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Do you support Optometrists doing surgery? - ODs allowed to do scalpel surgery in OK!

Discussion in 'Ophthalmology: Eye Physicians & Surgeons' started by Yogi Bear, Apr 28, 2004.

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Do you support Optometrists doing surgery?

  1. Absolutely No: MD/DO/medical student

    761 vote(s)
    58.1%
  2. Absolutely No: Optometrist/Optometry student

    36 vote(s)
    2.8%
  3. Absolutely No: All others

    136 vote(s)
    10.4%
  4. Yes w/ proper optometry "surgical fellowships": MD/DO/medical student

    110 vote(s)
    8.4%
  5. Yes w/ proper optometry "surgical fellowships": Optometrist/Optometry student

    105 vote(s)
    8.0%
  6. Yes w/ proper optometry "surgical fellowships": All others

    58 vote(s)
    4.4%
  7. Absolutely Yes: MD/DO/medical student

    13 vote(s)
    1.0%
  8. Absolutely Yes: Optometrist/Optometry student

    25 vote(s)
    1.9%
  9. Absolutely Yes: All others

    22 vote(s)
    1.7%
  10. Undecided

    43 vote(s)
    3.3%
  1. Yogi Bear

    Yogi Bear 2K Member
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    Reposting poll since previous attempt didn't work.

    choice yes; yes w/ restrictions; no as well as your background: medical, optometry, all others.
     
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  3. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    You all know my vote! ;)
     
  4. xmattODx

    xmattODx Senior Member
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    I hate to hi-jack this thread - perhaps it would be better as a new thread. What do you people think optometrists should be able to do? i.e. only refract, glaucoma treatment, treatment of ocular infections, etc.
     
  5. Energon

    Energon Nobody Summons Megatron
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    How do optometrists plan on getting hospital rights? Do they plan to do a surgical residency after the OD degree?
    Even if optometrists do a surgical residency, they will be competing head on with opthalmologists for procedures and this seems counterproductive for everyone involved. I have no bias against optometrists, if they had a niche of their own (surgically speaking), it would be ok.
    For example:
    Oral surgeons do some heavy duty OR based surgeries but they have to go through a 4-6 year surgical residency to be qualified. Also, there isn't anyone else out there who is trained to do a lot of dentoalveolar based maxillary and madibular procedures along with TMJ surgeries, (I am sure some ent's can pull it off ;) ). My point being there is a lot of work out there specifically for OMSs. (granted they have to compete with plastics and ent for esthetic surgery procedures )
     
  6. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    Academy Fights New Oklahoma Law that Could Convert Optometrists to Ophthalmologists
    http://www.aao.org/aao/news/release/20040429d.cfm

    April 30, 2004

    WASHINGTON? The American Academy of Ophthalmology stands ready to fight the precedent-setting provisions recently signed into law in Oklahoma. With the signing of H.B. 2321 on April 28, optometrists are now permitted to perform eye surgery with scalpels. The bill, which passed both house and senate days after it was introduced, also contains provisions that allow optometry to self-regulate its members.

    ?This new law essentially converts optometrists to ophthalmologists, ?said H. Dunbar Hoskins Jr., MD, Executive Vice President, American Academy of Ophthalmology. ?Moreover, it raises serious patient safety and quality care issues.?

    The new law will seriously impact patient care, and not just in Oklahoma.

    ?What is going on in Oklahoma threatens quality patient care everywhere and cannot go unchallenged,? said Allan Jensen, MD, Academy President. ?Legislating surgical privileges in Oklahoma will surely feed optometry?s hunger for these same privileges in other states.?

    For example, optometry has used Oklahoma as a way to expand its scope to include surgery within the Department of Veterans Affairs health system, where the Academy is currently fighting a patient safety battle. Oklahoma stands alone as the only state where optometrists can currently perform any laser eye surgical procedure.

    The ramifications of the new Oklahoma law for ophthalmologists and their patients are so severe that the Academy is working with the Oklahoma Academy of Ophthalmology and a united House of Medicine to fight this devastating assault on patient safety.

    Through a backdoor legislative effort, the provisions, introduced by pro-optometry interests, were a last-minute insert to a conference bill that had broad support in the legislature. This move by optometry to take advantage of the end-of-session legislative rush in essence prohibited public debate on optometric surgical scope. The bill authorizes the Board of Examiners in Optometry?a body composed mainly of optometrists?to decide optometric scope of practice including the types of surgeries optometrists will be able to perform on the eye and face, including cataract surgery, plastic surgery, facial reconstruction and eyeball removal. With the bill signed, the Academy?s fight to preserve quality surgical care moves to the rulemaking process, where, along with its allies, the Academy will continue to battle for patient safety.

    ?In rulemaking, the Academy will fight for patient surgical safety,? added Dr. Hoskins. Although Oklahoma Governor Brad Henry has indicated to ophthalmology that the medical and osteopathic communities will have input into this process, the rulemaking is overseen by the Oklahoma Board Examiners in Optometry, which in the past, has aggressively pushed for OD scope expansion.
     
