Lid Lacs?

[dantt]

Out of curiosity...what do you do now? What would you do if this bill were law?

http://www.capitol.tn.gov/Bills/108/Amend/SA0863.pdf

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[thiaeyemd]

Out of curiosity...what do you do now? What would you do if this bill were law?

http://www.capitol.tn.gov/Bills/108/Amend/SA0863.pdf

I would be busier performing eyelid laceration revision surgery (which I already do). Honestly, I would be shocked if an optometrist tried to suture eyelid lacerations...considering most ophthalmologists (who trained in it for three years) send it to oculoplastic surgeons. This bill really makes me scratch my head to think "What exactly are people trying to prove here?". If you think a weekend course or even a 1 week course from 9-5 is going to prepare you to repair eyelid lacerations, you've lost your mind. My residents usually take months just to be able to identify the appropriate plan for eyelid lacerations. These are the simple ones that don't involve the margin, tear duct or orbital fat...Most are not comfortable addressing the complex ones ever. That is even before they begin to repair them or place one stitch. This bill seems to reflect a lot of hubris and assumptions on how "easy" something appears. It makes me doubt the judgement of people who introduce such legislation. Why not just include orbital surgery while your at it? On the other hand,..I will be there if it is messed up and a reconstructive repair is much more complicated than a primary repair...and believe me folks if you don't know what you are doing..it is easily messed up...if you don't believe me ask the other medical surgical specialties that attempt to repair simple eyelid lacerations and then send it to oculplastic surgeons.

Is this how things work? Give enough money to politicians and they will agree to anything?

 

[thiaeyemd]

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[dantt]

I would be busier performing eyelid laceration revision surgery (which I already do). Honestly, I would be shocked if an optometrist tried to suture eyelid lacerations...considering most ophthalmologists (who trained in it for three years) send it to oculoplastic surgeons. This bill really makes me scratch my head to think "What exactly are people trying to prove here?". If you think a weekend course or even a 1 week course from 9-5 is going to prepare you to repair eyelid lacerations, you've lost your mind. My residents usually take months just to be able to identify the appropriate plan for eyelid lacerations. These are the simple ones that don't involve the margin, tear duct or orbital fat...Most are not comfortable addressing the complex ones ever. That is even before they begin to repair them or place one stitch.

Interesting point of view. While I would strongly consider sending my private patients off to an oculoplastics surgeon for a "professional" job, margin involving lid lacs all over the country are done by ophthalmology residents (many without ever having seen one done) without plastics or attending supervision. These aren't the best jobs in the world but you get what you pay for.

 

[ophthope]

Interesting point of view. While I would strongly consider sending my private patients off to an oculoplastics surgeon for a "professional" job, margin involving lid lacs all over the country are done by ophthalmology residents (many without ever having seen one done) without plastics or attending supervision. These aren't the best jobs in the world but you get what you pay for.

Who is training where you repair a lid lac completely alone for the first time? No way in my residency is that happening.

 

[310]

I have zero interest in fixing a lid laceration.

 

[dantt]

Who is training where you repair a lid lac completely alone for the first time? No way in my residency is that happening.

Happens all the time...somebody I know had one first call of residency in July...senior put in the first suture and left them to finish the rest.

I did my first one with the patient draped and my copy of Will's open to page 26 on his chest LOL.

 

[thiaeyemd]

Happens all the time...somebody I know had one first call of residency in July...senior put in the first suture and left them to finish the rest.

I did my first one with the patient draped and my copy of Will's open to page 26 on his chest LOL.

I am the main oculoplastics surgeon at a major residency program in the midatlantic…Pardon my candor but to hear a 1st year resident attempting eyelid laceration margin repairs on their own with no supervision is a damn disgrace. It is a disservice to the patient and the resident performing it. There is no way a 1st year resident is performing that procedure properly greater than 50% of the time. How would one feel if that was your mom or dad who was the patient? It is an embarrassment to your program that patient care exists like that. It is completely and utterly unacceptable. The fact that the senior resident thought it was ok to do that reflects a lack of professionalism, care for the patient and at our program would result in a suspension or visit to the PD's office.

