diseases ODs can't treat

[pudgie84]

I read in an older post that ODs shouldn't refer their patients to an OMD unless they need surgery or have some rare disease. So I was wondering what diseases or conditions in particular ODs are not trained/legally allowed to treat (in most states).

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[east]

Most states do not allow treatment of ocular disease with surgery/injection as defined by state law. State law varies somewhat on the definition as to the "what and where" of surgery/injection, and what instrument is used for surgery. Aside from surgery/injection, ODs would be legally allowed to treat ocular disease with medications both topical and oral, again medication delivered by injection is a less common allowance by state law.

 

[east]

I live in a state with a fairly restrictive scope of practice, you name an ocular disease and I'll tell you if I can treat it or not.

 

[Jibslider]

I read in an older post that ODs shouldn't refer their patients to an OMD unless they need surgery or have some rare disease. So I was wondering what diseases or conditions in particular ODs are not trained/legally allowed to treat (in most states).

Broken leg, prostate cancer, there's some others too.

 

[Shnurek]

Broken leg, prostate cancer, there's some others too.

haha

ODs can't treat retinoblastoma and cataracts for example.

 

[Tippytoe]

The most obvious and serious disease ODs can't treat happens to infect 80% of ODs themselve. It's called 'Wussyitis" and is rampant from OD school through graduation and into practice. It's seems to be both nature and nurture, passed on by airborn sound waves from senior docs and from corporate associate-degree middle managers to junior and experienced ODs.

ODs are scared of their own shadow. Scared of taking on more debt. Scared of taking a risk in private practice. Scared to stand up to the AOA. Scared to treat conditions that don't get better with Tobradex in 2 days. Scared to treat an IOP over 30. Scared to monitor a diabetic with a few dot hems. Scared to stand up to insurance companies. Scared to stand up to patients. Scared to stand up to on-line companies.

Just scared of their own shadow so they get walked on by everyone. Wussyitis is an epidemic in optometry and there is no known cure in the near future. It's financially fatal.

Many eye disease are 'treated' by monitoring it (watching). Macula degeneration, glaucoma, diabetes, catracts. We and OMDs watch it and monitor through testing until (and if) they get bad enough to require surgery. The treatment for dry AMD is prayers, sunglasses, vitamins and low vision aids (which most OMD ignore or forget). Wet AMD is treated by OMDs and then return to ODs for vision help via glasses or low vision aids (the hard part). That is if the OD is not a totally wussy and working for an eye mart where they frown on wasting time on "non-eyeglass" related chair time.

Glaucoma is treated identically,topically by both ODs and OMDs initially (in the US at least) and for most people, this is sufficient over their lifetime. If it gets to the point where topicals meds no longer work (or don't work at all) an OMDs takes over to perform laser or surgery (and in my case returning the pt back to me afterwards for post operative care and future monitoring via visual fields, OCT, gonioscopy, IOPs, etc...). Again if your in Mall-Wart, you liikely won't see the patient back because no one with a serious eye disease wants to go to a warehouse store for care and few OMDs can recommend to the patient that they should go to a place beside a hair salon and photo center. Just a fact.

Cataracts are the same. Monitor by OD or OMDs and to the OMD when surgery required. I see the pt back the next day for the 90 day post op periiod. The OMD sees the patient the day or surgery for one eye and then 2-3 weeks later for a one day surgery on the other eye. Two visits and they don't 'bond' with the surgeon. But many OMDs will try their best to steal the patient away so you have to refer to ethical ones.

Diabetics are monitor with a dilated retinal and overall eye exam that is the same by the OD or OMDs (despite what the clowns at the American Academey of Ophthalmology say.). When retinopathy starts, you continue to monitor working with the patient and primary care or diabetic doc (and/or endocrinologist). Some times better control resolves the retinopathy. Sometimes the pt will continue to get worse developing disc/nerve/iris neo and proliferative retinopathy in which case they go to a retinal OMD for laser/surgical treatment. Afterwards, they come back to me for routine monitoring every 2-6 months as the case requires.

About the only 'disease cases' that come to mind that ODs don't treat at all or only mildy is severe trauma (knife through the eye) or rare hereditary eye disease that only OMDs at teaching universities get excited over. But even then it's given a name and then dumped back on to the OD to 'magically' make them see with glasses. My state allows injection of lid lesions, mainly chalazion (which I find resolve excellently with kenolog (steroid) most of the time. Some lid and ocular muscle disorders require surgical repair by an OMD such as trauma, entropion/extropion and strab surgery, etc.... Corneal transplant also come to mind for trauma or keratonus (usually only after RGP contact trials). Retinal detachments are repaired by retinal OMD and then returned to OD for routine monitoring. I can't think of anything else but there is probably a few more.

