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

[JennyW]

I don't think optometrists realize how difficult it is to match for ophthalmology. We just selected applicants for interview at Iowa, and it was a humbling experience.


There are only ~450 spots available. There are ~1000 applicants. From the 300 I saw who applied to Iowa, each will be competitive for residency spots at other programs.

Well if that's the case then it appears that there is an acceptance ratio of 1:2.2 which isn't THAT much worse than optometry school.

There was a factory that opened up near where I live in upstate New York. 3400 people applied for 40 positions. That's an acceptance ratio of 1:85. I guess factory work is much more competitive than optometry school, medical school and opthalmology residency.

Jenny

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[maddoc1979]

Well if that's the case then it appears that there is an acceptance ratio of 1:2.2 which isn't THAT much worse than optometry school.

There was a factory that opened up near where I live in upstate New York. 3400 people applied for 40 positions. That's an acceptance ratio of 1:85. I guess factory work is much more competitive than optometry school, medical school and opthalmology residency.

Except you forgot to tack on the rate of medical school acceptance, which as quoted earlier by Dr. Doan, is roughly 1 in 3. Therefore, the acceptance rate to ophthalmology residency programs is actually 1:6.6, which is far more diffcult than that of optometry school.

The statistic about factory work is more of a comment on the state of the local economy than about the competitiveness of anything. As an absolute statistic, yes, it was more competitive for the workers to find work at the factory, but you're only really talking about 1 factory and not the entire industry. And you have to take into account the desired wages, etc. Basically, this is all apples and oranges. No relation to one another whatsoever.

 

[Andrew_Doan]

Well if that's the case then it appears that there is an acceptance ratio of 1:2.2 which isn't THAT much worse than optometry school.

It's nice that you take my statistic out of context. You forgot to include my comment that 300 applications I reviewed were AWESOME.

Applying to ophthalmology is self-selected for only the best of the best from medical school. Each year, US medical schools graduate 15,000 MDs. Of these, only the top candidates are able to apply for ophthalmology. If they don't have the grades, USMLE, or track record to make it, then their Dean or advisor steers them away from applying to ophthalmology. The number of ophthalmology positions to potential US applicants is on the order of 1 to 33.

In addition, this also assumes, as pointed out above, that the applicant was accepted to medical school first (1:3 odds), which is already more difficult than the 1 : 1.7 odds for optometry school.

 

[Mirror Form]

Applying to ophthalmology is self-selected for only the best of the best from medical school. Each year, US medical schools graduate 15,000 MDs. Of these, only the top candidates are able to apply for ophthalmology. If they don't have the grades, USMLE, or track record to make it, then their Dean or advisor steers them away from applying to ophthalmology. The number of ophthalmology positions to potential US applicants is on the order of 1 to 33.

In addition, this also assumes, as pointed out above, that the applicant was accepted to medical school first (1:3 odds), which is already more difficult than the 1 : 1.7 odds for optometry school.

Exactly, and lets not forget either that the initial medical school applicants are also a very self selected group. Tons of people who start out as pre-med in college get weeded out before the application process even begins. The same thing doesn't happen with optometry.

 

[Mirror Form]

Bzzzzzzzzzztttttt. Nice try, Sledge.

http://www.opted.org/info_profile2.cfm

That hardly shows the same number of applicants as slots. But go ahead and think that if it makes you feel better about yourself.

It's still a cake walk compared to matching into ophthalmology!

And you don't have to generalize what a few renegade ODs in Oklahoma are trying to do to the entire profession. As someone who's been in practice for more than 10 years, I think I know a bit more about what's going on in my field than a medical intern.

Hmm, a few renegade OD? Considering that they have so much influence over oklahoma's state government, I'd be surprised if it were just "a few renegade ODs." It's clearly a very large and very organized effort. Also, Oklahoma isn't the only state where optometrists have been pushing for surgical rights. Basically, you're just in denial.

No one is going to deny that ophthalmology is a competetive match. But don't worry Sledge. If you don't match at any of your "programs that suck" I guess you could always go to optometry school. According to you, we'll all be surgeons within a year anyways.

Jenny

It funny how you continually make fun of the "programs that suck" thread, when every one of those programs is literally ten time harder to get into then optometry school

 

[rickard]

ever think of getting optometry banned altogether?

how strong a lobby is the Academy of Ophtho, anyway?

Really?? Ban optometry altogether, huh??? Well, who exactly do you plan on going to when you can't see clearly or need pre and post-op checks? Ophthalmologists focus their work on surgery, primarily, and prefer not to spend a lot of time doing primary care and carrying out follow up checks.

 

[Andrew_Doan]

As far as scare tactics go, according to the OMD academy, the number of "surgeries" that ODs are allowed to do originally was 14 with this new law. Now it's into the 100s. Sounds like scare tactics to me.

Do YOU have a list of these mysterious 14 procedures?

I spoke with a few people and have a better understanding of why the surgical list is long for optometry in OK. I also met with the Chairman of the Ophthalmology Dept. of the U of Oklahoma today because he was visiting Iowa.

The problem lies in the language that the Board of Optometry used. It's vague, and it's vague for a reason. Optometry in OK want to do surgery, such as pterygium removal, tumor removal, and other surgical procedures. Board of Optometry states 'exclusions" rather than what is "included" in their scope of practice. For instance, with the current specification that optometry is permitted to "remove eye surface lesions", this will permit optometrists to perform pterygium removal, lamellar keratectomy, strabismus surgery, and scleral buckle procedures, because "intraocular surgery" is prohibited but not "surface surgery of the eye".

 

[JennyW]

I spoke with a few people and have a better understanding of why the surgical list is long for optometry in OK. I also met with the Chairman of the Ophthalmology Dept. of the U of Oklahoma today because he was visiting Iowa.

The problem lies in the language that the Board of Optometry used. It's vague, and it's vague for a reason. Optometry in OK want to do surgery, such as pterygium removal, tumor removal, and other surgical procedures. Board of Optometry states 'exclusions" rather than what is "included" in their scope of practice. For instance, with the current specification that optometry is permitted to "remove eye surface lesions", this will permit optometrists to perform pterygium removal, lamellar keratectomy, strabismus surgery, and scleral buckle procedures, because "intraocular surgery" is prohibited but not "surface surgery of the eye".

But in another thread, you state that ODs in Oklahoma are already doing pterygium removal, tumor removal and other surgical procedures. I'm not sure I see where the exapnded scope of practice is. And I don't see how anyone could make the argument that strabismus or sclearal buckle procedures are "removal of eye surface lesions." That makes no sense at all.