 

[20DOC20]

There would be no way on God's green earth I'd touch any of that with, excepting injecting a longstanding and persistent chalazion with Kenalog. I'd do the latter only if access to an ophthalmologist were difficult and if the patient insisted on immediate treatment.

It would be flat-out irresponsible for an OD to repair lid lacerations, or doing any other type of lid work other than an occasional steroid injection for chalazion, simply because we haven't the training for it and the risk of scarring is too high. And if the lid scars, it won't close properly. Not only is it bad for the patient, but it's a huge medical liability for the OD.

I like to send patients straight to an oculoplastics specialist for any of that stuff.

 

[20DOC20]

QUOTE: I am the main oculoplastics surgeon at a major residency program in the midatlantic…Pardon my candor but to hear a 1st year resident attempting eyelid laceration margin repairs on their own with no supervision is a damn disgrace. It is a disservice to the patient and the resident performing it. There is no way a 1st year resident is performing that procedure properly greater than 50% of the time. How would one feel if that was your mom or dad who was the patient? It is an embarrassment to your program that patient care exists like that. It is completely and utterly unacceptable. The fact that the senior resident thought it was ok to do that reflects a lack of professionalism, care for the patient and at our program would result in a suspension or visit to the PD's office."


I couldn't agree with you more!!! I've been practicing optometry for 18 years and I'm embarrassed as the behavior of colleagues trying to "advance" our profession. It's not advancing anything, it's flat-out changing it! I never wanted to treat glaucoma. I wanted to do vision therapy stuff going into school and those programs are being phased out.

I went into optometry not because I couldn't get into medical school, but because I faint at the sight of blood! (I had GPA to qualify for med school) I'm not a good candidate for med school because medicine is just gross. To be honest, the sight of muco-purulent discharge in some conjunctivitis patients turns my stomach, especially seeing it on high mag in a slit-lamp --- even after all these years.

Also, instilling dilating drops and getting patients tears on my hands grosses me out, too. Just being honest. I wash my hands a lot.

I feel at hostage to all the OD's wanting to "advance" this once quaint, clean and unique profession.

I have also worked with an oculoplastic surgeon -- long ago. I got to see his post-ops. I got to remove the sutures of blepharoplasties. That was pretty cool though. But that's the limit of my medical interest there.

So, on behalf of sane optometrists everywhere, please do what you can to stop legislation such as this, doctor!

 

[310]

QUOTE: I am the main oculoplastics surgeon at a major residency program in the midatlantic…Pardon my candor but to hear a 1st year resident attempting eyelid laceration margin repairs on their own with no supervision is a damn disgrace. It is a disservice to the patient and the resident performing it. There is no way a 1st year resident is performing that procedure properly greater than 50% of the time. How would one feel if that was your mom or dad who was the patient? It is an embarrassment to your program that patient care exists like that. It is completely and utterly unacceptable. The fact that the senior resident thought it was ok to do that reflects a lack of professionalism, care for the patient and at our program would result in a suspension or visit to the PD's office."


I couldn't agree with you more!!! I've been practicing optometry for 18 years and I'm embarrassed as the behavior of colleagues trying to "advance" our profession. It's not advancing anything, it's flat-out changing it! I never wanted to treat glaucoma. I wanted to do vision therapy stuff going into school and those programs are being phased out.

I went into optometry not because I couldn't get into medical school, but because I faint at the sight of blood! (I had GPA to qualify for med school) I'm not a good candidate for med school because medicine is just gross. To be honest, the sight of muco-purulent discharge in some conjunctivitis patients turns my stomach, especially seeing it on high mag in a slit-lamp --- even after all these years.

Also, instilling dilating drops and getting patients tears on my hands grosses me out, too. Just being honest. I wash my hands a lot.

I feel at hostage to all the OD's wanting to "advance" this once quaint, clean and unique profession.

I have also worked with an oculoplastic surgeon -- long ago. I got to see his post-ops. I got to remove the sutures of blepharoplasties. That was pretty cool though. But that's the limit of my medical interest there.