  7. ckyuen

    ckyuen Senior Member
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    This is ridiculous. Now you can see why everyone in Texas hates Oklahoma. They are completely backwards and this just shows their lack of education. We must all unify to fight against this. The argument that care will be provided cheaper by optometrists is just not true. They get compensated the same amount as ophthalmologists by medicare. So for the same amount of money you get someone with four less years of training. Also do a quick lit search and you see that optoms order ancillary tests probably too frequently. 47% of optoms in the below survey ordered HVFs on all cataracts. Not at all indicated. I found also that they are using oct to dx DM CSME. I can understand doing it you are treating to judge response, but to charge a full pay patient cash then refer them off to county is foolish. It's called clinically significant macular edema for a reason. It's suppose to be a clinical diagnosis. You could argue that with all of the extra tests they order it cost the patient more in the end. I've seen some patient encounters that look more like menus with all the options their offered. Refuse any and some make you sign a disclaimer saying you realize they are not able to perform a complete exam and may have missed something. Anyways. Let's not start this again. Andrew any suggestions what we should do now? We need to act now.

    Variation in ophthalmic testing prior to cataract surgery. Results of a national survey of optometrists. Cataract Patient Outcome Research Team.

    Bass EB, Steinberg EP, Luthra R, Schein OD, Javitt J, Sharkey P, Tielsch J, Legro MW, Kassalow J, Steinwachs D.
     
  8. DrMom

    DrMom Official Mom of SDN
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    This has been an issue for a while. The optometrists basically convinced the legislature that this was the only way that rural areas can get eye surgery. :rolleyes: This is a huge mistake, IMO.
     
  9. Yogi Bear

    Yogi Bear 2K Member
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    man, that sucks. :mad: in terms of surgery, i think the main thing the optometrists want to do is lasik...that'd be the bulk of the money for them. things like gluacoma/cataract surgery would take too long to learn/perform and not pay nearly as well. the ultimate question will be if insurance companies are willing to cover the optometrists doing surgery.
     
  10. doc05

    doc05 2K Member
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    ever think of getting optometry banned altogether?

    how strong a lobby is the Academy of Ophtho, anyway?
     
  11. Mirror Form

    Mirror Form Thyroid Storm
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    Wow, this is pretty scary news! I hope I don't regret going into ophthalmology!
     
  12. exmike

    exmike NOR * CAL
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    At this point, what can be done about this bill? Is limiting the scope during the rulemaking process the only form of recourse now? This is seriously threatning to the field of ophthalmology.

    I was thinking maybe ophthalmology will have to change its "name" so optometrists cant use the similarity between the two names to obfuscate the issues. What about "Oculosurgeon".. still has the "O" though.

    Its amazing that the extremely bright medical school graduates that go into ophtho are now on par with optometrists - some (not all) of whom went that route b/c they couldnt get into medical school.
     
  13. mjl34

    mjl34 Member
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    I don't think you'll regret it. I DO think we have a responsibility to support the AAO and our PAC in order to maintain high-quality patient care and patient safety.

    Is their whole argument access to care? Certainly ther have to be enough ophthalmologists in the state to do cataracts, right? They have to drive a few hours to get their coronary bypass or hip replacement too right? Anybody want to take the hit and move to Oklahoma? (I hear the weather is nice there :) )
     
  14. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    One of my colleagues is moving to Oklahoma in July. She's writing the Governor. We all should write the Governor of Oklahoma and express our concerns. :thumbup:

    Governor Brad Henry
    Governor's Office State Capitol Building
    Suite 212
    Oklahoma City, OK 73105
    ________________________________
    News Article (http://www.kfor.com/Global/story.asp?S=1806731)

    The bill was opposed by ophthalmologists who warned optometrists lack the training necessary to perform surgery and could lead to permanent harm for Oklahoma patients.

    House Bill 2321, by Rep. Jim Wilson, D-Tahlequah, simply redefines optometry to include "non-laser surgery procedures as authorized by the Oklahoma Board of Examiners in Optometry, pursuant to rules promulgated under the Administrative Procedures Act." The bill passed the House 85-9. Within hours, the measure passed the state Senate 40-6. The bill will now go to Gov. Brad Henry for his signature or veto.

    Supporters said an opinion issued April 6 by the Office of the Attorney General forced the Legislature to amend state law to explicitly authorize optometrists to do non-laser surgical procedures. The opinion ruled that the Board of Examiners in Optometry does not have the legal authority to allow optometric physicians to perform surgical procedures as defined by professional medical codes because the word "surgery" does not appear in Oklahoma's practice act for optometrists except for references to "laser surgery." Supporters said optometrists have been allowed to do many surgical procedures since 1998.

    Rep. Joan Greenwood, R-Moore, said House Bill 2321 simply allows optometrists to continue performing those eye care tasks. "This is not a new thing," she said. "But because of that attorney general's opinion we must get the word 'surgery' into the statutes."

    Several legislators argued that forcing people to use ophthalmologists instead of optometrists would place a financial and medical hardship on many Oklahomans in rural areas. While ophthalmologists possess doctorates and can diagnose and treat eye diseases, optometrists primarily provide glasses and other visions aids.