First there was a supposed list of 14 new surgical procedures. Then there was 100s of procedures that ODs are suddenly allowed to do. Which is it? And what are these 14 procedures? Did you have any luck talking with your contacts?

Jenny

 

[JennyW]

OB-GYN- Expecting mothers are our patients too. As ophthalmologists, we often monitor and screen for pre-eclampsia. We are also careful about the medical and surgical treatments that may affect the fetus.

QUOTE]

Yes. During my recent pregnancy, after my appointments with my OB, I would always be sent downstairs for a consult with an ophthalmologist. You can imagine my relief when the ophtalmologist told me I didn't have pre-eclampsia.

 

[Andrew_Doan]

OB-GYN- Expecting mothers are our patients too. As ophthalmologists, we often monitor and screen for pre-eclampsia. We are also careful about the medical and surgical treatments that may affect the fetus.

QUOTE]

Yes. During my recent pregnancy, after my appointments with my OB, I would always be sent downstairs for a consult with an ophthalmologist. You can imagine my relief when the ophtalmologist told me I didn't have pre-eclampsia.

Your responses are often short-sighted and sarcastic.

We receive consults from OB for fundus exams when mothers at risk develop visual loss. You knew that there can be serous retinal detachments with pre-eclampsia and eclampsia?

In addition, let me illustrate a few scenarios where we do consider the health of the fetus when treating pregnant women:

1) pseudotumor cerebri with severe visual loss;

2) juvenile glaucoma (i.e., do you know which drops can be safely used in pregnant women???);

3) optic neuritis treatment in multiple sclerosis.

In regards to optometry in OK, there is unofficial and official scope of expansion. I'll update you after the AAO meeting this week.

______________________
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12555046

Ocular changes in pregnancy.

Obstet Gynecol Surv. 2003 Feb;58(2):137-44.

Dinn RB, Harris A, Marcus PS.

Indiana University School of Medicine, Indianapolis 46202, USA.

Visual changes in pregnancy are common, and many are specifically associated with the pregnancy itself. Serous retinal detachments and blindness occur more frequently during preeclampsia and often subside postpartum. Pregnant women are at increased risk for the progression of preexisting proliferative diabetic retinopathy, and diabetic women should see an ophthalmologist before pregnancy or early in the first trimester. The results of refractive eye surgery before, during, or immediately after pregnancy are unpredictable, and refractive surgery should be postponed until there is a stable postpartum refraction. A decreased tolerance to contact lenses also is common during pregnancy; therefore, it is advisable to fit contact lenses postpartum. Furthermore, pregnancy is associated with a decreased intraocular pressure in healthy eyes, and the effects of glaucoma medications on the fetus and breast-fed infant are largely unknown. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the various ocular changes that occur during pregnancy, summarize the ocular disturbances that occur with preeclampsia and diabetes, and describe the management of some ocular problems during pregnancy.

 

[JennyW]

Your responses are often short-sighted and sarcastic.

We receive consults from OB for fundus exams when mothers at risk develop visual loss. You knew that there can be serous retinal detachments with pre-eclampsia and eclampsia?

In addition, let me illustrate a few scenarios where we do consider the health of the fetus when treating pregnant women:

1) pseudotumor cerebri with severe visual loss;

2) juvenile glaucoma (i.e., do you know which drops can be safely used in pregnant women???);

3) optic neuritis treatment in multiple sclerosis.

In regards to optometry in OK, there is unofficial and official scope of expansion. I'll update you after the AAO meeting this week.

Yes.

1) ok
2) yes
3) ok

I'd be very interested to hear what happens at your meeting. I'd also be interested in what "unofficial" scope of practice expansion is.

Jenny

 

[Andrew_Doan]

I'd be very interested to hear what happens at your meeting. I'd also be interested in what "unofficial" scope of practice expansion is.

The problem lies in the wording of the current optometry scope of practice laws in Oklahoma. Because of this, there can be "unofficial" scope of practice expansions. The language is based on "exclusions" rather than what procedures are "included".

For instance, consider the current "laser surgery" law. Oklahoma optometrists can do "laser surgery", except retina, LASIK, and cosmetic lid surgery. Asides from retina, LASIK, and skin laser surgery, an Oklahoma optometrist has full privileges for everything else. A reasonable optometrist, like yourself, would agree that this law permits an optometrist to perform PRK, ALT, and Yag capsulotomy in Oklahoma. However, what about cyclophotocoagulation (CPC) and surface ablation of corneal lesions? I am sure you would agree that this is beyond the scope of practice even for an Oklahoma optometrist. Unfortunately, because the current law only excludes retina, LASIK, and skin laser, an aggressive optometrist in Oklahoma could argue that CPC and PTK are within their scope of practice; thus, the "unofficial" scope of practice expansion evolves. For those who don't know, CPC is a destructive procedure of the ciliary body reserved for end stage, untreatable glaucoma and blind, painful eyes, and this procedure can lead to a phthisical eye (i.e., shruken, dead eye).

Let's consider a more recent law that's being considered by the Governor. Optometry wants to pass a law to increase their scope of practice to include "intraocular injections". Without specific inclusions and exclusions, the law essentially allows Oklahoma to be the ONLY state to allow a non-surgically trained individual to stick a needle in the eye, and an aggressive optometrist could "unofficially" expand their scope of practice into microsurgical cataract surgery.

Using the same "needle", they can make a paracentesis wound, complete a capsulorrhexis, perform hydrodissection & hydrodelineation of the lens, and with a larger "needle" remove the lens and inject a foldable lens. Optometry would argue that it's not surgery! We are only using "needles", and there are no sutures! With the new intraocular "contact lenses", I can see optometry demanding rights to implant these because optometrists are the experts in contact lenses! Does this sound similar to the arguments used for the expansion into "laser surgery"? Laser surgery isn't real surgery because we're using light, and we're not cutting tissue.

This is not propaganda by the American Academy of Ophthalmology, The American Society of Cataract and Refractive Surgery, The American College of Surgeons, and The American Medical Association. The aggressive optometric expansion in scope of practice in Oklahoma is real and unjustified. In fact, it is so aggressive that prominent ophthalmologists in Oklahoma have received death threats. Because of the vagueness and purposeful exclusions and inclusions of certain procedures in the scope of practice laws, this is how "unofficial" scope of practice expansion occurs. Years later, lobbyists scramble to make "unofficial" practices "official" by sneaking in bills and laws.