So, on behalf of sane optometrists everywhere, please do what you can to stop legislation such as this, doctor!

Please don't bundle treating glaucoma in with treating lid lacerations. Thanks.

 

[EyeCaptain]

Current legislation lobbying does not always reflect the views of Optometrists in general. Comments about hubris and lack of experience can be directed toward those actually involved in the legislation, and a handful of Optometry students who would love to be able to perform complicated surgery with no training.

 

[epalacios]

FYI, the bill did pass here in TN. OD's are now allowed to use injectible anesthesia for minor lid procedures that are already in the scope of practice (lumps and bumps, etc.) OD's were aleady allowed to perform said procedures, but previously were only allowed to use topical anesthesia.
I completely understand that some OD's do not like the broadening scope of practice. That's fine, stay in your comfort zone. There's nothing wrong with that. But don't get in the way or bad mouth those of us who wish to practice to the fullest extent of our potential! I have absolutely no interest in performing "lid reconstructive surgery." That's not what this is about. Small "lumps and bumps," such as a chalazion don't qualify as lid reconstructive surgery.
I'm thankful for those who have come before me in the profession to broaden the scope of practice. If we didn't have legislative efforts, we never would have gotten the right to use diagnostics, topicals, or even orals. As technology continues to evolve, newer ways to treat patient conditions will be brought to market. Since optometry is a legislated profession, we must continue to fight to be sure we have access to the latest treatment modalities. Already in the horizon awaiting FDA approval are corneal collagen cross linking and drug-eluting contact lenses, both procedures that should be within optometric scope of practice, but we will most likely have to fight a legislative battle for.

 

[EyeCaptain]

I completely understand that some OD's do not like the broadening scope of practice. That's fine, stay in your comfort zone. There's nothing wrong with that. But don't get in the way or bad mouth those of us who wish to practice to the fullest extent of our potential! I have absolutely no interest in performing "lid reconstructive surgery." That's not what this is about. Small "lumps and bumps," such as a chalazion don't qualify as lid reconstructive surgery.

To clarify, my comments were directed toward legislation that would push Optometrists beyond the limits of their training. Optometry has always been a legislated profession and will continue to be. That is how the profession moves forward. The danger lies in pushing for privileges beyond our capabilities.

This does not constitute something beyond OD capabilities. In case the other posters are like me and didn't bother to click on the link above, here is a line from the document: "Nothing in this subdivision shall be construed as allowing an optometrist to perform any reconstructive surgical procedure on the eyelid."

 

[Commando303]

QUOTE: I am the main oculoplastics surgeon at a major residency program in the midatlantic…Pardon my candor but to hear a 1st year resident attempting eyelid laceration margin repairs on their own with no supervision is a damn disgrace. It is a disservice to the patient and the resident performing it. There is no way a 1st year resident is performing that procedure properly greater than 50% of the time. How would one feel if that was your mom or dad who was the patient? It is an embarrassment to your program that patient care exists like that. It is completely and utterly unacceptable. The fact that the senior resident thought it was ok to do that reflects a lack of professionalism, care for the patient and at our program would result in a suspension or visit to the PD's office."


I couldn't agree with you more!!! I've been practicing optometry for 18 years and I'm embarrassed as the behavior of colleagues trying to "advance" our profession. It's not advancing anything, it's flat-out changing it! I never wanted to treat glaucoma. I wanted to do vision therapy stuff going into school and those programs are being phased out.

I went into optometry not because I couldn't get into medical school, but because I faint at the sight of blood! (I had GPA to qualify for med school) I'm not a good candidate for med school because medicine is just gross. To be honest, the sight of muco-purulent discharge in some conjunctivitis patients turns my stomach, especially seeing it on high mag in a slit-lamp --- even after all these years.

Also, instilling dilating drops and getting patients tears on my hands grosses me out, too. Just being honest. I wash my hands a lot.

I feel at hostage to all the OD's wanting to "advance" this once quaint, clean and unique profession.

I have also worked with an oculoplastic surgeon -- long ago. I got to see his post-ops. I got to remove the sutures of blepharoplasties. That was pretty cool though. But that's the limit of my medical interest there.