    "We might have a lot of ophthalmologists in my area; I just don't know one and I don?t know where they are," said Rep. Jack

    Bonny, D-Burns Flat. "I can't see coming to Oklahoma City every time." He noted that a local optometrist had removed metal from his eye on two occasions and to have the procedure done by an ophthalmologist would have required a trip to Oklahoma City.

    "There are many people that can't see an ophthalmologist," said House Speaker Larry Adair, D-Stilwell. "They don't have the ability to travel to Oklahoma City. They don't have the means to pay for the costs that are involved in this type of care. Those people have to rely upon optometrists that are spread all across this state."

    Rep. Dale Wells, D-Cushing, said ophthalmologists operate in only 18 of Oklahoma's 77 counties while optometrists can be found in 72 counties. "There are 101 Oklahoma ophthalmologists to serve the 3.5 million citizens of Oklahoma ? 101," Wells said. "There are in excess of 600 optometrists across this state, most of them in rural Oklahoma." But opponents said the bill would allow optometrists to perform procedures that they lack the training to safely conduct.

    "The way this bill is written right now, it is too broad," said Rep. Odilia Dank, R-Oklahoma City. "It is expanding the scope of the practice of optometry." She said the attorney general's opinion does not prevent optometrists from removing "superficial corneal foreign objects or bodies" and addresses only the most serious eye surgeries. She warned of serious consequences for patients that receive eye surgery from optometrists since the "slightest error can do huge damage." "One-tenth of a second, I am told, could render a person blind," Dank said.

    A release issued by the American Academy of Ophthalmology this week urged legislators to oppose House Bill 2321, saying the bill would allow "non-surgeons to perform eye surgery with scalpels." "It should be of concern to Oklahomans that only in Oklahoma health care providers who are not trained surgeons are allowed to use lasers to perform delicate eye surgery," said Cynthia Bradford, secretary for state affairs for the American Academy of Ophthalmology. "This is unprecedented policy. It is not in the best interest of patient eye care."

    Wells said a "small group" of ophthalmologists are "trying to use fear and disinformation to convince you that the optometrists of Oklahoma are not qualified to do the procedures that they have been doing for decades." Wilson said the bill provides safeguards for consumers. "We will control the behavior of the optometrists through the rulemaking," he said. He also noted that optometrists must complete eight years of education and training that includes 8,000 clinical hours of training before an individual could be licensed, and that the industry's medical malpractice insurance rates prove there are few occurrences of serious damage to patients.

    "There is no risk here," Wilson said. "There's nothing measures risk better than an insurance premium. We see the (medical malpractice) insurance premium sitting at $412 a year for $2 million in coverage ? less than $500 for an upper limit of $3 million. That's how we measure risk. Nobody's getting hurt."
    ____________________


    Malpractice insurance premium is not a good measure of risk! This is what happens when we place medical decisions in the hands of politicians. My friend's dad in Oklahoma also stated that OK is debating Tort reform with a cap of $250,000 in damages; thus, this is one reason the optometrists pushed this bill now.
    :mad:
     
  15. MacGyver

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    The key to winning this battle is access to care. When optometrists point out that only 18 of Oklahoma's 77 counties has MDs for eye care, that sends a very powerful message to the politicians.

    One way to change this is to expand opthalmology residency slots. Many people get turned away from opthalmology, and this gives the optoms EXACTLY the ammunition they need to expand scope.

    Opthalmologists DESPERATELY need data showing that optometry care is inferior and increases patient risk. If they cant show such data, why should the state legislatures listen to them?

    Whats the deal with Oklahoma and optometrists? Are there a lot of optometrists who happen to serve in the state legislature? I dont get it. There are lots of states that have even more rural areas than OKlahoma, and I dont see them continually expanding optoms scope of practice.
     
  16. exmike

    exmike NOR * CAL
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    Maybe next optometrists will ask for cardiothoracic surgery priviledges so rural oklahomans wont have to drive to OK City for their quadruple bypass surgeries.
     
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  17. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    I don't get it either. Iowa is large and mostly rural, yet we have ophthalmologists in every corner of the state. We don't need more residents; instead, we need more young ophthalmologists and practices to expand into Oklahoma. There is obviously a need for ophthalmologists in Oklahoma.
     
  18. Tony.

    Tony. Senior Member
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    for anyone who doesnt know:
    I begin optometry school this year and I cant wait to begin!

    I really hope that by the time I finish, OD's and MD's would be able to work WITH each other and not AGAINST each other..... :thumbup:
     
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  19. MPS

    MPS Senior Member
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    US ophthalmology has shot itself in the foot. The best strategy to counter the optometrist's arguments would have been to set up some outreach clinics in OK (easier said than done). Of course, it's easy to plot a course of action in hindsight, but you'd have thought that this lesson could have been learnt from past "battles".

    As regards the efficiency of organised optometry in lobbying, I think you've got to hand it to them. Traditionally, optometry has had little political power. Ophthalmology needs to focus on differentiating itself from optometry in the eyes of the public.
     
  20. exmike

    exmike NOR * CAL
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    Like i said, lets change the name to "oculosurgeon" :p
     
  21. MPS

    MPS Senior Member
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    There already is an alternative name which could be used - and is used in the UK - ophthalmic surgeon. Unfortunately, this name would marginalise those specialising in medical ophthalmology.
     