 

[JennyW]

The problem lies in the wording of the current optometry scope of practice laws in Oklahoma. Because of this, there can be "unofficial" scope of practice expansions. The language is based on "exclusions" rather than what procedures are "included".

For instance, consider the current "laser surgery" law. Oklahoma optometrists can do "laser surgery", except retina, LASIK, and cosmetic lid surgery. Asides from retina, LASIK, and skin laser surgery, an Oklahoma optometrist has full privileges for everything else. A reasonable optometrist, like yourself, would agree that this law permits an optometrist to perform PRK, ALT, and Yag capsulotomy in Oklahoma. However, what about cyclophotocoagulation (CPC) and surface ablation of corneal lesions? I am sure you would agree that this is beyond the scope of practice even for an Oklahoma optometrist. Unfortunately, because the current law only excludes retina, LASIK, and skin laser, an aggressive optometrist in Oklahoma could argue that CPC and PTK are within their scope of practice; thus, the "unofficial" scope of practice expansion evolves. For those who don't know, CPC is a destructive procedure of the ciliary body reserved for end stage, untreatable glaucoma and blind, painful eyes, and this procedure can lead to a phthisical eye (i.e., shruken, dead eye).

Let's consider a more recent law that's being considered by the Governor. Optometry wants to pass a law to increase their scope of practice to include "intraocular injections". Without specific inclusions and exclusions, the law essentially allows Oklahoma to be the ONLY state to allow a non-surgically trained individual to stick a needle in the eye, and an aggressive optometrist could "unofficially" expand their scope of practice into microsurgical cataract surgery.

Using the same "needle", they can make a paracentesis wound, complete a capsulorrhexis, perform hydrodissection & hydrodelineation of the lens, and with a larger "needle" remove the lens and inject a foldable lens. Optometry would argue that it's not surgery! We are only using "needles", and there are no sutures! With the new intraocular "contact lenses", I can see optometry demanding rights to implant these because optometrists are the experts in contact lenses! Does this sound similar to the arguments used for the expansion into "laser surgery"? Laser surgery isn't real surgery because we're using light, and we're not cutting tissue.

This is not propaganda by the American Academy of Ophthalmology, The American Society of Cataract and Refractive Surgery, The American College of Surgeons, and The American Medical Association. The aggressive optometric expansion in scope of practice in Oklahoma is real and unjustified. In fact, it is so aggressive that prominent ophthalmologists in Oklahoma have received death threats. Because of the vagueness and purposeful exclusions and inclusions of certain procedures in the scope of practice laws, this is how "unofficial" scope of practice expansion occurs. Years later, lobbyists scramble to make "unofficial" practices "official" by sneaking in bills and laws.

All legitimate points, and I would agree with most of them. I would point out a couple of things though.

1) ODs are not the only group who "sneak in bills and laws." OMDs are just as bad, as evidenced by the stories that I've told on here many times.

2) I'm not sure language that is based on exclusions is necissarily bad. For example, in my home state of New York ODs treated glaucoma safely and effectively for a number of years. When Xalatan came out, OMDs immediately sued to block ODs from not only using Xalatan but from treating glaucoma all together. The argument was made that since the original formulary did not include "prostaglandin analogs" then ODs should not use Xalatan. Then the argument was made that since ODs couldn't use the "latest treatment options" then they should be prohibited from using any.
A judge (who's brother in law happened to be an OMD) agreed and for three months, ODs could NOT write precriptions for glaucoma medications until the legislature reconvened and the wording was changed to "any and all topical medications for the treatment of glaucoma." Now wasn't that just a waste of everyones time?

I would also be interested to know if anyone has heard of any cases where an OD was sued in Oklahoma because of malpractice resulting from "surgery." Surely if this was a major problem, or even a MINOR problem, it would be in the AAO newsletter in 72 point type.

Jenny

 

[rpie]

All legitimate points, and I would agree with most of them. I would point out a couple of things though.

1) ODs are not the only group who "sneak in bills and laws." OMDs are just as bad, as evidenced by the stories that I've told on here many times.

2) I'm not sure language that is based on exclusions is necissarily bad. For example, in my home state of New York ODs treated glaucoma safely and effectively for a number of years. When Xalatan came out, OMDs immediately sued to block ODs from not only using Xalatan but from treating glaucoma all together. The argument was made that since the original formulary did not include "prostaglandin analogs" then ODs should not use Xalatan. Then the argument was made that since ODs couldn't use the "latest treatment options" then they should be prohibited from using any.
A judge (who's brother in law happened to be an OMD) agreed and for three months, ODs could NOT write precriptions for glaucoma medications until the legislature reconvened and the wording was changed to "any and all topical medications for the treatment of glaucoma." Now wasn't that just a waste of everyones time?

I would also be interested to know if anyone has heard of any cases where an OD was sued in Oklahoma because of malpractice resulting from "surgery." Surely if this was a major problem, or even a MINOR problem, it would be in the AAO newsletter in 72 point type.

Jenny

Well-argued and interesting thread. I do have a problem with the comments that the Ophthalmologist is the brightest since the competition is greater. As with all professions, there are the average, below average, and the brightest. I have worked with Ophthalmologists that were sharp as a whip, and some, that had me wondering how they ever got through their medical education. I believe that regardless of which school a person attends; medical, optometric, osteopathic etc., a bright person will always shine and should succeed in what ever discipline they choose to practice. What strikes my amusement is that DOs have also joined in the fight against ODs scope of practice when not long ago MDs were trying to abolish DOs.

Cheers

rpie

 

[Mirror Form]

Well-argued and interesting thread. I do have a problem with the comments that the Ophthalmologist is the brightest since the competition is greater.

It was definitely not my intention to say that ophthalmologists are inherently smarter then optometrists and I'm sorry if any of my arguments came out sounding that way. My point was simply that it is in general more competitive to become an ophthalmologist.

 

[Andrew_Doan]

As with all professions, there are the average, below average, and the brightest.

I agree. However, the most important question is: will society benefit from developing an alternative, backdoor route to ophthalmic surgery when there is already an outstanding method to train competent surgeons, i.e. medical school and ophthalmology residency?

I'd rather have the below average cataract surgeon who has performed over 100 cataract surgeries during residency, than the brightest optometrist who was allowed to perform cataracts via legislation and a weekend course practicing on 10 pig eyes.

