general is low. How often should people get an eye exam is another public health/eye care provider economics discussion entirely.
 
Do you also believe in UFO's?

Yes, most UFOs are weather balloons, and I believe in weather balloons. They're usually harmless.

Do you think optometrists killed JFK?

No, a short man with the last name "Oswald" killed JFK, and as far as I know, he wasn't an OD. I can suggest some great books on the topic if you'd like.

Are you prepared for the mayan apocalypse?

Not really, we have some canned food and a couple of bottles of Culligan water, but I'd say we need additional preparation. I do have some twinkies and they're supposed to have a shelf life of several years, so we might be ok.

you keep saying that its ok for a healthy, normal to have a stand alone refraction. But how does a "healthy, normal" know they are a "healthy normal"? Don't they have to see an eye doctor to find out if they are a "healthy normal"? Well of course they do. Are they going to go there after they go to the eye doctor to first rule out anything of significance? If thats what you propose then I could definitely get on board with that, altho I think is still kind of pointless.

Ok, this is really getting annoying now. You need to learn how to stop, slow down, and actually read posts carefully. Take your time and read them. I never once, at any point, ever, not in any circumstance, in any way, shape or form, said, implied, or in any other way conveyed that in my opinion, it was "ok" for people to get a stand-alone refraction. I actually said the complete opposite about a half dozen times. You're sounding desperate now and it's really starting to get ridiculous. What I said was, it shouldn't be illegal, that's a very different thing than saying it's perfectly fine and absent of risk for the patient.

Give it up, chieftain. You can keep trying to twist what I'm saying, but it's all in print above so it's really pointless on your end.


you keep saying that its ok for a healthy, normal to have a stand alone refraction. But how does a "healthy, normal" know they are a "healthy normal"? Don't they have to see an eye doctor to find out if they are a "healthy normal"? Well of course they do. Are they going to go there after they go to the eye doctor to first rule out anything of significance? If thats what you propose then I could definitely get on board with that, altho I think is still kind of pointless.

You really seem to have difficulty grasping this concept from outside the profession. Stop thinking about this from the standpoint that you're an OD and it's your responsibility to "know better" for your patients. People have the right to be self-destructive and irresponsible, unless you're in NYC, in which case, the local government will tell you what size soda you can buy. What's next, I can't buy a Big Mac anymore because it's too fattening? I can't get a pizza anymore because it's too fattening? Forced annual physicals, forced exercise? You can't say it wouldn't have a public health benefit. Would you sign on for that sort of forced health regulation? What's the difference?
 
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I understand you have a problem with big brother advocating and legislating on the public behalf....really I get it. Now all you have to do is stop saying that big brother is advocating to allow ODs/MDs to control "refraction" for sole reason of obtaining profit (which is of course totally ridiculous). Instead (if you want to be consistent) you should say "big brother is mandating exam for preventative health reasons". Because that IS what they are doing. You obviously disagree with that approach...and thats ok.
 
I understand you have a problem with big brother advocating and legislating on the public behalf....really I get it. Now all you have to do is stop saying that big brother is advocating to allow ODs/MDs to control "refraction" for sole reason of obtaining profit (which is of course totally ridiculous).

Fail. You're wrong. The government did not come up with the rule on its own. Eye care did it. If you don't see that, you're kidding yourself. If Uncle Sam were so worried about our eyes, he'd make us all get eye exams, even emmetropes. It's not the government, it's us. We've advocated for our own benefit many times, and this is just another example. Wake up, dude - be objective and see reality for what it is.

Instead (if you want to be consistent) you should say "big brother is mandating exam for preventative health reasons". Because that IS what they are doing.

Big brother is not mandating Rxs for preventative health reasons. Our government has never been interested in preventative health - ever. Only a couple of states mandate eye exams for children. Those states are looking out for public health. What about the other states that don't mandate childrens' eye exams? If they're so interested in public health, why don't they require exams before age 5, or 6, or whenever? It's not public health driving it - it's our interest. It just happens to have a positive effect.

Look around. We're the fattest nation on the planet.
 
Fail. You're wrong. The government did not come up with the rule on its own. Eye care did it. If you don't see that, you're kidding yourself. If Uncle Sam were so worried about our eyes, he'd make us all get eye exams, even emmetropes. It's not the government, it's us. We've advocated for our own benefit many times, and this is just another example. Wake up, dude - be objective and see reality for what it is.