  22. mjl34

    mjl34 Member
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    You can fax him if you want at (405) 521-3353

    his website has a place for you to place a message to him, check it out at
    http://www.governor.state.ok.us/message.php
    :)
     
  23. Mirror Form

    Mirror Form Thyroid Storm
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    I think a name change is a great idea. We should definitely switch to ophthalmic surgeon.
     
  24. dammit2

    dammit2 Junior Member
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    Dear Gov. Henry,

    It is with great trepidation that I read news of Oklahoma's House Bill 2321, which effectively grants optometrists the right to perform ophthalmic surgery in your state.

    I'll begin with some obvious facts that you no doubt are aware of. First, optometrists are NOT -- and will never be -- physicians. Training received in four years of optometry school is in no way equivalent to an ophthalmologist's training: four years of medical school, four years of residency, and 1-2 years of fellowship. Secondly, although the eye may appear to be a simple, isolated organ, it is not. Rather, like all organs in the body, the eye is subject to systemic effects and illnesses and is therefore best managed by someone who has received extensive training in the physiology and treatment of the entire body -- in short, an ophthalmologist. Finally -- and most importantly -- allowing eye patients in your state to be operated on by inadequately-trained NON-PHYSICIANS is a glaring health hazard that does great disservice to the people of Oklahoma.

    I do not downplay the state's need to serve its patients. I was disturbed by the statistic that only 18 of 77 counties in your state have ophthalmologists. Yet I am even more deeply disturbed that legislators in the state believe that allowing non-physicians and non-surgeons to operate on Oklahomans would be the answer to this pressing problem.

    Surely there are safer alternatives for the people of your state. For example, rather than unsafely and unreasonably expand the scope of practice for non-physicians in your state, it would appear more logical to attempt to recruit more adequately trained ophthalmologists to Oklahoma. This could surely be accomplished by expanding the number of ophthalmology residency positions in Oklahoma.

    The strategy that the legislators in your state wish to adopt would most certainly to have the opposite effect -- that is, alienate trained physicians from wishing to practice in Oklahoma, or talented medical students from wishing to pursue ophthalmology training in this state. As a medical student who will be applying for ophthalmology residency in 2005, I know I will certainly avoid Oklahoma as a potential place for residency if it appears that I will be unable to receive adequate training from qualified physicians there.

    I shudder at the thought that perhaps a decade from passing this misguided law, there will be no true, well-trained eye physicians in Oklahoma, and all eye care in this state will be administered by underqualified, undertrained optometrists whose brief schooling cannot hope to provide the breadth of experience that a true medical residency and fellowship affords the ophthamologist. To me, it has the undertone of a true public health and safety disaster that you, as governor of Oklahoma, have a great responsibility to avert.

    Please carefully consider the welfare, health, and safety of the residents of Oklahoma before allowing this disturbing, illogical, and most importantly unsafe law to go into effect.

    Sincerely,
    [Name deleted]
     
  25. jwolfe

    jwolfe Junior Member
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    fantastic letter!

    We should all take the time to send a letter.
     
  26. Mirror Form

    Mirror Form Thyroid Storm
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    I already wrote my letter to that stupid governor. It was no way near as eloquent as dammit2's though.
     
  27. Yogi Bear

    Yogi Bear 2K Member
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    i suggest www.petitiononline.com if anyone's interested in starting it up... i think u could really spread the news quickly to medical students/residents/docs/etc. quickly if we all just send a link around via email. :D
     
  28. exmike

    exmike NOR * CAL
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    I love that word... "trepidation"

    The question is if the governor will understand it since they dont understand the diff. between ophtho and optometry :p
     
  29. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    Nice letter! :thumbup:

    This is a well-written letter, and I've modified it for my situation. I've also sent a letter to Gov. Henry. Strong work! ;)
     
  30. ophtho1122

    ophtho1122 Member
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    Very well stated!!! I couldn't think of any better way to say what we all our feeling. I hope everyone is alerting other Ophtho people in your school and community about this situation to get them on board.
     
  31. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    Of the " Yes w/ proper optometry "surgical fellowships": MD/DO/medical students", I want to know why they think it is okay for optometrists to complete surgical fellowships. Please voice your opinions.
     
  32. dammit2

    dammit2 Junior Member
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    Hi all,

    Thanks for the positive support re: my letter. I should have mentioned that I posted it so that people can 1) critique it -- i.e. punch holes in my arguments or add supporting evidence that I had not included; and 2) to serve as a modifiable template for your own letters.

    Please feel free to modify my letter and send in your own; no copyright issues here. :laugh: Hopefully this letter will make composing your own letters easier, and our "grass-roots" letter-writing campaign will benefit the future of ophthalmology.


     
  33. Andrew_Doan

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    Ophthalmic/Medical Trade Press Contact Information

    Letter to the Editor Guidelines

    Make your voice heard ? demand surgery by surgeons!

    With optometry expanding its surgical scope of practice legislatively in Oklahoma, the impact will be felt throughout the remaining 49 states and in places like the Department of Veterans Affairs (VA). As articles appear in the various eye care trade publications on the VA issue, we urge you to respond with letters to the editors.