 

[rpie]

I agree. However, the most important question is: will society benefit from developing an alternative, backdoor route to ophthalmic surgery when there is already an outstanding method to train competent surgeons, i.e. medical school and ophthalmology residency?

I'd rather have the below average cataract surgeon who has performed over 100 cataract surgeries during residency, than the brightest optometrist who was allowed to perform cataracts via legislation and a weekend course practicing on 10 pig eyes.

When you say ?back door route?, that was the same argument MDs used in trying to limit what DOs could practice. As with all educational advances, it is the normal course for all professions, to advance their skills and scope of practice. What is very disappointing is that the AAO barred all ODs from attending their meeting citing that Optometry would use what they learn to expand the scope of practice. (I think that all ODs know that just because you attend an educational seminar the information you learn does not automatically translate into practice expansion)

As far as having a below average surgeon vs. a bright OD, the real test would be what the post-op result is. I also doubt very much that if ODs were going to do surgeries as invasive as cataract extraction, the certification process would involve much more than a weekend course working on animal eyes.

 

[Andrew_Doan]

What is very disappointing is that the AAO barred all ODs from attending their meeting citing that Optometry would use what they learn to expand the scope of practice. (I think that all ODs know that just because you attend an educational seminar the information you learn does not automatically translate into practice expansion)

The educational experiences at the AAO have been used by optometry to legislate for scope expansion. While these courses will not automatically translate into practice expansion, the same courses are used to bolster optometry's legislation efforts.

I also doubt very much that if ODs were going to do surgeries as invasive as cataract extraction, the certification process would involve much more than a weekend course working on animal eyes.

The training required to perform cataract surgery and other ophthalmic surgery requires patients and an intensive surgical ophthalmology residency. Without the need for additional surgeons and a limited patient volume, do you think an optometry surgical residency will be the same caliber as current MD/DO ophthalmology residencies? I doubt it. You'll be producing "backdoor" surgeons.

In addition, surgeons cannot learn cataract surgery alone. The surgeon needs to be prepared to handle numerous surgical complications and challenges. The knowledge and experience required to handle these surgical situations can only be learned after an intensive surgical residency and an adequate number of cases.

 

[rpie]

The educational experiences at the AAO have been used by optometry to legislate for scope expansion. While these courses will not automatically translate into practice expansion, the same courses are used to bolster optometry's legislation efforts.



The training required to perform cataract surgery and other ophthalmic surgery requires patients and an intensive surgical ophthalmology residency. Without the need for additional surgeons and a limited patient volume, do you think an optometry surgical residency will be the same caliber as current MD/DO ophthalmology residencies? I doubt it. You'll be producing "backdoor" surgeons.

In addition, surgeons cannot learn cataract surgery alone. The surgeon needs to be prepared to handle numerous surgical complications and challenges. The knowledge and experience required to handle these surgical situations can only be learned after an intensive surgical residency and an adequate number of cases.

Andrew, please tell me where you are getting the information that ODs use these courses to bolster the legislative efforts.

As stated earlier, the comment of producing ?back door surgeons? is what MDs said about DO s. Now that the DOs have advanced their education, DO s are considered equals to MDs, in most cases.

 

[Andrew_Doan]

Andrew, please tell me where you are getting the information that ODs use these courses to bolster the legislative efforts.

As stated earlier, the comment of producing ?back door surgeons? is what MDs said about DO s. Now that the DOs have advanced their education, DO s are considered equals to MDs, in most cases.

My sources come from the AAO. In the past, I've met with the president of the AAO, former president of the AAO, and the Executive Vice President of the AAO, Dunbar Hoskins, MD. In addition, I'm now in contact with a lawyer from the AAO OphthPAC.

The following is from Cataract & Refractive Surgery Today October 2004. "VA Optometric Surgery Campaign" by Michael Brennan, MD:

"In stark contrast to the VA scene where the optometric strike was silent, sudden, and almost subtle, the Oklahoma encounter lasted a decade and featured legislative and legal face offs. [In November 1998] optometrists who had attended a laser surgery session at the annual AAO meeting began performing PRK and YAG capsulotomies at the Northeastern State University College of Optometry in the mid-1990s, based on the assumption that a clause in the scope-of-practice statue permitted optometric laser surgery."

Must I remind you what happend since the mid-1990s in Oklahoma? The "unofficial" scope-of-practice expansion became "official" after optometry dumped millions of legislative dollars into the pockets of the Oklahoma politicians.

In regards to the DOs, they complete four years of medical training similar to MDs; in addition, osteopathic physicians (D.O.) complete an intensive medical and surgical residency to become ophthalmic surgeons. Need I remind you that optometrists do not do either of the above?

Hence, if optometry changes its education to be similar to the four year curriculum taught at osteopathic and allopathic medical schools, then, you may have an argument for completing a surgical and medical residency. Only then will you have a sound argument for scope expansion into surgery. Until then, your profession can only gain surgical privileges by the millions of dollars you all pour into your PAC, until the public becomes outraged.

 

[rpie]

My sources come from the AAO. In the past, I've met with the president of the AAO, former president of the AAO, and the Executive Vice President of the AAO, Dunbar Hoskins, MD. In addition, I'm now in contact with a lawyer from the AAO OphthPAC.

The following is from Cataract & Refractive Surgery Today October 2004. "VA Optometric Surgery Campaign" by Michael Brennan, MD:

"In stark contrast to the VA scene where the optometric strike was silent, sudden, and almost subtle, the Oklahoma encounter lasted a decade and featured legislative and legal face offs. [In November 1998] optometrists who had attended a laser surgery session at the annual AAO meeting began performing PRK and YAG capsulotomies at the Northeastern State University College of Optometry in the mid-1990s, based on the assumption that a clause in the scope-of-practice statue permitted optometric laser surgery."

Must I remind you what happend since the mid-1990s in Oklahoma? The "unofficial" scope-of-practice expansion became "official" after optometry dumped millions of legislative dollars into the pockets of the Oklahoma politicians.

In regards to the DOs, they complete four years of medical training similar to MDs; in addition, osteopathic physicians (D.O.) complete an intensive medical and surgical residency to become ophthalmic surgeons. Need I remind you that optometrists do not do either of the above?

Hence, if optometry changes its education to be similar to the four year curriculum taught at osteopathic and allopathic medical schools, then, you may have an argument for completing a surgical and medical residency. Only then will you have a sound argument for scope expansion into surgery. Until then, your profession can only gain surgical privileges by the millions of dollars you all pour into your PAC, until the public becomes outraged.