Big brother is not mandating Rxs for preventative health reasons. Our government has never been interested in preventative health - ever. Only a couple of states mandate eye exams for children. Those states are looking out for public health. What about the other states that don't mandate childrens' eye exams? If they're so interested in public health, why don't they require exams before age 5, or 6, or whenever? It's not public health driving it - it's our interest. It just happens to have a positive effect.

Look around. We're the fattest nation on the planet.

very superficial assessment on your part, but I'm done here, gotta move on
 
very superficial assessment on your part, but I'm done here, gotta move on

I'm just reading this and commenting on this as an outside observer but I have to say that either you are dyslexic or you are choosing to selectively edit your comprehension of JasonK's posts. I have read these 2 pages and I can follow his argument but I cannot follow yours.
 
I've stated before that I don't think ODs have any business doing surgery. We don't have the training in our OD programs to support it.

I actually believe ODs should be allowed to perform LASIK, LASEK, PRK, and other surface refractice surgeries, but there should be a mandatory 1 year residency program after optometry school in order to be able to perform these. That's my opinion.
 
I actually believe ODs should be allowed to perform LASIK, LASEK, PRK, and other surface refractice surgeries, but there should be a mandatory 1 year residency program after optometry school in order to be able to perform these. That's my opinion.

When optometry lobbies to be able to perform these elective, highly lucrative surgeries, they are basically destroying the original argument that optometrists should be able to perform emergency surgeries to those who cannot immediately see an OMD...It's sad, but point Ophthalmology
 
When optometry lobbies to be able to perform these elective, highly lucrative surgeries, they are basically destroying the original argument that optometrists should be able to perform emergency surgeries to those who cannot immediately see an OMD...It's sad, but point Ophthalmology

No, I'm talking about technical capability to accurately perform the procedure. I have no desire to perform lid surgery, EOM surgery, vitrectomies, cataract surgeries, retrobulbar injections, and others. I'm not a big fan of performing surgeries in general, personally, but if a residency program which has some legal standing is required, then I think ODs are capable of corneal refractive surgeries. A patient will know if he or she is getting the procedure done by an OD and not an OMD, and it will probably be a lower price than by an OMD. An OD that elects to do this will also be greatly enhancing his or her legal risk, and should need greater malpractice insurance than a standard OD.

As for emergency surgeries to those who do not have access to an OMD, this is more an issue of OMD undersupply than anything. I don't want to do that if I don't have to, not counting some foreign body removals, pseudomembrane removals, etc that we already do. I'd feel more comfortable allowing a trained ophthalmologist to do it. A LASIK OD would have training, though.
 
No, I'm talking about technical capability to accurately perform the procedure. I have no desire to perform lid surgery, EOM surgery, vitrectomies, cataract surgeries, retrobulbar injections, and others. I'm not a big fan of performing surgeries in general, personally, but if a residency program which has some legal standing is required, then I think ODs are capable of corneal refractive surgeries. A patient will know if he or she is getting the procedure done by an OD and not an OMD, and it will probably be a lower price than by an OMD. An OD that elects to do this will also be greatly enhancing his or her legal risk, and should need greater malpractice insurance than a standard OD.

As for emergency surgeries to those who do not have access to an OMD, this is more an issue of OMD undersupply than anything. I don't want to do that if I don't have to, not counting some foreign body removals, pseudomembrane removals, etc that we already do. I'd feel more comfortable allowing a trained ophthalmologist to do it. A LASIK OD would have training, though.

Is one year enough? As we all know, ophthalmologists go through a 4 year residency, and most who want to be doing refractive surgery/CE go through a 1-2 year CORNEA/refractive surgery fellowship. They are trained in those rare instances when something goes terribly wrong. What is an optometrist going to do if their LASIK patient develops endophthalmitis? Optometrists may be able to perform the surgeries, but can they clean up any potential messes they make? Not legally.

A patient will know if he or she is getting the procedure done by an OD and not an OMD, and it will probably be a lower price than by an OMD.