So, on behalf of sane optometrists everywhere, please do what you can to stop legislation such as this, doctor!

I think that's a tremendously salient point. Optometry, politically, fights an ever-enthusiastic battle to essentially move into medicine. The fact is, the profession's primary goal for itself needs to be to understand what it seeks its identity to be, rather than to pantingly pursue anything and everything it can concerning "scope of practice."

 

[EyeCaptain]

I think that's a tremendously salient point. Optometry, politically, fights an ever-enthusiastic battle to essentially move into medicine. The fact is, the profession's primary goal for itself needs to be to understand what it seeks its identity to be, rather than to pantingly pursue anything and everything it can concerning "scope of practice."

What do you think Optometry's identity should be? Do you think the procedures outlined in this bill are beyond the scope and training of Optometry? I'm curious to hear your opinion.

If Optometry is seeking the identity of primary eye care provider (which, consequently, is the definition) then I don't see this legislation as anything radical or dangerous for patients. Some things are beyond the scope of optometric training. This is not one of them. Not everyone in Optometry is afraid of new procedures, and luckily for those who are, no one will be forced to integrate these procedures into their practices.

 

[ophthope]

Already in the horizon awaiting FDA approval are corneal collagen cross linking and drug-eluting contact lenses, both procedures that should be within optometric scope of practice, but we will most likely have to fight a legislative battle for.

No offense, but I'm pretty sure that's going to be an easy one to defend for our scope of practice defense "Surgery by Surgeons" lobby. It is just highly unlikely that you're going to be doing collagen cross linking. Is there any country in the world you can point to where this is routinely done by Optometry instead Ophthalmology? Do you think you've done enough surgical procedures in training to be confident in doing an epi-off CXL? It's kind of staggering to me how you can outright claim that this procedure should be within your scope of practice, when I know some Comprehensive Ophthalmologists that wouldn't do it because they think a Cornea subspecialist is better suited to safely perform that procedure, and they'd refer out.

 

[Commando303]

No offense, but I'm pretty sure that's going to be an easy one to defend for our scope of practice defense "Surgery by Surgeons" lobby. It is just highly unlikely that you're going to be doing collagen cross linking. Is there any country in the world you can point to where this is routinely done by Optometry instead Ophthalmology? Do you think you've done enough surgical procedures in training to be confident in doing an epi-off CXL? It's kind of staggering to me how you can outright claim that this procedure should be within your scope of practice, when I know some Comprehensive Ophthalmologists that wouldn't do it because they think a Cornea subspecialist is better suited to safely perform that procedure, and they'd refer out.

I am not advocating that optometry perform C.X.L., but I will say, it is not a terribly complex procedure, and the gross majority of it actually would be carried out by an ophthalmologist's technicians (you know, if the absurd F.D.A. ever approves it for use in the United States of America, at all — ).

 

[ophthope]

I am not advocating that optometry perform C.X.L., but I will say, it is not a terribly complex procedure, and the gross majority of it actually would be carried out by an ophthalmologist's technicians (you know, if the absurd F.D.A. ever approves it for use in the United States of America, at all — ).

Techs would most definitely not be doing CXL. You know techs don't do our procedures and surgeries, right? They don't inject, scrape, excise, biopsy, cut, tie, suture, cauterize, laser, etc. It's not necessarily the intrinsic difficulty of a procedure or surgery that makes it require more training. I've done every part of a laparoscopic appendectomy multiple times over, but I'd never dream of doing one by myself. I've seen enough complications to realize that there's more than just the steps of the seemingly uncomplicated procedure involved that make it potentially complicated. Eye surgeries and procedures are no different.

And yes the F.D.A. needs to get off its butt and approve it. At this rate they'll have been doing it in Europe for 100 years before it's FDA approved. Maybe around the same time as Avastin goes on-label for ARMD.