Andrew?....Sounds like you are about to blow a fuse.

I think you should also look at other sources than your AAO. I assume you realize that your association will favor your interests.

As far as Optometric education, once again you discredit and show little or no respect for what Optometric education is.

 

[mike3kgt]

Andrew?....Sounds like you are about to blow a fuse.

I think you should also look at other sources than your AAO. I assume you realize that your association will favor your interests.

As far as Optometric education, once again you discredit and show little or no respect for what Optometric education is.

I am not sure if I want to get in the middle of this mud-slinging but I read this article and asked myself, "Just what does an optometric physician do?"

From http://www.aoa.org/about/DoctorofOpt.asp:

Doctors of optometry are independent primary health care providers who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions. Optometrists examine the internal and external structure of the eyes to diagnose eye diseases like glaucoma, cataracts and retinal disorders; systemic diseases like hypertension and diabetes; and vision conditions like nearsightedness, farsightedness, astigmatism and presbyopia. Optometrists also do testing to determine the patient's ability to focus and coordinate the eyes, and to judge depth and see colors accurately. They prescribe eyeglasses and contact lenses, low vision aids, vision therapy and medicines to treat eye diseases.

As primary eye care providers, optometrists are an integral part of the health care team and an entry point into the health care system. They are skilled in the co-management of care that affects the eye health and vision of their patients and an excellent source of referral to other health care professionals.

The optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete a residency.

--

Last time I checked optometrists and ophthalmologists work together to help treat patients and co-manage disease. My optometrist is the nicest person and I pay him more $$ to specially see him to fit my contacts/glasses and notice signs & symptoms of disease. If I ever need a surgical procedure, please let me see somebody who is more qualified to manage surgical procedures, anesthesia, technique, emergency medicine, trauma, and overall systemic health.

-Mike

 

[mdkurt]

Andrew?....Sounds like you are about to blow a fuse.

I think you should also look at other sources than your AAO. I assume you realize that your association will favor your interests.

As far as Optometric education, once again you discredit and show little or no respect for what Optometric education is.

I don't believe (correct me if I'm wrong) that Iowa works closely with an optometric school. Our program did, so I might have more of a working understanding of optometric education than Dr. Doan. Optometry students were very well taught with respect to refraction, contact lenses, and detection of diabetic retinopathy. NOT so good with glaucoma detection/management or with assessment of ocular emergencies. Knowledge of basics like angle anatomy was not present, and most 4th year students could not tell me what kind of laser was used in a trabeculoplasty. My opinion is that the current scope of optometric practice goes beyond the scope of optometric training.

 

[rpie]

I don't believe (correct me if I'm wrong) that Iowa works closely with an optometric school. Our program did, so I might have more of a working understanding of optometric education than Dr. Doan. Optometry students were very well taught with respect to refraction, contact lenses, and detection of diabetic retinopathy. NOT so good with glaucoma detection/management or with assessment of ocular emergencies. Knowledge of basics like angle anatomy was not present, and most 4th year students could not tell me what kind of laser was used in a trabeculoplasty. My opinion is that the current scope of optometric practice goes beyond the scope of optometric training.

To all my Optometric and Ophthalmologic colleges. I have been fortunate to have been able to graduate from not only Optometry school (SCCO) but also USC School of medicine. Finishing an internship, residency and a fellowship in retina, I have had the privilege of teaching Optometric interns, residents and Ophthalmology residents. Joining a group practice, I now practice Optometry and Ophthalmology. What is disturbing, is when some of my Ophthalmology colleges express what Kurt and Andrew states; that Optometric education is deficient and not worthy of their scope of practice. I think everyone should note that Optometric education is at a level that allowed me to test out of many medical school classes. As with all students Optometric and Ophthalmologic, they all have deficiencies, some more than others, thus the reason they are students. As an educator, we try to fill those deficiencies before they graduate. If a 4th year Optometric student does not know basic angle anatomy and the type of laser that is used in a trabeculoplasty, that student probably did not pass part one of the national Optometry board, and will probably have a difficult time graduating or even get a license to practice. Observing both sides of the surgery debate. I believe the truth is some where in-between, and regardless of what you may hear, I do not believe it is Optometry?s goal is to do invasive surgery like cataracts, retina etc. or displace Ophthalmology

 

[mdkurt]

To all my Optometric and Ophthalmologic colleges. I have been fortunate to have been able to graduate from not only Optometry school (SCCO) but also USC School of medicine. Finishing an internship, residency and a fellowship in retina, I have had the privilege of teaching Optometric interns, residents and Ophthalmology residents. Joining a group practice, I now practice Optometry and Ophthalmology. What is disturbing, is when some of my Ophthalmology colleges express what Kurt and Andrew states; that Optometric education is deficient and not worthy of their scope of practice. I think everyone should note that Optometric education is at a level that allowed me to test out of many medical school classes. As with all students Optometric and Ophthalmologic, they all have deficiencies, some more than others, thus the reason they are students. As an educator, we try to fill those deficiencies before they graduate. If a 4th year Optometric student does not know basic angle anatomy and the type of laser that is used in a trabeculoplasty, that student probably did not pass part one of the national Optometry board, and will probably have a difficult time graduating or even get a license to practice. Observing both sides of the surgery debate. I believe the truth is some where in-between, and regardless of what you may hear, I do not believe it is Optometry?s goal is to do invasive surgery like cataracts, retina etc. or displace Ophthalmology

1. Were your internship, residency, and fellowship optometric or ophthalmologic?

2. What exactly do you see as the final end point for optometry? Which surgeries do you think should fall within optometric scope of practice?

3. Why did you go to medical school?

 

[rpie]

1. Were your internship, residency, and fellowship optometric or ophthalmologic?

2. What exactly do you see as the final end point for optometry? Which surgeries do you think should fall within optometric scope of practice?

3. Why did you go to medical school?

Kurt-

You statements, comments and questions exudes your arrogance and misunderstandings.

cheers-

 

[Andrew_Doan]

To all my Optometric and Ophthalmologic colleges. I have been fortunate to have been able to graduate from not only Optometry school (SCCO) but also USC School of medicine. Finishing an internship, residency and a fellowship in retina, I have had the privilege of teaching Optometric interns, residents and Ophthalmology residents. Joining a group practice, I now practice Optometry and Ophthalmology.

I agree with Kurt. You claim to be a retina specialist, but your posts are vague about your background and training.

If you're a "retina specialist", then why are you practicing primary eye care? Why aren't you getting consults for surgical management?