Optometry rubs me the wrong way in their pretense to help the underserved areas while later revealing their true motives to open up highly profitable refractive surgery sites. No one is going to perform refractive surgery in rural America because there is no demand for it there. They're going to flock to the cities where people are looking for a bargain. It seems like an additional motive for pushing this idea is to piss off Ophthalmology and the AMA by undercutting their prices for these surgeries. If optometry wants in on the profits from surgery, that's fine. But don't hide behind the banner of "we want to help the underprivileged" because it's glaringly obvious that this is not the whole truth.

But I digress. Back to the point of the thread. My opinion is opticians should not be performing independent refractions, even though they probably could for 95% of the population. If they refract someone incorrectly or miss a BV issue, they will probably have more trouble figuring it out than an optometrist. Likewise, optometrists should not be performing surgeries by the same logic.

PS I love optometry. I wholeheartedly dislike the priorities of the AOA.
 
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What is an optometrist going to do if their LASIK patient develops endophthalmitis? Optometrists may be able to perform the surgeries, but can they clean up any potential messes they make? Not legally.

Bad example. They'd do the same thing if a post-cataract patient develops endophthalmitis...
 
Bad example. They'd do the same thing if a post-cataract patient develops endophthalmitis...

This is true, but the OD in question didn't do the procedure that led to the complication. He can simply say "Hey, you did the surgery, the recovery is not going as planned....you fix it." When MDs start getting even a small number of post surgical complications in patients operated on by ODs, you can be sure it will be entirely the fault of an incompetent OD, and there will be a trail of MDs on the stand to state how horrible the mistake was. As others have said before, we're incompetent until proven otherwise, while the opposite is true for MDs.

All I'm saying is, there is no underlying foundation in our education that supports anything but the most minor, noninvasive surgical procedures. A high school kid could be taught to perform lasik or prk. I know an orthopedic surgeon who claims anyone could be trained to perform a knee replacement. He calls it "glorified carpentry," but that's not the point. The point is, we're not surgeons. Even if we do some sort of residency that incorporates a surgical training portion, it doesn't change the fact that we're still not surgeons. In my opinion, if you're cutting into people or doing any sort of permanent tissue destruction, patients deserve that the person performing the procedure have done it repeatedly, hundreds or thousands of times. During training, patients deserve to have their inexperienced operator supervised by someone who has performed thousands of procedures. As ODs, we simply don't have the resources to allow for that kind of volume or supervision.

I just don't see the reason to introduce elective refractive procedures to the OD practice act. It makes zero sense. There aren't even enough lasik/prk patients for MDs right now so when we're added into the mix, it's really going to get ugly. I just don't think rapid expansion of our practice act is what's needed right now.

ODs need to circle the wagons and figure out how to fix the problems within the profession. It's just like in the business world; when you expand too fast, and you don't have the infrastructure to support your own weight, your business collapses. The same will happen to us if we continue to spread ourselves too thin, on many different levels.
 
Rationalizing that we can do refractive procedures makes about as much sense as letting opticians refract. A one year fellowship so an OD can do surgery is nowhere near the same as a four year residency and a refractive fellowship. As much as we try to convince ourselves it is the same thing, it isn't and statements like that make OMDs think we are idiots. In that one year, is the OD being brought up to speed with ocular diseases etc.. or just surgery? Wouldnt two years be needed at a minimum, one for ocular disease and one for surgery? Also, An OMD does surgery over three years in residency...somehow an OD can learn in one? How does that make any sense?

This reminds of me of the secession request of Texas...saying things without actually thinking it all out.

In case anyone was wondering...we filled that open position that I had posted last month. Twenty seven applicants..six interviews.. Great guy trained at PCOM.
 
Rationalizing that we can do refractive procedures makes about as much sense as letting opticians refract. A one year fellowship so an OD can do surgery is nowhere near the same as a four year residency and a refractive fellowship. As much as we try to convince ourselves it is the same thing, it isn't and statements like that make OMDs think we are idiots. In that one year, is the OD being brought up to speed with ocular diseases etc.. or just surgery? Wouldnt two years be needed at a minimum, one for ocular disease and one for surgery? Also, An OMD does surgery over three years in residency...somehow an OD can learn in one? How does that make any sense?

This reminds of me of the secession request of Texas...saying things without actually thinking it all out.

In case anyone was wondering...we filled that open position that I had posted last month. Twenty seven applicants..six interviews.. Great guy trained at PCOM.