    This forum provides an opportunity to react to an article, state your opinion, emphasize something that may have been left out, or reinforce your position on this issue. The more, the better ? so please write in often and encourage your friends and colleagues to do so as well. Following are guidelines to increase your chances of getting the letters placed in the publications.

    1. Keep it short and to the point ? Check the publication guidelines, but as a rule of thumb, limit letters to no more than 200-250 words.
    2. Take a position ? Quickly state a strong opinion and if possible, a recommended solution. Don?t restate the issue.
    3. Personalize ? Include a personal experience or unique perspective whenever possible, i.e., if you are a veteran or an optometrist/ophthalmologist, include that information in your letter and explain why it makes your opinion unique.
    4. Stick to the messages - The Academy developed the following themes to be used in all VETS communications. For the full messages, please go to our Talking Points (63K) :
    - Theme: Veterans deserve the same healthcare we do.
    - Theme: Only surgeons should conduct surgery.
    - Theme: Laser surgery is surgery with all the associated risks.
    5. Don?t Repeat Negatives - Don't repeat negative language or the negative argument in the piece you are responding to.
    6. Include your credentials ? After your signature, include a brief listing of your credentials to establish yourself as an expert.
    7.
    Follow the guidelines - Many publications have guidelines regarding where and how to send the letter (fax, email), length, inclusion of contact information.

    American Journal of Ophthalmology
    Attn: Thomas J. Liesegang, MD
    Mayo Clinic
    4500 San Pablo Rd.
    Jacksonville, FL 32224-1865
    phone: 904.953.2555
    fax: 904.953.2551
    e-mail: [email protected]

    Submit letters to the editor online via their editorial manager feature at www.editorialmanager.com/ajo/. Correspondence submitted should not exceed 500 words of text and five references

    American Medical News
    515 N State St
    Chicago, IL 60610
    phone: 312.464.4429
    fax: 312.464.4445
    e-mail: [email protected]

    Preferred delivery method: e-mail

    Archives of Ophthalmology
    Attn: Daniel M. Albert, MD
    Suite 102, 2870 University Ave.
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    Letters should be limited to 800 words. Send them to her directly via e-mail. We can also discuss potential articles with her.

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    Letters should be double-spaced and a word count should be provided with each letter. JAMA prefers that letters be submitted electronically, to [email protected]. Letters can also be faxed to the editorial office at 312.464.5225 (also mail a hard copy).

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    Letters should be no longer than 500 words. They can be sent directly to her via e-mail or fax.

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    They should be no longer than 400 words.

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  34. John DO

    John DO A.T. Still Endowed Chair
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    Wow . . . you guys are getting whipped into a frenzy! The multiple derogatory remarks about the intelligence of the good people of my state aside, I have to say that a lot of this concern may be somehwat premature. This is by no means an attempt to eliminate Ophtho in OK. I lived in OK and worked as an Optician for 8 years prior to going to medical school and can vouch for the fact that if Optometrists were not allowed to do drill-outs and foreign body removals, many Oklahomans would suffer loss of vision bc the Ophthos are just not there. I have a friend on the Optometric Board of Governors in OK and received word from him that the Optos did not even ask for this opinion from the Attorney General to be rendered. He claims that this was an effort by the Ophthos of the state to limit Optos more; unfortunately, the opinion rendered indicated that Optos are NOT allowed to perform surgery at all, as stipulated in the above news report someone posted. This includes punctum plugs, FB removal, etc. These are minor procedures that have been performed by Optos for years. They are not seeking to expand scope of practice into laser surgery, etc. My opinion is that, if we are truly specialized physicians who provide a service that cannot be provided by a lesser-trained individual, then the market will correct itself. If Optos seek to expand their scope of practice into areas they are not qualified to practice, then as patients and insurance companies see negative ramifications, Optos will be formally limited. As it stands, this bill merely clarifies the symbiotic relationship that the 2 O's have enjoyed for years. Optos performing minor Ophthalmic emergency surgery prevents the Ophtho from having to set up practice in an area he/she does not really want to practice: rural Oklahoma. The relationship provides for an excellent practice opportunity for OK Ophthos bc he/she can work in practice with a group of referring Optos who take care of minor procedures while the eye specialist travels between clinics, working at each one a day or two a week to perform the serious procedures referred to him by the Optos.
     
  35. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    I agree that the two fields need to work together; however, the above attitude has allowed optometry to gain more scope of practice.

    Read the new Oklahoma bill:
    http://www.aao.org/aao/advocacy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=37379&CFID=4638371&CFTOKEN=98200708

    1) The optometry Board in OK may decide what laser and non-laser (i.e. scalpel) surgeries can be performed by optometrists.

    2) This law allows a non-surgical board to decide surgical privileges. As a physician, how can you agree with that?

    Consider this too:

    Academy Fights New Oklahoma Law that Could Convert Optometrists to Ophthalmologists


    April 30, 2004


    WASHINGTON? The American Academy of Ophthalmology stands ready to fight the precedent-setting provisions recently signed into law in Oklahoma. With the signing of H.B. 2321 on April 28, optometrists are now permitted to perform eye surgery with scalpels. The bill, which passed both house and senate days after it was introduced, also contains provisions that allow optometry to self-regulate its members.