I have found working with these subspecalists beneficial because not only do they co-manage, they referred me patients that needs monitoring like a person with diabetic retinopathy that does not have a primary eye care provider. This type of referral was un heard of 15 years ago, and is direct result form what we all fought for.

Being an OD in a group private practice for 19 years, and also having a chance to teach interns as an adjunct clinical professor, I commend your efforts and welcome every one of you to the Optometric profession.

You use the word "we" as you're part of optometry; however, you rarely present views that are consistent with an ophthalmologist. I met several OD-MD ophthalmologists, and none of them agree with your views presented in this forum. Are you an optometrist who went to medical school, and now practices medicine and optometry?

 

[Mirror Form]

I think everyone should note that Optometric education is at a level that allowed me to test out of many medical school classes.

haha, if you think that's possible then you obviously didn't go to medical school. It's too bad that you can't defend your views using honesty.

 

[mdkurt]

Kurt-

You statements, comments and questions exudes your arrogance and misunderstandings.

cheers-

Seriously, rpie, answer the damn questions. Don't jerk me around with optometric internship, residency, etc.

-Kurt

 

[rpie]

Seriously, rpie, answer the damn questions. Don't jerk me around with optometric internship, residency, etc.

-Kurt

By getting your ire up, I finally got you to recognize that Optometric education involves doing internships and in some case additional training in residencies and fellowship. Yes, my additional training was Optometric, and Yes I did attend medical school. The reason I attend medical school is because my main goal was to be in education. Since you and Andrew keep saying that Optometric education is deficient, the point I am making is that the basic sciences that are taught in Medicine and Optometry school are comparable. The major differences were the clinical rotations.

As far as where the end point of where Optometry wants to go, As VA Hopeful has stated, Yags, ALT, Orals and limited indictable. I believe most ODs are not interested in doing LASIK, or cataract removal.

 

[JennyW]

By getting your ire up, I finally got you to recognize that Optometric education involves doing internships and in some case additional training in residencies and fellowship. Yes, my additional training was Optometric, and Yes I did attend medical school. The reason I attend medical school is because my main goal was to be in education. Since you and Andrew keep saying that Optometric education is deficient, the point I am making is that the basic sciences that are taught in Medicine and Optometry school are comparable. The major differences were the clinical rotations.

As far as where the end point of where Optometry wants to go, As VA Hopeful has stated, Yags, ALT, Orals and limited indictable. I believe most ODs are not interested in doing LASIK, or cataract removal.

We can debate the difficulty or whether ODs should be doing YAGs and ALTs, but I would suggest that there is not much point in training ODs to do this. There just isn't enough volume for the overwhelming majority of ODs to have a laser in their office, or even to share a laser amongst a large group of ODs. I treat a reasonable amount of glaucoma for a private practice OD, and I can not remember the last time I had to refer for a PI. MAYBE one or two per year. ALT I refer for a bit more frequently, but even that is rare.

Orals and limited injectable is much more reasonable.

Jenny

 

[Andrew_Doan]

By getting your ire up, I finally got you to recognize that Optometric education involves doing internships and in some case additional training in residencies and fellowship. Yes, my additional training was Optometric...

Optometric internships = rotations as an optometry student (hardly an internship that MDs complete, but your PAC will mislead the politicians into believing that your internships are equivalent. I know this firsthand because I've spoken directly with politicians on Capital Hill.

Optometric residencies/fellowships = 1 year post-graduate experiences that do not prepare optometrists for surgical privileges. Less than 15-20% of OD grads complete these so called "residencies" and "fellowships".

We understand optometric education, but your disregard for the clinical and surgical preparation MDs must complete to be an ophthalmologist illustrates why optometrists should not be trained as surgeons. Your ideas are dangerous to the public.

 

[aphistis]

Anybody *else* smell a troll?

 

[Mirror Form]

Yes, my additional training was Optometric, and Yes I did attend medical school. The reason I attend medical school is because my main goal was to be in education.

So let me get this straight: first you went to optometry school, then you went to medical school, and then you did additional optometry training and practice now as an optometrist?

Sorry, but I find it a little hard to believe that anyone would spend the all the time, energy, and money on four years of medical school when they don't plan on using their MD degree to practice medicine. And it's not like you need an MD to teach!

And please do tell us which classes you "tested out of" in medical school? That's the part of you obviously false story that I really find amusing

 

[buckeyes 05]

So let me get this straight: first you went to optometry school, then you went to medical school, and then you did additional optometry training and practice now as an optometrist?

Sorry, but I find it a little hard to believe that anyone would spend the all the time, energy, and money on four years of medical school when they don't plan on using their MD degree to practice medicine. And it's not like you need an MD to teach!

And please do tell us which classes you "tested out of" in medical school? That's the part of you obviously false story that I really find amusing

I am a 4th year OD student at Ohio St. and I have had a couple of OD,MD profs. that did not prictice medicine.

 

[eyeguysean]

I am a 4th year OD student at Ohio St. and I have had a couple of OD,MD profs. that did not prictice medicine.

The most prominate OD, MD is Dr. Walls. He was dean of Pacific U Optom. and is now the President of So. Calif. Optom.

Just my 2 cents worth.

eyeguysean scco 06

 

[Mirror Form]

I am a 4th year OD student at Ohio St. and I have had a couple of OD,MD profs. that did not prictice medicine.

I guess it does occasionally happen, but did those profs go to medical school knowing ahead of time that they had no interest in practicing medicine and simply wanted to teach? Or did they get the MD degrees in order to help with research grants, etc?

Regardless, the story is still obviously false b/c there is no way that any normal medical school class (especially not several) could be tested out of via an optometry education. Generally you can't test out of a class for any reason. It doesn't matter if you have a phd in biochemistry, most med schools will still make you retake it.

 

[buckeyes 05]

I guess it does occasionally happen, but did those profs go to medical school knowing ahead of time that they had no interest in practicing medicine and simply wanted to teach? Or did they get the MD degrees in order to help with research grants, etc?

Regardless, the story is still obviously false b/c there is no way that any normal medical school class (especially not several) could be tested out of via an optometry education. Generally you can't test out of a class for any reason. It doesn't matter if you have a phd in biochemistry, most med schools will still make you retake it.

One of my Profs know Dr. Rpie and told me that he wanted to be in administration, and he really is an OD, MD.
GO BUCKS!