 

[EyeCaptain]

No offense, but I'm pretty sure that's going to be an easy one to defend for our scope of practice defense "Surgery by Surgeons" lobby. It is just highly unlikely that you're going to be doing collagen cross linking. Is there any country in the world you can point to where this is routinely done by Optometry instead Ophthalmology? Do you think you've done enough surgical procedures in training to be confident in doing an epi-off CXL? It's kind of staggering to me how you can outright claim that this procedure should be within your scope of practice, when I know some Comprehensive Ophthalmologists that wouldn't do it because they think a Cornea subspecialist is better suited to safely perform that procedure, and they'd refer out.

In most countries Optometrists are nothing more than Opticians with zero medical training. Comparing what Optometrists do in other countries to what happens in the US is not a viable argument.

YAG laser Capsulotomy is a surgical procedure that Optometrists are now able to perform in Louisiana. Do you think this procedure is beyond the scope of Optometric training?

 

[ophthope]

In most countries Optometrists are nothing more than Opticians with zero medical training. Comparing what Optometrists do in other countries to what happens in the US is not a viable argument.

YAG laser Capsulotomy is a surgical procedure that Optometrists are now able to perform in Louisiana. Do you think this procedure is beyond the scope of Optometric training?

If it was my family member, I'd want the surgeon who did their cataract doing their YAG. The question whether it is 'beyond the scope of Optometric training' is a pretty loaded question though. Any Ophthalmologist has been trained to do YAG safely, is aware of the risks, and is better poised than an Optometrist to do the surgery and to handle the complications that may arise. Instead of asking "is this beyond the scope of Optometric training," why don't we ask "which provider is best suited to perform this service for patients?" It's Ophthalmologists. In my training I perform tons of laser surgeries - YAGs, PRPs, PIs, ALTs, SLTs, endolaser, focal, etc. And since I see a large and broad amount of pathology, I see the complications from these and other surgeries that I also perform on human patients. I am aware that some Optometry schools may expose their students to some laser surgeries. It will be nothing near an Ophthalmologist's experience. There are plenty of us, people aren't waiting days to get their YAG, there is no need for Optometrists to widely perform Nd: YAG capsulotomies, so why would they? What is the impetus for this scope expansion? Patients don't need their Optometrists to do YAG. It's not cheaper, it's not vastly more convenient, and it's definitely not more safe than an Ophthalmologist doing it. Plus it's not safer for eye care at large for more people to be doing fewer surgeries each, as it makes the average surgeon less trained as he or she will have done fewer of the surgery. So why does it matter if 'Optometric training' prepares you to be minimally able to do it? Why would you do it when at best it's not as good as an Ophthalmologist doing it, and at worst it hurts eye care overall?

 

[EyeCaptain]

I don't disagree with everything you said. You have made some very good points. My question wasn't loaded, it was simply a question. We agree that certain procedures are within the abilities of an OD. Obviously, some are not, and I don't think any professional should be authorized to do something they are not equipped to handle. "Surgery by Surgeons" is not as black and white as you might like it to be. That's why I brought up YAG capsulotomy. Do you consider the procedures mentioned in this bill to be surgical? As for impetus: Optometry has been expanding it's scope for decades. It is becoming increasingly more medical, and will only continue to do so. At the moment, most ODs are practicing well below their level of training. You can disagree with that, but neither of us has experienced the other's training. Whether people are waiting in line for an Ophthalmologist or not, I do not think patients will suffer at the hands of trained ODs. In reality, many ODs will decide not to perform certain procedures that may be within their legal scope of practice. Those who do not feel comfortable or competent will likely prefer to continue practicing within their experience level, which varies greatly between providers. Again, this all depends on which procedures we are talking about. In the case of this thread, we are talking about the Bill from the first post, which is completely within reason.