I do not understand what you are saying about disease, with the current OD scope of practice and education, there is no disease OMDs can recognize which ODs cannot recognize. The curriculum at my school is often overlapped with physicians in shared courses. We have extensive training in disease recognition and understanding of treatments already. Maybe training was not as broad when you graduated.

OMDs learn a lot of surgical procedures over 4 years, I'm saying just one such as LASIK/LASEK, with laser only, no scalpels. We already know everything about LASIK, and a year of training on how to operate seems appropriate to me, but you're the practicing OD so your opinion is appreciated.
 
I do not understand what you are saying about disease, with the current OD scope of practice and education, there is no disease OMDs can recognize which ODs cannot recognize. The curriculum at my school is often overlapped with physicians in shared courses. We have extensive training in disease recognition and understanding of treatments already. Maybe training was not as broad when you graduated.

OMDs learn a lot of surgical procedures over 4 years, I'm saying just one such as LASIK/LASEK, with laser only, no scalpels. We already know everything about LASIK, and a year of training on how to operate seems appropriate to me, but you're the practicing OD so your opinion is appreciated.
There are no diseases that OMD's can recognize which OD's can't **in theory**. EVERY practicing optometrist will at some point have something that they cannot definitively diagnose. I had a patient with an unusual lid growth recently. It didn't match any description of a lid lesion that I know of. I referred out to an OMD and found out it was a really bizarre BCC. This happens a handful of times a year, and I expect it does to most optometrists as well. Optometry school does a good job of telling you what the classic example of disease/condition looks like, but in practice, many conditions do not present classically. Didactic learning in OD school is broad but not deep. And ophthalmologists do not gain their knowledge of ocular disease in medical school but during residency, where I'm sure they see things like BCC on a regular basis. (Btw, during their residencies, they work 80 hours on the clock and up to 20 hours off the clock. Even in an ocular disease optometry residency, it is a 40 hour work week...this means they have >2x more patient encounters in a given week/year). I'm sure they see dozens, maybe hundreds, of classic and not-so-classic presentations of most diseases. The average OMD's clinical knowledge far exceeds the average OD's. When you're competing against OMD's, it would be wise for future optometrists performing surgery to have a thorough disease background before operating.

Also, a microkeratome is essentially a scalpel. Even with intralase, the laser essentially acts as a scalpel. I'm still confused by optometrists wanting to perform refractive surgery. Someone mentioned above that there is not as big of a demand for refractive surgery as it is made out to be. Most surgical centers are probably doing 70% CE (insurance covers), 30% refractive surgery (insurance does not cover...ever).
 
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Gigan998...once you are done with school...tell me if you think your training prepared you for ocular diseases. If that was the case..what is the point of ocular disease residencies that ODs do? They should be obsolete. I would agree that graduating ODs are at a totally different level compared to OMDs finishing residency. Its not even comparable...

What class overlaps are you taking with physicians? I asked my brother who is an OMD and he has never heard of an OMD taking classes at an optometry school anywhere in the country.
 
What class overlaps are you taking with physicians? I asked my brother who is an OMD and he has never heard of an OMD taking classes at an optometry school anywhere in the country.

Gross Anatomy, Head and Neck Anatomy, Neuroscience, Molecular and Cellular Basis of Medicine, Immunology, and Interprofessional case studies are all courses OD students share with osteopathic DO students at WesternU. They're the same identical courses we share and test in.

Honestly, if long practicing ODs do not feel optometry has a sufficient background to ever perform any kind of refractive surgery, I'll take your advice over my own opinion. In many cases, you've been working with real patients for years longer than I have been out of high school, or maybe even born. I'm just a second year student, but the curriculum at WesternU is intensive, and I have also heard through the grapevine of lasers possibly being in the future of OD practice.
 
Gross Anatomy, Head and Neck Anatomy, Neuroscience, Molecular and Cellular Basis of Medicine, Immunology, and Interprofessional case studies are all courses OD students share with osteopathic DO students at WesternU. They're the same identical courses we share and test in.

Of all of those courses, only neuroscience and head/neck anatomy have any real practical value in optometry, and even then, a lot of it is extra information. It's nice that you have exposure to those other classes, but you could probably completely remove the other courses and have the same clinical competence.
 