 

[Andrew_Doan]

One of my Profs know Dr. Rpie and told me that he wanted to be in administration, and he really is an OD, MD.
GO BUCKS!

But Dr. Rpie is not an optometrist AND ophthalmologist as he implied by his statement that he practices both optometry and ophthalmology.

 

[John_Doe]

Here is another of Henry signature bought by PAC money:

Henry approves optometry rule

ASSOCIATED PRESS

Updated: October 30, 2004 6:52 AM

Governor Brad Henry has signed an emergency rule that would limit what surgical procedures an optometrists can do.

Ophthalmologists, medical doctors who specialize in the eye had asked Henry to reject a rule adopted by optometry board.

That rule allowed optometrists, who aren't physicians, to cut eyelids and do other surgery.

Optometrists say the new rule only allowed them to perform procedures they have been doing for more than 20 years [so why do they need Gov Henry to approve?].

Ophthalmologists say that those procedures amounted to surgery and never had been authorized in state law.
------------------------
"Oklahoma no longer appears to be an abberation . . . . If you are not involved in the political system, it is assumed that you do not care. Bet involved with your state and national academies, or optometry will define ophthalmology." (Lanciano R, crstoday).

If you think what is happening in Oklahoma does not foreshadow what will occur in your state, then think again.

The future of ophthalmology and patient eye care is in the process of tremendous transformation. I would be concerned if I were thinking of entering this profession - and even more so if already in the early years of training/practice.

 

[Mirror Form]

One of my Profs know Dr. Rpie and told me that he wanted to be in administration, and he really is an OD, MD.
GO BUCKS!

LOL, sure he did! Funny how you don't have any other posts, kind of makes me wonder if you're not actually the same person as rpie.

 

[Mirror Form]

I am a 4th year OD student at Ohio St. and I have had a couple of OD,MD profs. that did not prictice medicine.

BTW, which professors? And just to get this right, you're claiming that they went to med school w/o any intention of practicing medicine?

 

[Andrew_Doan]

LOL, sure he did! Funny how you don't have any other posts, kind of makes me wonder if you're not actually the same person as rpie.

This is a good point. I just checked the IP addresses, and the IP addresses of RPIE and buckeyes 05 are identical. Also, their hotmail IDs are very similar.

This person goes from being an optometrist, to ophthalmologist, to "retina specialist", and now senior optometry student...

 

[aphistis]

This is a good point. I just checked the IP addresses, and the IP addresses of RPIE and buckeyes 05 are identical. Also, their hotmail IDs are very similar.

This person goes from being an optometrist, to ophthalmologist, to "retina specialist", and now senior optometry student...

Respectfully, Dr. Doan, then what's keeping you from kicking him/her off SDN? That's a bannable offense.

 

[drusso]

American Osteopathic Association Shocked by Oklahoma Governor's Approval of Optometrists Performing Surgery

CHICAGO--(BUSINESS WIRE)--Nov. 2, 2004--The American Osteopathic Association (AOA), representing more than 54,000 osteopathic physicians (D.O.s) across the United States including thousands of ophthalmologists, was shocked to learn of Oklahoma Governor Brad Henry's decision to allow optometrists to perform surgery.


"The AOA wholeheartedly disagrees with Governor Henry's approval, allowing optometrists to perform surgery," says AOA President-Elect Philip L. Shettle, D.O., a board certified ophthalmologist who has three sons - one an ophthalmologist and two optometrists. "His decision shows blatant disregard for the safety of Oklahoma residents and potentially thousands of other Americans."

In 1998, Oklahoma optometrists were granted rights to perform laser surgery which represented an increase in their scope of practice. Since 1998, Oklahoma optometrists have been taking the laser surgery one-step further and performing other surgeries including removing foreign objects from the eye without the education and training to do so.

Saturday, Governor Henry declared that he approves of optometrists performing surgery, not just laser surgery, and that it doesn't expand the scope of practice of optometrists. His decision came almost three weeks before the deadline for ruling.

"The fact that he was able to make this decision so quickly without giving it the full 45 days tells me that he didn't have time to contemplate the potential impact that his decision could have on patient safety for not only Oklahoma residents, but all Americans and U.S. veterans," adds Dr. Shettle.

According to Dr. Shettle, if one state allows this increase in the scope of practice, it has the potential to create a domino effect where other states begin to follow. In addition, this rule has implications for providing quality eye care for U.S. veterans.

"Optometrists are not licensed physicians," emphasizes Dr. Shettle. "And, surgery is a serious matter. It's more than just cutting the eye. It involves pre-operative care, anesthesiology and post-operative care. It's total quality care. Optometrists aren't trained to perform surgery or oversee these other areas of care. If something does go wrong, they aren't trained to deal with it."

Ophthalmologists complete four years of medical school, a residency and three years of surgical training. Whereas, optometrists attend four years of optometric school, but are not required to complete a surgical residency.

The AOA plans to continue to fight this scope of practice expansion to preserve patient quality care, and will work to educate patients to choose only licensed physicians when undergoing surgery.

The AOA represents the nation's more than 54,000 D.O.s, promotes public health, encourages scientific research, serves as the primary certifying body for D.O.s and is the accrediting body for all osteopathic medical schools and health care facilities.

 

[John_Doe]

Press Release Source: The American Academy of Ophthalmology


Academy Continues Fight for Patient Safety
Thursday November 4, 7:08 am ET
Implementation of Optometric Scalpel Surgery Regulation in Oklahoma Poses a Threat to Patient Surgical Care


WASHINGTON, Nov. 4 /PRNewswire/ -- Oklahoma Governor Brad Henry has signed a regulation approved by the Oklahoma Board of Examiners in Optometry on October 4, 2004, that will allow optometrists to perform surgery with a scalpel. This move makes Oklahoma the only state in the nation that allows health practitioners who are not medical or osteopathic doctors to perform delicate scalpel eye surgery.
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"The implementation of this regulation presents serious patient safety concerns and knocks Oklahoma to the bottom rung of the ladder with regards to patient quality of surgical care," said H. Dunbar Hoskins Jr., MD, American Academy of Ophthalmology executive vice president. "But the Academy and allied medical groups are more energized than ever to fight for patient safety and to stop the enactment of legislation and regulations that lower patient standards of care."

When it was discovered earlier this year that optometrists were cutting on eyelids, an opinion was requested from Oklahoma Attorney General Drew Edmondson, who confirmed that optometrists had no authority to perform these surgeries. The optometrists quickly returned to the Oklahoma legislature to get approval to perform scalpel surgery on the eye. The Board of Examiners of Optometry followed by approving controversial regulations defining surgical procedures that may be performed by optometrists that go far beyond the limits established by Attorney General Edmondson's opinion.