 

[ophthope]

I think most of the things in this bill qualify as 'surgical' or 'procedural.' There's plenty of vascular surgeons who would call vein stripping or harvesting a saphenous vein graft a 'procedure' but it's sure surgical. More often I see them use terms like "minor surgery" and "major surgery." Most of this bill is talking about 'minor surgery' I suppose, but if you ask a General Surgeon about cataract surgery they'll tell you it's minor surgery too, because they've never seen one. It's all just nomenclature. This bill includes things like excisions of skin lesions which I consider to be minor surgery. Lid lac repair and foreign body removal most would consider surgery. I've seen people come back with pretty nasty complications from "simple" biopsies. The bill has things in it like needle drainage of a hematoma or abscess that can end up getting nasty. And again you have to consider what's in the patient's best interest. If you botch that lid lac, who are you going to send that patient to? I'm not going to take the risk of being involved in that case. I can imagine it being pretty hard to find an Oculoplastics doc who was willing to see a complication of lid lac surgery performed by an Optometrist.

I have no doubt that many Optometrists are performing below their level of training, but if you don't use it you lose it. I ran codes, put in central lines, managed ventilator settings, etc as an intern this year. Even a year from now I likely wouldn't feel safe doing this stuff. The knowledge I've gained will be useful in many ways, but the skills and intimate knowledge with the finer points of this stuff gets lost over time from disuse. And you and I both know that most Optometrists don't manage a whole whole lot of things like we see in this bill in their clinics every day. In my experience which is admittedly limited, it's the Optometrists working in clinic alongside Ophthalmologists who see the most medical pathology. If there were fewer Optometrists then you'd be seeing more diverse pathology per provider and likely wouldn't have that danger.


I think the best possible outcome for everyone would be the following:

1. Shut down maybe half of the Optometry schools in existence, maybe even more, and severely decrease the number of ODs currently in training. Everybody knows there are way more Optometrists than needed and we've known it for years. Control your educational arm. Look at lawyers to see where this is leading.
2. This leads to a higher volume of patients per each Optometrist, exposing them to a larger and broader volume of pathology
a. If point #1 happened, I bet you'd see a lot more partnership between medical schools and optometry schools. Take a look at Podiatry training - there are very few schools (I think 8 total) and most of them do the first two years side by side with medical students taking the same courses. There is some tension at times between Ortho and Podiatry, but most of the time the residents and attendings work well together.
b. Side effect of seeing more patients is greater income per Optometrist, making it again a more attractive field and attracting higher quality applicants to the now more competitive spots available
3. These things put Optometrists into a position to greater utilize their medical training, and in fact have more medical training in Optometry school. It's better for patients and better for everyone.


I'm pretty pessimistic though, and I doubt this will ever happen. Most likely more new schools will continue to open and the supply of Optometrists will be so abundant that, like many law school grads, you'll have to find work outside of eye care. Your salaries will continue to plummet and we'll continue to fight over scope incessantly. The only way to fix this would be a massive organization of Optometrists to smack the ACOE into line on this matter. It would also help if the AOA would stop lying about salaries and job prospects with information like can be found on this page stating salaries on average for Optometrists is $130,000. Quite frankly, I've seen Optometrist job offers in clinics where I know the Ophthalmologists. Even in those practices where Optometrists usually enjoy higher income, the salaries are declining. Why would the AOA continue to disburse such misleading data? They have to know that they are outright lying. The crash is already happening with law school, and the writing seems to be on the wall for Optometry too unless some vast and sweeping changes are made. I'll put it this way: I know plenty of Ophthalmology residents and young Ophthalmologists whose parents are ODs. Their parents didn't encourage them to go to Optometry school to take over the practice. They went to medical school and became Ophthalmologists, and from what I know all of their parents thought that was a much better plan. That says something to me about what those successful ODs think about the stability of Optometry in the future.

I don't mean to keep sidelining this, but I think the scope of practice and training/supply issues for Optometry are inseparable.