    ?This new law essentially converts optometrists to ophthalmologists, ?said H. Dunbar Hoskins Jr., MD, Executive Vice President, American Academy of Ophthalmology. ?Moreover, it raises serious patient safety and quality care issues.?

    The new law will seriously impact patient care, and not just in Oklahoma.

    ?What is going on in Oklahoma threatens quality patient care everywhere and cannot go unchallenged,? said Allan Jensen, MD, Academy President. ?Legislating surgical privileges in Oklahoma will surely feed optometry?s hunger for these same privileges in other states.?

    For example, optometry has used Oklahoma as a way to expand its scope to include surgery within the Department of Veterans Affairs health system, where the Academy is currently fighting a patient safety battle. Oklahoma stands alone as the only state where optometrists can currently perform any laser eye surgical procedure.

    The ramifications of the new Oklahoma law for ophthalmologists and their patients are so severe that the Academy is working with the Oklahoma Academy of Ophthalmology and a united House of Medicine to fight this devastating assault on patient safety.

    Through a backdoor legislative effort, the provisions, introduced by pro-optometry interests, were a last-minute insert to a conference bill that had broad support in the legislature. This move by optometry to take advantage of the end-of-session legislative rush in essence prohibited public debate on optometric surgical scope. The bill authorizes the Board of Examiners in Optometry?a body composed mainly of optometrists?to decide optometric scope of practice including the types of surgeries optometrists will be able to perform on the eye and face, including cataract surgery, plastic surgery, facial reconstruction and eyeball removal. With the bill signed, the Academy?s fight to preserve quality surgical care moves to the rulemaking process, where, along with its allies, the Academy will continue to battle for patient safety.

    ?In rulemaking, the Academy will fight for patient surgical safety,? added Dr. Hoskins. Although Oklahoma Governor Brad Henry has indicated to ophthalmology that the medical and osteopathic communities will have input into this process, the rulemaking is overseen by the Oklahoma Board of Examiners in Optometry, which in the past, has aggressively pushed for OD scope expansion.
    ###

    The American Academy of Ophthalmology is the voice for ophthalmologists and their patients in Washington, D.C., and is the world's largest organization of eye physicians and surgeons, with more than 27,000 members.

    Reporter Contact: Sandra Remey, Governmental Affairs, 202.737.6662 or [email protected]
     
  36. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    You make valid arguments. I can assure you that 99.9% of ophthalmologists do not want to take punctal plugs and foreign body (FB) removal away from optometry. These are not surgical procedures.

    The Attorney General's opinion is a classic example why physicians and optometrists need to work together to develop laws that are acceptable to both organizations. Law makers and the public do not know enough about medicine and the practice of optometry to make these laws and decisions about patient care. Thus, because CPT codes include plugs and FB removal as "surgical procedures", the Attorney General included these procedures in his opinion: http://www.aao.org/aao/advocacy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=36420&CFID=4643998&CFTOKEN=36047521

    Unfortunately, ophthalmologists and optometrists are not working together. For instance, instead of rewording the law to include foreign body removal and punctal plugs, organized optometry pushes for full surgical privileges yet to be determined by the Optometry Board (a non-surgical entity). It is difficult to trust organized optometry with a track record of lobbying for more medical and surgical privileges. The attitudes of optometrists in Oklahoma are scary, and this will have serious long-term manifestations in regards to recruiting talented physicians to Oklahoma.
     
  37. rpames

    rpames Optometrist
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    I would just like to point out that in the above letter it states ODs only have THREE years of schooling, it is FOUR. A growing number is even taking on a one year residency. I'm not saying this qualifies them to perform surgery, I'm just saying you need to check your facts. I understand your possition on this topic, but you need to read the curriculum ODs have before you write a letter to the gov.


    About ODs pushing for Rights (surgical or medical):
    Most ODs are not pushing for full surgical rights, and they shouldn't. Like anything, sometimes you have to push for more than you want or expect to get in order for you to get what you want. It is like buying a car, the dealer starts with the price high and you start low. Eventually you end up close to where you both expected to end up. Again, I'm not fully supporting ODs performing surgery, but I don't think any OD would start hacking away at the eye without proper training. There would be residency programs started and the OD would be well qualified to do what ever they plan to do before they put on the scrubs. Not to mention, who in their right mind you allow a Walmart OD to do surgery on them:eek:. I know many patients would not know the difference between an OD or a MD/DO, but then I say who would insure them, who would give them privliges? Even if the bill passes for full surgical rights, I don't think any of us will see an optometric surgeon anytime soon.

    I should qualify the above position: I'm the son of an OD and in a few hours I will be a second year optometry student.
     
  38. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    I respect your opinions and input here on SDN. Thanks for your comments! :D

    I'll edit the letter above to four years. I corrected this when I sent out my letter.

    In regards to doing a one-year residency, I think this is great. However, only 15%-20% of optometry graduates do a one year residency in the following. Historically, only 10% of all practicing optometrists have completed a residency program (Fellows of the American Academy of Optometry (FAAO)).