Over all, I agree with the statement that there are very few referrals necessary unless surgery is needed...................unless your one of the 75% of OD ****** that spend your life trying to ignore the cash registers and fighting with someone's baby mama about taking her shopping cart and 6 bastard kids out of your refracting closet. If that case, you will not be treating anything except myopia/hyperopia/astigmastism and presbyopia 25 times per day, 6 days per week. You may need to chip in to change a baby diaper or to jump start your welfare patient's mercedes. At least that will give you a little variety in the life that is your personal hell.

 

[east]

agree 100% and also have a life so no way in hell I would write that much, but kudos tippy. some of us out there have the sack to play the game hopefully more than 20%, but you might be right. i just kept thinking on that guy's question....i cant think of anything non-surgical i don't "treat".

 

[Shnurek]

My state allows injection of lid lesions, mainly chalazion (which I find resolve excellently with kenolog (steroid) most of the time.

Over all, I agree with the statement that there are very few referrals necessary unless surgery is needed...................unless your one of the 75% of OD ****** that spend your life trying to ignore the cash registers and fighting with someone's baby mama about taking her shopping cart and 6 bastard kids out of your refracting closet. If that case, you will not be treating anything except myopia/hyperopia/astigmastism and presbyopia 25 times per day, 6 days per week. You may need to chip in to change a baby diaper or to jump start your welfare patient's mercedes. At least that will give you a little variety in the life that is your personal hell.

Kudos to you for treating using injections.

Aren't only 25% of ODs working in a commercial/commercial-like setting?

 

[CL Doc]

Kudos to you for treating using injections.

Aren't only 25% of ODs working in a commercial/commercial-like setting?

It may be 25% of all ODs but it's probably 75% of new ODs.

 

[Tippytoe]

It may be 25% of all ODs but it's probably 75% of new ODs.

I have no hard facts on this one. My guess would be 40-50% currently. Problem is, when surveys are sent out, ODs are asked the general question, "Are you: in a private practice, an employee, in group practice, commercial", etc....)

Many ODs that work in Walmart and other commercial places like to list themselves as "private practice" because they are delusional and because the recruiters tell them it is "their practice" to do as they please. And as they are "seperate" from the optical, they really consider themselves private. (ie. If you tell yourself the same thing enough times, you start believing it

So they list private practice on their survey.

In fact, I don't know of any way to find out for sure. I know in my city of 200,000, I counted the ODs a few years ago and out of 42, 20 were affiliated with commercial stores (for the record, I consider Lenscrafters and the like to be a commercial outlets while some do not).

 

[CMM83]

I would agree that 40-50% is a good estimate of commercial affiliation. It's hard to measure. When I worked for an ophthalmology group out of school they were contracted to provide OD coverage to a local optical for something around 20 hours a week. Every now and then they'd make me man that fort but I wouldn't have considered myself a "commercial optometrist" only being there a day or two a month.

 

[thiaeyemd]

Most MDs have no interest in "stealing" cataract patients after surgery. For what would that be exactly? To refract them every year? I do oculoplastics and I want to do the surgery and essentially once everything is ok and the patient is satisfied, get them back to their referring doc. I have no interest in refracting them or "yearly checks". That is absolutely boring for me and no profitable. There may be some ophthalmologists who try to steal the patient but I think it is very uncommon. I have had patients who say to me "Doc I would like to see your from now on" and I dissuade them. Sometimes they then go and try to make an appointment to see me anyway and I have to sit them down and explain to them "My practice works on referrals, if I see you as a regular patient, Dr Smith will never send me a patient again". Generally, they understand and go back to their referring doc.Why would a cataract surgeon want to hold onto a post op cataract patient and close off that line of referrals. A cataract is worth roughly 7 routine exams. Just doesn't make sense. I think when that happens it happens by accident in that the MD sees the patient lets say for several months, the patients makes a routine appointment and they don't check or something. No one in their right mind would conciously do that.