 

[EyeCaptain]

Sing it preacher. I wish those things would happen as well, and I unfortunately agree with you that we are likely to see more and more Optometry schools cropping up around the country. My underlying thesis from before is that Optometry will likely continue to lobby for expanded scope of practice. Some of those things I agree with, some of them I don't. The frustrating thing is that a united Optometry would mean just about endless possibilities, but there are countless numbers of OD's who watch from the sidelines as things get worse. My best guess is that the AOA is interested in more lobbying power, and more Optometry graduates fit that bill (no pun intended) hence false information on the bureau of labor statistics as well as fancy new schools popping up like daisies. I'm not as pessimistic as some on this website, and I don't see many OD's looking for work outside of eye care, at least not yet. Certainly there are those who are fed up, and they leave, but I don't see it becoming the norm. Decreased pay - that's already happening, but I attribute at least a measurable fraction of that to poor practice management decision making. May a new generation of Optometrists will decide to do something about it. If not maybe I'll pack my things, and start on my journey down the yellow brick road toward the carefree and wonder-filled land of Dentistry. Or become a pop artist. That can't be hard judging by what I hear on the radio.

 

[ophthope]

Dentistry is still a good field precisely because they have continued to restrict their numbers, and they have continued to maintain control of payment systems and not become slaves to the insurance industry. With all the healthcare pressure these days they'll see some changes soon as well I'm sure, but they are much more resistant to these things and as a whole united against any harmful changes. They might get pressured into taking some minimal payments for doing root canals or fillings on the uninsured or the 'new uninsured' - those with the minimal tier coverage available under the healthcare laws at no out of pocket charge due to the subsidies. But I don't know how the government would even go about exerting that pressure. Those dentists are pretty united and it has really helped their field. I wish us doctors had the same type of united front, but we've allowed ourselves to become subservient to the payers-insurance/medicare/medicaid requirements dictate what we do far more than is healthy. And the AMA sure isn't doing much of anything to make us less of a slave to this system.

 

[EyeCaptain]

I hope Dentistry is able to continue to stave off many of the scourges to the health care industry. You mentioned the AMA and their lack of action, certainly the AOA is in the same boat, if not a more rickety one. What action would you like to see the AMA take in protecting physicians?

in my opinion the true enemies to Optometry are vision care plans. ODs are essentially becoming subservient to these entities, and I am aware of one in particular that will send information to patients (unbeknownst to the doctor of course) advertising their own contact lenses etc. discouraging them from purchasing directly from their Optometrist. Not to mention the restrictions and regulations they slap on everything. The simple answer at the moment would be to simply not accept the worst of these plans. I've heard of many practices taking that course of action. It will undoubtedly mean fewer patients, but volume does not necessarily equal income.

Dentistry has been very successful in marketing the importance of a cleaning every 6 months. Which is why I've started a marketing campaign to promote the importance of the bi-weekly eye exam.

 

[Commando303]

Techs would most definitely not be doing CXL. You know techs don't do our procedures and surgeries, right? They don't inject, scrape, excise, biopsy, cut, tie, suture, cauterize, laser, etc. It's not necessarily the intrinsic difficulty of a procedure or surgery that makes it require more training. I've done every part of a laparoscopic appendectomy multiple times over, but I'd never dream of doing one by myself. I've seen enough complications to realize that there's more than just the steps of the seemingly uncomplicated procedure involved that make it potentially complicated. Eye surgeries and procedures are no different.

And yes the F.D.A. needs to get off its butt and approve it. At this rate they'll have been doing it in Europe for 100 years before it's FDA approved. Maybe around the same time as Avastin goes on-label for ARMD.

Re-read my comment if you'd like: I said the vast majority (not the entirety) of C.X.L. would be carried out by technicians. It would be. This is not a controversial statement.

 

[ophthope]

Re-read my comment if you'd like: I said the vast majority (not the entirety) of C.X.L. would be carried out by technicians. It would be. This is not a controversial statement.

Yeah, I'm still in near-complete disagreement with that statement. What exactly do you think technicians will be doing that comprises "the vast majority of C.X.L"? Do you think they perform "the vast majority" of other procedures in Ophthalmology clinics?

 

[thiaeyemd]

There is a video on this page of CXL. Can anyone tell please educate me what ophthalmologist in their right mind would let their technician do anything other than turn the "on" button on the machine in the last step or put the drop of riboflavin in the eye?

http://eyewiki.aao.org/Corneal_Collagen_Cross-Linking

Love you Commando but that statement about technicians doing this is straight up cray-pots.
#normallygreatcommentsbutthatwastotallyinsane
#wouldn'thappeninabillionyears
#milliondollarlawsuit

 

[Commando303]

Yeah, I'm still in near-complete disagreement with that statement. What exactly do you think technicians will be doing that comprises "the vast majority of C.X.L"? Do you think they perform "the vast majority" of other procedures in Ophthalmology clinics?