    We already have a mechanism for producing ocular surgeons. Most of us agree that the OD and MD curriculum is different; therefore, I don't support a separate residency program to develop a new breed of optometric surgeons. This is similar to chiropractors developing a program to perform back surgery.

    Finally, the optometric surgery bill has passed in OK and the Board of Optometry has full power to determine the surgical privileges of optometrists. This is happening, and it is happening today. I am not being paranoid. Read the news and read the approved bill I linked to above.

    http://www.okcbusiness.com/news/news_view.asp?newsid=3741
    http://www.kfor.com/Global/story.asp?S=1806731

    Newly passed OK bill:
    http://www.aao.org/aao/advocacy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=37379&CFID=4638371&CFTOKEN=98200708
     
  39. droliver

    Moderator Emeritus 10+ Year Member

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    Andrew,

    you have my sympathies with the scope of practice issues facing Optho. Plastic Surgery & ENT are also having a state by state battle with the Dentists who have decided they are now qualified to perform extraoral surgery of the head and neck using similar strategies & the OD's to get privledges in the legislatures.
     
  40. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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  41. Yogi Bear

    Yogi Bear 2K Member
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    kinda off-topic....

    http://www.cbsnews.com/stories/2004/06/23/eveningnews/main625818.shtml

    The Battle Of Nips And Tucks

    LOS ANGELES, Calif., June 23, 2004



    Clash Of The Surgeons

    A surgeon pulls a stitch tight. (Photo: CBS)



    Plastic surgeons say despite oral surgeons' work in the ER, or how easy reality TV makes it look, doing delicate facial cosmetic surgery takes specific training that only they receive.


    (CBS) In the capital of manmade beauty, where facelifts and eye jobs are as commonplace as designer duds on Rodeo Drive, there is an ugly battle brewing.

    "There's no shortage of trained cosmetic surgeons in the state of California, and it certainly isn't appropriate," says Dr. Harvey Zarem, president of the California Plastic Surgeon's Association. "A group of surgeons who are untrained and willing to take on procedures that are beyond their ability and expertise."

    Zarem has been nipping and tucking in Beverly Hills for 30 years. As CBS News Correspondent Sandra Hughes reports, Zarem is worried about a proposed law in California that would allow oral and maxillofacial surgeons ? dentists - to step into his world.

    "They are not physicians," says Zarem. "They want to bypass medical school. They want to bypass surgery training and go immediately into being doctors, taking care of patients and undertaking cosmetic surgery."

    Oral surgeons counter that they already do difficult emergency cosmetic surgeries and that until four years ago, it was perfectly legal for them to perform all cosmetic surgery. Then, something strange happened: the dental board took the privilege of elective cosmetic surgery away from their own members.

    "The dental board was basically pressured by the medical board to pass a regulation saying that they felt that, while we could do the most difficult surgeries out there, we couldn't do the more simple ones in our offices under controlled conditions," says Dr. Larry Moore, an oral surgeon.

    Plastic surgeons say despite oral surgeons' work in the ER, or how easy reality TV makes it look, doing delicate facial cosmetic surgery takes specific training that only they receive.

    "I'm often asked, 'Is this easy to do?' And my answer is 'yes,' if you know how to do it," says Zarem. "It's like flying from here to New York. It's easy to do if you're a trained commercial pilot. It's not easy if you don't know what you're doing."

    Both sides faced off in California's Capitol. One woman's daughter had a nose job by an oral surgeon.

    Moore counter-attacked with before-and-after photos of patients made beautiful by oral surgeons.

    Laura Maynard was one of them.

    After her jaw was crushed in a car accident, Moore fixed it and then straightened her lifelong crooked chin.

    "He did just a beautiful job," says Maynard.

    She believes the cosmetic surgery battle is absurd, saying that it should be the best doctor who wins the patient.

    "This just makes no sense to me," says Maynard.

    Maybe not to her, but it's dollars and cents to the doctors or dentists who win the coveted cosmetic surgery prize.
     
  42. governaitor

    governaitor Senior Member
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    If you are just talking about Lasix, then sure why the hell not, doesn't it just basically involve "pushing a button". It doesn't seem like it involves much extensive training.

    If you are talking about "real surgery" than no, I don't think optometrists should do that.

    More people doing it will drive down the cost benefiting society as a whole. Plus it will free up opthos, so that they can do "real medicine" and not BS "cosmetic" procedures.
     
  43. governaitor

    governaitor Senior Member
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    Is the law talking about real surgery or just "lasix"?
     
  44. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    "lasix" is the loop-diuretic pill. LASIK is surgery. It may appear simple, but there is more to it than 'pushing a button'. The decision making process in determining good surgical candidates require extensive training and understanding of surgical principals.

    Read this thread: http://forums.studentdoctor.net/showthread.php?t=66061

    BTW, the OK law is talking about real surgery, but it appears none will be granted by the current Governor. The law is written to allow introduction of incisional surgery, e.g. cataracts, with the OK Board of Optometry having control over optometric surgery.

    Is the price of cheap LASIK really that important to you that you're willing to risk a life-time of visual disability?
     