 

[Tippytoe]

Most MDs have no interest in "stealing" cataract patients after surgery. For what would that be exactly? To refract them every year? I do oculoplastics and I want to do the surgery and essentially once everything is ok and the patient is satisfied, get them back to their referring doc. I have no interest in refracting them or "yearly checks". That is absolutely boring for me and no profitable. There may be some ophthalmologists who try to steal the patient but I think it is very uncommon. I have had patients who say to me "Doc I would like to see your from now on" and I dissuade them. Sometimes they then go and try to make an appointment to see me anyway and I have to sit them down and explain to them "My practice works on referrals, if I see you as a regular patient, Dr Smith will never send me a patient again". Generally, they understand and go back to their referring doc.Why would a cataract surgeon want to hold onto a post op cataract patient and close off that line of referrals. A cataract is worth roughly 7 routine exams. Just doesn't make sense. I think when that happens it happens by accident in that the MD sees the patient lets say for several months, the patients makes a routine appointment and they don't check or something. No one in their right mind would conciously do that.

I commend you. You do it the way it should be done. But in many markets, it's more of a dog-eat-dog world. I have to keep a dry erase board of every patient I send out to make sure I get them back. My staff has to call to make sure we get notes. I've had OMDs tell my patients I am not qualifed to see children and they must come back to him. Or they'll say, "You know, Dr. Smith didn't go to medical school so he really is NOT qualifed to monitor your cataract. I'd like for you to see me in 6 months." All kinds of stuff. Pitiful really.

All 10 Ophthalmologists around me have a large, full scale opticals and would love nothing more than for the patient I send to them to stay forever-- And bring their family members. They have ODs or techs do the routine stuff and scout out the surgical cases. I do have a oculoplastic and strab OMD within 45 minutes. They are on their own and are stellar docs and people. Like you, they have no interest in refractive -2.00 myopes or monitoring glaucoma. I refer to them whenever possible to keep them out of the local OMDs opticals (they like to keep them sitting 1 hour in the reception area with a clear view of their optical in hopes they will browse---an oldie but a goodie .

It's a big problem for many ODs. I do have one referral center that does not have an optical and is very adamant about sending patients back. Of course they are 1 hour away so it's not very hard for them.

You are a specialist. I think you give your general ophthalmologist colleagues way too much credit : )

 

[Meibomian SxN]

The most obvious and serious disease ODs can't treat happens to infect 80% of ODs themselve. It's called 'Wussyitis" and is rampant from OD school through graduation and into practice. It's seems to be both nature and nurture, passed on by airborn sound waves from senior docs and from corporate associate-degree middle managers to junior and experienced ODs.

Seems that nurses are gaining WAY more traction than us Wussyitis ODs. Smh, I need to jump ship soon....

http://forums.studentdoctor.net/showthread.php?t=865041

 

[KHE]

Most MDs have no interest in "stealing" cataract patients after surgery. For what would that be exactly? To refract them every year? I do oculoplastics and I want to do the surgery and essentially once everything is ok and the patient is satisfied, get them back to their referring doc. I have no interest in refracting them or "yearly checks". That is absolutely boring for me and no profitable. There may be some ophthalmologists who try to steal the patient but I think it is very uncommon. I have had patients who say to me "Doc I would like to see your from now on" and I dissuade them. Sometimes they then go and try to make an appointment to see me anyway and I have to sit them down and explain to them "My practice works on referrals, if I see you as a regular patient, Dr Smith will never send me a patient again". Generally, they understand and go back to their referring doc.Why would a cataract surgeon want to hold onto a post op cataract patient and close off that line of referrals. A cataract is worth roughly 7 routine exams. Just doesn't make sense. I think when that happens it happens by accident in that the MD sees the patient lets say for several months, the patients makes a routine appointment and they don't check or something. No one in their right mind would conciously do that.

If you are working as a subspecialist then you are not the problem. The problem in this area is usually group practices of general ophthalmologists who employ ODs and/or who have opticals on site.

Those are the ones telling people that they can't see me because of their "unusual astigmatism" or how they need to see the whole family because their IOPs of 19 make them (and their families) glaucoma suspects.

 

[Shnurek]

If you are working as a subspecialist then you are not the problem. The problem in this area is usually group practices of general ophthalmologists who employ ODs and/or who have opticals on site.

Those are the ones telling people that they can't see me because of their "unusual astigmatism" or how they need to see the whole family because their IOPs of 19 make them (and their families) glaucoma suspects.

Or calling ODs "glasses salesmen". And then getting pissed off at the staff that ODs can do whatever they can except for surgery. "They didn't go to medical school. What the hell." This happened 2 months ago..

 

[Tippytoe]

But the bulk of the problem stems from the fact that ODs school keep pumping out way too many graduates to further dilute the pool. It makes recuiting patients harder and harder for everyone.

Simple supply and demand. There is not enough patients to go around, thus the need to steal from other eye docs.