I think it has nothing to do with "long practicing ODs" and our opinion. It would be great if ODs coming out of training could handle ocular diseases however they need between 5-10 years of experience (IMO) before they can PROPERLY handle ocular diseases. An OMD coming out of training is probably better (IMO) out of training than some OMD practicing 10 years in their niche specialty. I have seen both over my career from 1995 to now and yes have ODs improved ..of course..are they the same...hell no...not even close.

In terms of courses...I think an OMD taking biochem or "inter professional" classes with an OD makes no comments about their ocular training. When dentists and OMDS take head and neck anatomy together in school does that mean the OMD can now pull teeth? What do those classes have anything to do with ocular disease or surgery? Just my opinion....
 
There's nothing wrong with opticians' refracting patients for spectacles-fitting — honestly, I think the profession probably is at least as knowledgable as that of optometry, in this regard.
 
There are no diseases that OMD's can recognize which OD's can't **in theory**. EVERY practicing optometrist will at some point have something that they cannot definitively diagnose. I had a patient with an unusual lid growth recently. It didn't match any description of a lid lesion that I know of. I referred out to an OMD and found out it was a really bizarre BCC. This happens a handful of times a year, and I expect it does to most optometrists as well. Optometry school does a good job of telling you what the classic example of disease/condition looks like, but in practice, many conditions do not present classically. Didactic learning in OD school is broad but not deep. And ophthalmologists do not gain their knowledge of ocular disease in medical school but during residency, where I'm sure they see things like BCC on a regular basis. (Btw, during their residencies, they work 80 hours on the clock and up to 20 hours off the clock. Even in an ocular disease optometry residency, it is a 40 hour work week...this means they have >2x more patient encounters in a given week/year). I'm sure they see dozens, maybe hundreds, of classic and not-so-classic presentations of most diseases. The average OMD's clinical knowledge far exceeds the average OD's. When you're competing against OMD's, it would be wise for future optometrists performing surgery to have a thorough disease background before operating.

Also, a microkeratome is essentially a scalpel. Even with intralase, the laser essentially acts as a scalpel. I'm still confused by optometrists wanting to perform refractive surgery. Someone mentioned above that there is not as big of a demand for refractive surgery as it is made out to be. Most surgical centers are probably doing 70% CE (insurance covers), 30% refractive surgery (insurance does not cover...ever).

Here's a thought for you, what about OD's doing refractive surgery after "x" amount of years in practice? If your argument against us performing laser procedures is lack of patient encounters, well, how about after we have enough patient encounters to equal the amount an OMD has after residency?

The refractive surgeon fellow who has performed tens of thousands of procedures at one point in his/her training had to perform their 1st LASIK, and at that point in their career they had just as much experience with refractive surgery as an OD.

Also, I can guarantee you that EVERY OMD will have something in their chair that they can not definitively diagnose as well, just like every OD and GP, and neurologist, etc. It's called practicing optometry, ophthalmology, medicine, for a reason.

Students, if you want to do refractive surgery, graduate, and do your residency down in Tahlequah.
 
There's nothing wrong with opticians' refracting patients for spectacles-fitting — honestly, I think the profession probably is at least as knowledgable as that of optometry, in this regard.

How absurd

in about half of the states there is no formal licensure, no required education, no testing, no training required whatsoever, no nothing. Zip. Zero. Zilch Thats right you can be an "optician" in a huge chunk of the country with nothing more then a GED. You just open up shop, get a tax id and you are good to go.

I think too many ODs have been stuck in the mall getting dumber and probably perform what are essentially refractions and little else, and thats probably why they have a such a low opinion of their training and responsibility. You'd think you guys have never seen amblyopia, glaucoma, or anything else except primary refractive error. Perhaps you just "treat" everyone as routine, prescribing unecessary glasses, etc. You have been corrupted by the "retailers" mindset that has overun this profession. Hey when the only tool you have is a hammer, all you see are nails....right?
 
How absurd

in about half of the states there is no formal licensure, no required education, no testing, no training required whatsoever, no nothing. Zip. Zero. Zilch Thats right you can be an "optician" in a huge chunk of the country with nothing more then a GED. You just open up shop, get a tax id and you are good to go.