  45. Richard_Hom

    Richard_Hom Senior Member
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    Dr. Doan,

    I've seen several teenagers and children who have had LASIK "south of the border" and who are returning for post-operative complicatios to our clinic. Have you had much exposure with under 15 year old LASIK patients?

    Richard
     
  46. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    I haven't seen LASIK done on minors.
     
  47. Richard_Hom

    Richard_Hom Senior Member
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    Dr. Doan,
    From the dozen or so I have seen in the last several months, all seem to show a progression in corneal curvature and astigmatism to 2-4 diopters about 2-3 years post operatively. I don't have their pre-op data, but most said that their vision became worse over those 2-3 years so I'm concluding that these residual refractive errors are post operative either by natural progression of refractive error or by some other mechanism. The surgical outcomes, except one, are uncomplicated.

    Richard
     
  48. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    http://www.aao.org/aao/advocacy/state/oklahoma.cfm
     
  49. mdkurt

    mdkurt Senior Member
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    Wow. The Academy is really winning my respect on this one. I figured we needed to be taking out full page newspaper ads, but I think the radio ads should be more effective. It's about time that we really educate people about what's going on in Oklahoma.
     
  50. PBEA

    PBEA Senior Member
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    My perspective is that of an OD that has been in private practice for only 4 years, some random thoughts that are somewhat on topic

    There is without question some harmony yet to be achieved in understanding the balance of society's need for primary, secondary, and tertiary eyecare. The exact definitions of each level of care will always overlap. There will always exist a ratio of need for each level of care. A dynamic, educational process should exist such that a qualified doctor deliver this care.

    The ophthalmological tract is comprehensive but I feel that one obstacle lies before it. The vast array of specialty areas in ocular medicine are just that, vast (as we all realize). As a result the need to have even further training (ie fellowship) for ophthalmology exists in order to have true proficiency in certain areas. In the end, there are fewer tertiary providers and more primary and secondary providers. Fine, this is as it should be. In the current system, the number of secondary and tertiary OMD's is probably adequate given the demand, but the number of primary providers is completely lacking (considering OMD's only). What is the solution? To increase OMD residencies? I don't think so, what OMD do you know of that wants to spend all that education doing soley primary care? And should they be forced to? Is this the best way to train someone who is supposed to handle complicated surgical cases? This increase might arguably lead to a "watering down" effect since there may not be enough surgical volume to sustain everyone's appropriate learning. The result, at least in my opinion, is that ophthalmology has decided that much of primary eye care is best left to FP's et al. This has been vaguely evidenced by ophthalmology's opposition to legislation promoting annual exams for children, citing optometrists need to fill there schedule, or that FP screening are adequate. Please, don't quote any study that contends screening as comparable to comprehensive exam. And no, I don't prescribe glasses for children unless I think it is necessary.

    Currently, optometrists capably fills the primary care void but there is definetely some overlap, I know this because I do it everyday. I know my limits, but I practice to a level that ophthalmology would argue I am not trained well enough to perform. Why? Do they really want to see these people? Is this most effective or efficient? I don't do anything that I would consider surgery, nor do I want to. I do however see many glaucoma, diabetes, HTN, etc. Things that are beyond my skill level, I refer appropriately. I am keenly aware of my limits, my profession has taught me this, my education hammered this into my psyche. For me it requires very little thought, in fact, to determine that further care is needed by an OMD. I think ophthalmology has discounted the overwhelming need for primary eyecare, higher costs have been mentioned but I'm not going to pretend that people should be getting annual dental exams or PCP visits, instead of an eye exam. The truth is they benefit from all the above. The possible lack of symptoms for many eye concerns are misinterpreted or missed altogether by patients (or unknowing doctors). We all know this yet I have this sinking feeling that ophthalmology wants to somehow keep optometry out of this clinical management loop. This will never happen, it isn't possible, and there is no justifiable reason for it.

    I'm ramblimg now, so feel free to lambast me, but I have recently led myself to the conclusion that the constant bickering between OMD's and OD's is destined to continue, despite all the PAC money etc. I like to think that the professions will join in developing some common educational tract that results in adequate numbers of primary eye doctors as well as the most highly trained subspecialists, but alas this will never happen.
     
    poojerrr likes this.
  51. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    Thanks for your post. I think you make some very good points. I think what you listed above are within your scope of practice, unless you're actually performing laser procedures.

    In regards to training adequate numbers of primary eye care providers, there are adequate numbers. Optometry schools graduate over 1200 students per year compared to ophthalmology residencies that graduate over 400 ophthalmologists per year. There are currently over 40,000 optometrists working in the U.S. verses only ~15,000 ophthalmologists. In fact, the optometry lobby boasts how there is at least one optometrist located in almost every part of the country.

    The points I want to emphasize are:

    1) Optometry schools do a great job training primary eye care providers: fitting glasses & contact lenses, diagnosing and treating minor and early ocular diseases, and recognizing serious problems to refer.

    2) We don't need to increase our numbers of optometrists. Some complain they aren't busy enough, and that they can't make enough money.

    3) We may need more ocular surgeons in the future with the baby boomer generation getting older.

    4) This thread is about revoking surgical rights for optometrists, not restricting your current scope of practice.
     

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