There is a video on this page of CXL. Can anyone tell please educate me what ophthalmologist in their right mind would let their technician do anything other than turn the "on" button on the machine in the last step or put the drop of riboflavin in the eye?

http://eyewiki.aao.org/Corneal_Collagen_Cross-Linking

Love you Commando but that statement about technicians doing this is straight up cray-pots.
#normallygreatcommentsbutthatwastotallyinsane
#wouldn'thappeninabillionyears
#milliondollarlawsuit

Maybe I should clarify what I mean by technicians' performing the "vast majority" of C.X.L.: I mean so with regard to time. Corneal collagen cross-linking, by most protocols, takes a bit more than half an hour to perform. The major chunk of this period involves instilling riboflavin drops on the patient's eye, so the compound can be absorbed by the corneal stroma.

The surgeon would abrade the epithelium (which takes ~a minute to do), then leave, as the periodic instillation of drops begins. At the end of this, the patient would be exposed to U.V. radiation, for which the surgeon again would enter the room. (Then, the procedure wraps up with some anti-biotic drops, and the application of a B.C.L.)

No doctor would waste thirty minutes' time or money sitting through the tedium of drop-instillation, which composes the vast majority of the C.X.L. procedure.

 

[ophthope]

Maybe I should clarify what I mean by technicians' performing the "vast majority" of C.X.L.: I mean so with regard to time. Corneal collagen cross-linking, by most protocols, takes a bit more than half an hour to perform. The major chunk of this period involves instilling riboflavin drops on the patient's eye, so the compound can be absorbed by the corneal stroma.

The surgeon would abrade the epithelium (which takes ~a minute to do), then leave, as the periodic instillation of drops begins. At the end of this, the patient would be exposed to U.V. radiation, for which the surgeon again would enter the room. (Then, the procedure wraps up with some anti-biotic drops, and the application of a B.C.L.)

No doctor would waste thirty minutes' time or money sitting through the tedium of drop-instillation, which composes the vast majority of the C.X.L. procedure.

You know what, yeah, you're right, basically our techs do 'the vast majority' of our surgery. Your logic is impeccable and I will not even attempt to dismantle it.

#SMH
#NoctorWho

 

[thiaeyemd]

Maybe I should clarify what I mean by technicians' performing the "vast majority" of C.X.L.: I mean so with regard to time. Corneal collagen cross-linking, by most protocols, takes a bit more than half an hour to perform. The major chunk of this period involves instilling riboflavin drops on the patient's eye, so the compound can be absorbed by the corneal stroma.

The surgeon would abrade the epithelium (which takes ~a minute to do), then leave, as the periodic instillation of drops begins. At the end of this, the patient would be exposed to U.V. radiation, for which the surgeon again would enter the room. (Then, the procedure wraps up with some anti-biotic drops, and the application of a B.C.L.)

No doctor would waste thirty minutes' time or money sitting through the tedium of drop-instillation, which composes the vast majority of the C.X.L. procedure.

Time and what constitutes the technical parts of the surgery are two different things. Hair transplant specialists harvest a graft and then give it to their technicians for preparation for reimplantation in the scalp. The technician part takes hours but no one would say they are doing the "vast majority of the surgery" even though it is an analogous situation. Putting drops in somesone's eyes is certainly not performing surgery....I think anyone would agree with that. You could say that techs do the majority of the nonsurgical components of CXL but they don't do any part of the surgery. When you dilate a patient by putting in drops you certainly wouldn't call that surgery?

 

[east]

Is this how things work? Give enough money to politicians and they will agree to anything?

I hope this is rhetorical. Otherwise you know nothing of politics.

 

[DrVinzKlortho]

This thread is all over the place but I want to comment on the K CXL'ing: nothing that is done during the procedure is outside of ODs current scope of practice.