I think too many ODs have been stuck in the mall getting dumber and probably perform what are essentially refractions and little else, and thats probably why they have a such a low opinion of their training and responsibility. You'd think you guys have never seen amblyopia, glaucoma, or anything else except primary refractive error. Perhaps you just "treat" everyone as routine, prescribing unecessary glasses, etc. You have been corrupted by the "retailers" mindset that has overun this profession. Hey when the only tool you have is a hammer, all you see are nails....right?

I don't see how this relates to my comment: I am not suggesting opticians should perform eye exams — that's not the topic of this thread. Regarding refraction, nothing suggests an optician would not carry out the job competently.
 
I don't see how this relates to my comment: I am not suggesting opticians should perform eye exams — that's not the topic of this thread. Regarding refraction, nothing suggests an optician would not carry out the job competently.

well, since "optician" isn't even recognized in about half the US, I think its probably fair that you rephrase your comment to say "nothing suggests that anybody with a high school diploma or GED would not carry out the job competently"

next

define "competently" in the context of an amblyopic 6yo
 
well, since "optician" isn't even recognized in about half the US, I think its probably fair that you rephrase your comment to say "nothing suggests that anybody with a high school diploma or GED would not carry out the job competently"

next

define "competently" in the context of an amblyopic 6yo

All right, I'll re-phrase: One does not need the four-year optometry education to refract; it takes a few weeks to learn, and several months to become proficient in. Do you disagree; and, if so, where?
 
There's nothing wrong with opticians' refracting patients for spectacles-fitting — honestly, I think the profession probably is at least as knowledgable as that of optometry, in this regard.

:barf:
 
All right, I'll re-phrase: One does not need the four-year optometry education to refract; it takes a few weeks to learn, and several months to become proficient in. Do you disagree; and, if so, where?

I agree but the 4 years is to learn how to provide examination (for which refraction is merely one component). Of course anybody can learn to "refract", but the real skill is prescribing. Without examination you are refracting in the dark. Would you feel comfortable having a high school grad "refract" the 6yo amblyope? presumably you would be ok allowing them to perform cycloplegic refraction? Ever see a 20/20 pt with NVD, NVE? how bout the 20/20 glaucoma pt? or the 20/20 pt with retinal detachment?
 
I agree but the 4 years is to learn how to provide examination (for which refraction is merely one component). Of course anybody can learn to "refract", but the real skill is prescribing. Without examination you are refracting in the dark. Would you feel comfortable having a high school grad "refract" the 6yo amblyope? presumably you would be ok allowing them to perform cycloplegic refraction? Ever see a 20/20 pt with NVD, NVE? how bout the 20/20 glaucoma pt? or the 20/20 pt with retinal detachment?

Pretty much this.
It is like how a dental assistant takes x-rays, allowing the dentist to perform fillings, root canals, and extractions. But a dental assistant doesn't do this without a dentist around, because he or she cannot interpret the data entirely; only superficially.
 
A 5 minute high school optician refraction, an NCT IOP test and a digitial retinal photo would suffice for approximately 80%+ of the population's refractive and ocular health needs.

Doctor referrals for:
-Best-corrected acuity less than 20/25
-Hazy retinal photo (indicating cataracts, corneal issues or possible ant seg/vitreous haze).
- High IOP.

A few peripheral retinal issues would be missed. But..........the sheep would be happy.
 
now the high school kid is interpreting fundus photos :eek:?

you guys are too funny, hurry up and get out of the mall before you lose any sense left in you.
 
I agree but the 4 years is to learn how to provide examination (for which refraction is merely one component). Of course anybody can learn to "refract", but the real skill is prescribing. Without examination you are refracting in the dark. Would you feel comfortable having a high school grad "refract" the 6yo amblyope? presumably you would be ok allowing them to perform cycloplegic refraction? Ever see a 20/20 pt with NVD, NVE? how bout the 20/20 glaucoma pt? or the 20/20 pt with retinal detachment?

That's a different question, then: whether a refraction may be a stand-alone procedure, or must be simply an aspect of a comprehensive eye examination. I have not voiced an opinion in this regard.
 
A 5 minute high school optician refraction, an NCT IOP test and a digitial retinal photo would suffice for approximately 80%+ of the population's refractive and ocular health needs.

