You can attack me all you want personally, but your rhetoric is rather immature and unsupported.
Perhaps
"you are a little out of touch with the real world" because patients
do not "already know what their dr. is going to do for them before they get to the office". Most don't even know the difference between optometry and ophthalmology. Many will print material from the internet, but they have no clue what it means. I spend time everyday explaining the difference between the two fields. Many patients think their optometrists perform "surgeries" when in fact it's co-managing cataract and LASIK patients.
Your cavalier attitude about medications supports what I claim about optometry. Some of the drops and pills you prescribe will blind and kill people. These are
NOT "extremely safe" medications. Indeed, when you prescribe something wrong, I am sure there is a physician who will cover your back and care for the patient. No malpractice suit will be charged. No report will ever be made. Why? Because ophthalmologists are afraid their referral base with disappear.
For instance, prescribe timolol or cosopt drops in a patient with asthma, COPD, or heart failure and you may kill them. Prescribe prednisone for pseudotumor in a diabetic with mucormycosis or a patient with orbital cellulitis and you may kill them. Prescribing prednisolone drops when you think it's "iritis" when it's endophthalmitis will blind the patient in 24 hours.
Let's look at how these medications are
"extremely safe" by considering these true cases:
Case #1: Last week, a patient came in with "iritis" and increased IOP of 40. The patient was treated by their optometrist with Q1H prednisolone drops and cosopt for 2 weeks without improvement. The patient comes in for a second opinion, and he/she had "iritis" of only red blood cells. In fact, there was a small hyphema, and florid iris neovascularization of the iris from his/her diabetes. Unfortunately, there was no view to the back so PRP couldn't have been delivered. In this case, delay of treatment (PRP) because the patient was being treated for "iritis" may lead to the patient losing his/her eye. Why wasn't the patient referred sooner? Because the OD thought he/she was treating the "iritis".
Case #2: A patient was co-managed and then consulted for increased IOP after cataract extraction. The optometrist was "burping" the cataract wound during the post-operative care (for the whole week) and pouring anti-glaucoma medications on the eye to reduce the pressure without luck. He/she thought that the medications were "treating" the problem. Unfortunately, the "burping" of the cataract wound was the problem because the patient developed a suprachoroidal hemorrhage.
Case #3: A normal tension glaucoma patient was consulted for advanced glaucoma managed only by drops. A GVF demonstrated that the patient had a 20 degree central field left OU. Surgery was needed years previously, and delay of surgery resulted in severe visual loss. Again, prescription drops provided a false sense of security that "treatment" was delivered.
Case #4: A patient had an industrial accident with a sharp piece of metal. The patient felt some "jelly-like material" on his/her cheek and complained of floaters. The vision was 20/20 still. An optometrist saw the conjunctival laceration but missed the 0.5 mm scleral laceration and the vitreous that plugged the hole. The floaters were dismissed as a "migraine phenomenon resulting from trauma". The "jelly-like material" was dismissed as tears or mucous from the eye. The optometrist prescribed Vigamox for the conjunctival laceration and sent the patient home. Over the week, the patient then developed more floaters and decreased vision to 20/60 with an increased anterior chamber reaction. On day #5, steroid was added for "traumatic iritis". The patient dropped from 20/60 vision to hand motions vision in less than 12 hours. The patient developed traumatic endophthalmitis.
I see two problems with the use of drops here. First, the use of Vigamox initially provided the practitioner the belief that he/she was doing something for the patient, when in fact, the patient needed primary closure of the trauma wound. Second, the use of steroids was like pouring gas on a fire. Thus, to accept your argument that our arsenal of medications are ""extremely safe" is similar to saying that guns are available every where and are "safe" to use. Medications are only safe when used properly, so please stop your banter about how primary eye care is so safe and simple.
White arrow points to vitreous and gray arrow points to scleral laceration from a penetrating globe injury in Case #4
Marley, these examples are of
"common "primary care" diseases of the eye". I will agree with you, however, that treating these diseases does not require a
"miraculous procedure" if the caregiver knows what they are doing and respects the medications they are prescribing.
This is the art of medicine that you clearly dismiss and have little regard for when you use terms like "extremely safe", "common primary care diseases", and "not a miraculous procedure". Unfortunately, common primary care diseases will blind and kill people too.