The regulation was sent to the governor for his signature after an October 4 hearing, where the Academy and its medical allies testified in objection to the regulation. The optometry board, as expected, rejected the Academy's concerns and adopted the rule.

"The governor's decision ignites the Academy's determination to inform the public, lawmakers and government leaders about what this regulation really means," said Ann Warn, MD, president of the Oklahoma Academy of Ophthalmology. "Unknowing consumers will now be placed in a situation to have delicate surgical procedures performed on their eyes by people who have not graduated from a four-year medical or osteopathic training program, have not completed a one-year hospital internship, and have not completed a three-year hospital residency program studying diseases of the eye and advanced surgical training.
*******This regulation will allow non-surgeons to perform more than 100 types of surgeries, to use a scalpel to cut the eyelid to remove skin cancer lesions, to cut the eye surface to remove cancer lesions, to stick a needle into the center of the eyeball to inject medication, and to inject Botox around the eye." *********

"It's a question of patient care," added Cynthia Bradford, MD, Academy secretary for state affairs. "Surgery should only be performed by medical or osteopathic surgeons. Education and training do make a difference. If surgery were simple, anyone could do it. The education and training required to become a surgeon can't be ignored without potentially serious negative ramifications for patients."

The Academy will continue to work with its medical allies to fight the implementation of this optometric regulation that allows surgery with scalpels and poses such a serious patient safety risk to Oklahoma citizens.

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.

 

[Andrew_Doan]

Oklahoma Governor Brad Henry Signs Optometric Scalpel Surgery Regulation

On October 29, Oklahoma Governor Brad Henry signed the Oklahoma Board of Examiners in Optometry?s recently approved regulation that will allow optometrists to perform lid and eye surgery using a scalpel. The regulation was sent to the governor for his signature after its approval on October 4, 2004. Ophthalmology testified during the hearing in opposition to the proposal and held a press conference the next morning condemning the regulation. In addition, a statewide radio news story and a TV ad were run, calling on the citizens of Oklahoma to call the governor. ASCRS joined with the AAO, the AMA and other physician organizations in calling on the governor to reject it and will continue to work with them to fight its implementation.

The language of the regulation is confusing because it primarily makes the statement in terms of exclusion and exception. Therefore, careful review is required to interpret its outline of optometric scope of practice. Some surgical procedures are specifically not allowed (such as current method utilized for cataract extraction). However, many surgical procedures, as well as injections, are allowed, including:

Laser Surgery
Laser capsulotomy
Laser iridotomy
Laser trabeculoplasty
Photorefractive keratectomy (PRK)
Phototherapeutic keratectomy (PTK)
LASEK (LASIK is excluded)
Laser ablation of vitreous strand

Incisional Surgery
Radial keratotomy
Astigmatic keratotomy
Pterygium excision without graft or flap
Chalazion incision and drainage
Entropion repair
Ectropion repair
Anterior chamber paracentesis for emergency IOP reduction

Injection Procedures
Periocular (no limitation as to drug type)
Intraocular (no limitation as to drug type)

Other Surgery
Retinal detachment repair by
scleral buckle,
injection of air, gas, or other substance

There is no exclusion for cataract removal by laser technology in the future.
NOTE: A one-word change in the Oklahoma guidelines to remove ?retinal? exceptions to laser procedures would allow PRP, focal laser, and PDT.

 

[David Zumbro]

I have lived and practiced Ophthalmology at a military base in Oklahoma. I can't believe that we are even having this debate. A apprentice pathway already exists for people to develop surgical skills. Go to med school and do a residency. There is nothing good that will come of this.

 

[powermd]

Since you and Andrew keep saying that Optometric education is deficient, the point I am making is that the basic sciences that are taught in Medicine and Optometry school are comparable. The major differences were the clinical rotations.

From what I know based on my sister's experience at NECO, the basic sciences, in terms of content and rigor, are not even remotely comparable to my experience in med school. The caliber of students in her class is not comparable to any med school class. There are some bright students who would likely succeed in med school, but not many. Nationally, less than 70% pass the optometry boards on their first attempt. The clinical rotations you speak of, at least at NECO, are a frightening joke. In the third year, students are seeing one or two patients per day in clinic- some see more, but this is typical. This educational program is not set up well enough to prepare graduates for anything more extensive than refraction, health screening, and prescribing for conjunctivits. 'Activist' optomotrists should back down and accept that the current educational standards in their profession are not sufficiently high to warrant expanding their scope of practice, and they endanger the public by pressing for this.

One more thing (for the MDs): who is going to train optometrists to perform invasive surgical/laser procedures, if not ophthalmologists?

 

[UABopt]

From what I know based on my sister's experience at NECO, the basic sciences, in terms of content and rigor, are not even remotely comparable to my experience in med school. The caliber of students in her class is not comparable to any med school class. There are some bright students who would likely succeed in med school, but not many. Nationally, less than 70% pass the optometry boards on their first attempt. The clinical rotations you speak of, at least at NECO, are a frightening joke.

POWERMD-

Perhaps the only way that you can feel good about yourself is to denigrate, belittle or otherwise speak ill of the accomplishments of others. You should in fact look at your own accomplishments, and be able to take pride in them because of their own inherent merit.
Having neither applied to, nor attended medical school, I cannot vouch for the quality of the medical school didactic, nor can I attest to its difficulty. There most certainly are differences between medical schools, as well as medical students, just as there are differences in optometry schools and variations in the quality of optometry students. Because of these inherent variations, I do not like to speak in generalities, but for the sake of argument, in this case I will.
Being an optometry student from UAB, I can most certainly say that the average optometry student (here at UAB) is quite well qualified, and I am very confident in their abilities as students. With an average undergraduate GPA of 3.66, above the combined average GPA of accepted allopathic medical school applicants of 3.62 (AMCAS 2003 figures http://www.aamc.org/data/facts/2003/2003mcatgpa.htm), I am quite sure that ANY of my classmates at UAB could have been both accepted and quite successful in medical school.
The point is we are not optometry school students because we are medical school rejects, but rather, we are optometry school students because we wanted to be optometry school students. I am quite certain that medical school was and still is quite difficult (if it is that much more difficult than optometry school, then you must have had more hours in a day than I do), but that, in and of itself, does not mean that an optometric education is poor or inadequate.