Doctor referrals for:
-Best-corrected acuity less than 20/25
-Hazy retinal photo (indicating cataracts, corneal issues or possible ant seg/vitreous haze).
- High IOP.

A few peripheral retinal issues would be missed. But..........the sheep would be happy.

If you really think the only problem that can manifest on the retina gives a subjectively "hazy" look, and that details like CRVOs, etc can be detected by someone with no training at all on how to look at a fundus, then you are a terrible eye doctor. And if you think of your patients, whose health is in your hands, as "sheep," you have no right to be a doctor at all.

You act like you've never seen a melanoma or fit a contact lens. What about ICE? What about catching early diabetes? What about a severe convergence insufficiency? You sound like you hate your job.
 
Here's a thought for you, what about OD's doing refractive surgery after "x" amount of years in practice? If your argument against us performing laser procedures is lack of patient encounters, well, how about after we have enough patient encounters to equal the amount an OMD has after residency?

The refractive surgeon fellow who has performed tens of thousands of procedures at one point in his/her training had to perform their 1st LASIK, and at that point in their career they had just as much experience with refractive surgery as an OD.

Also, I can guarantee you that EVERY OMD will have something in their chair that they can not definitively diagnose as well, just like every OD and GP, and neurologist, etc. It's called practicing optometry, ophthalmology, medicine, for a reason.

Students, if you want to do refractive surgery, graduate, and do your residency down in Tahlequah.

This is what my brother who is an OMD informed me about the training process:

An average OMD resident sees roughly 30 patients a day for 3 years. Some a little more and some a little less. That is roughly 22500 encounters. On top of that 99% of those patients have pathology...we are not talking glaucoma suspects. glaucoma patients but patients with all different forms of keratoconus, keratoglobus, retinal dystrophies, melanoma etc...

In my opinion:

Most ODs in their practice may take years and years of practice to see that volume of patients with pathology. Most will not. Seeing healthy patients who need glasses does not count which is what the vast majority of ODs see.

As a small example I have seen three melanomas in my twenty years. My OMD brother saw roughly 40-50 during his residency. I have seen 2 patients with dacryocystitis over twenty years. My brother had seen in residency roughly 20. It's a big difference. Hey I didn't do the training with that volume. There is no way I am going to catch up to that in my practice..where I do see about 15-20 patients a day and I have a high real pathology percentage (25%). I am not talking about BS pathology to just bill insurance like blepharitis or cataract but real pathology like advanced glaucoma, retinal dystrophies, keratoconus etc.. The other 75% are just refractions essentially with no pathology. So that works out to about 1250 pathology patients a year. If we went by straight numbers that would take 18 years for me to catch up to my brother or the average OMD out of training in clinic experience.


I have been practicing for 20 years roughly and in my career I haven't seen the breadth and depth of an ophthalmology trained doctor. My brother who is an OMD has had someone guide them in residency on how to manage these patients and he has then managed them on their own. It is different than seeing something and not knowing what it is..sending it out and getting a letter a week later telling me what it is and how it was managed. A practicing OD in my opinion will never catch up to an OMD who is trained. That being said an OMD over the years may forget so much info that I can catch up to them. The OMDs who have the most knowledge to me are the ones who are a few years out of training.

A refractive surgeon doing their first has assisted on roughly 1500 refractive procedures during fellowship. To say that they have the same experience as an OD is not correct. I certainly have not assisted on any refractive procedures. I have seen 2 or 4. I don;t think that is the same thing.

Of course "every" OMD will not know everything. No one does. But their depth of knowledge is broader and deeper. I know it is not politically correct for me to say but it really is the truth. Really wanting to believe something, saying it is true and wishing it was true...it doesn't make it any more true.

From having people in my family who were trained as OMDs and others such as myself who are ODs, the whole "we are the same thing" argument is nonsense and to be honest makes the ODs who say it look like fools. Just like when you are in a bar drinking beers watching monday night football and one of your friends says "I couldve been a quarterback in the NFL". Whatever..The sad thing is that some of my colleagues actually believe it and the OMDs in the philadelphia area have to treat their disasters.
 
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This is what my brother who is an OMD informed me about the training process:

An average OMD resident sees roughly 30 patients a day for 3 years. Some a little more and some a little less. That is roughly 22500 encounters. On top of that 99% of those patients have pathology...we are not talking glaucoma suspects. glaucoma patients but patients with all different forms of keratoconus, keratoglobus, retinal dystrophies, melanoma etc...

In my opinion:

Most ODs in their practice may take years and years of practice to see that volume of patients with pathology. Most will not. Seeing healthy patients who need glasses does not count which is what the vast majority of ODs see.

As a small example I have seen three melanomas in my twenty years. My OMD brother saw roughly 40-50 during his residency. I have seen 2 patients with dacryocystitis over twenty years. My brother had seen in residency roughly 20. It's a big difference. Hey I didn't do the training with that volume. There is no way I am going to catch up to that in my practice..where I do see about 15-20 patients a day and I have a high real pathology percentage (25%). I am not talking about BS pathology to just bill insurance like blepharitis or cataract but real pathology like advanced glaucoma, retinal dystrophies, keratoconus etc.. The other 75% are just refractions essentially with no pathology. So that works out to about 1250 pathology patients a year. If we went by straight numbers that would take 18 years for me to catch up to my brother or the average OMD out of training in clinic experience.


I have been practicing for 20 years roughly and in my career I haven't seen the breadth and depth of an ophthalmology trained doctor. My brother who is an OMD has had someone guide them in residency on how to manage these patients and he has then managed them on their own. It is different than seeing something and not knowing what it is..sending it out and getting a letter a week later telling me what it is and how it was managed. A practicing OD in my opinion will never catch up to an OMD who is trained. That being said an OMD over the years may forget so much info that I can catch up to them. The OMDs who have the most knowledge to me are the ones who are a few years out of training.

A refractive surgeon doing their first has assisted on roughly 1500 refractive procedures during fellowship. To say that they have the same experience as an OD is not correct. I certainly have not assisted on any refractive procedures. I have seen 2 or 4. I don;t think that is the same thing.

Of course "every" OMD will not know everything. No one does. But their depth of knowledge is broader and deeper. I know it is not politically correct for me to say but it really is the truth. Really wanting to believe something, saying it is true and wishing it was true...it doesn't make it any more true.

From having people in my family who were trained as OMDs and others such as myself who are ODs, the whole "we are the same thing" argument is nonsense and to be honest makes the ODs who say it look like fools. Just like when you are in a bar drinking beers watching monday night football and one of your friends says "I couldve been a quarterback in the NFL". Whatever..The sad thing is that some of my colleagues actually believe it and the OMDs in the philadelphia area have to treat their disasters.

Thank you for that, it is a good argument and makes me rethink my position on the 1 year residency thing.
 
That's a different question, then: whether a refraction may be a stand-alone procedure, or must be simply an aspect of a comprehensive eye examination. I have not voiced an opinion in this regard.

It's very easy to determine if a retinal photo shows a normal retina or one that is abnormal (and needs referral). A tech can be trained to do that in a few weeks/months.

For what it's worth, our local VA hospital recalls diabetic patients every two years. The tech checks the acuity and takes a retinal photo. If the pts acuity is 20/25 and they have no complaints and the tech determines the photos looks normal, the patients is done. Sent home. No exam.

I'm not saying this is ideal. But it has been determined, for the busy VA system, it's "good enough".
 
If you really think the only problem that can manifest on the retina gives a subjectively "hazy" look, and that details like CRVOs, etc can be detected by someone with no training at all on how to look at a fundus, then you are a terrible eye doctor. And if you think of your patients, whose health is in your hands, as "sheep," you have no right to be a doctor at all.

You act like you've never seen a melanoma or fit a contact lens. What about ICE? What about catching early diabetes? What about a severe convergence insufficiency? You sound like you hate your job.

Yes, I understand you know more than me about the eyes. And yes, I am a terrible doctor who happens to be very successful thorough 'word-of-mouth' referrals.

P.S. Only an idiot would not be able to tell a CRVO appearing in a photo that is a 'problem' needing referral. Have you ever even seen one? Pull out your text book and look it up. I never said a homeless person can do it. But the certifed ophthalmic techs working in many OMD offices could probably do it better than many ODs today. My techs (whom I've trained personally) can do it.

OPTOMETRY AIN'T ROCKET SCIENCE YA'LL. Optometry work is about on a 7th grade education level. Sorry for reality.:D
 
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