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

[JennyW]

Nationally, less than 70% pass the optometry boards on their first attempt.

That is not true.

Less than 70% pass PART 1 on their first attempt. But greater than 90% pass part II and part III on their first attempt.

http://www.optometry.org

Jenny

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[powermd]

Thank you for this important clarification. I only intend to convey that <70% pass PART ONE of the optometry boards on the first try. Why is that not close to 100%? 98% of my med school class passed usmle step 1 on their first try. I don't think anyone has ever argued that step 1 is easy to pass. Maybe med students are a bit more serious about what they do than optometry students, as a group.

 

[powermd]

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.

Perhaps, but whatever. I have denigrated, belittled, and spoken ill of no one. I'm just calling it as I see it. I posted facts. What more do you want?

You should in fact look at your own accomplishments, and be able to take pride in them because of their own inherent merit.

I do.

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.

Actually, you might be surprised to hear that med students are very homogenous. The caliber of students, their accomplishments, and the quality of education at their respective med schools are remarkably similar. This comes from 1) the extraordinary competition for enterance to med school, and 2) very careful oversight by the LCME, which enforces very high standards across all US med schools.

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.

But with no experience attending med school, you have no basis for comparison. Except what you post below.. which I will address now.

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.

I guess you must be right then, I mean, with a comparable, or increased average accepted GPA than med school matriculants, optometry students must be AS GOOD AS, OR BETTER QUALIFIED THAN MED SCHOOL APPLICANTS, right? (sarcasm alert for the impaired). Are there no other confounding variables here? Hmmm.. like where those matriculants attended undergrad? The rigor of the curriculum? Achieving a high score on the MCAT? (which optometry applicants don't take) Research publications and experience? Personal talents?
Finally, since you have no experience with med school, how can you possibly attest that you and your classmates would have been accepted, or had success with the curriculum? You can't, because you don't.

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.

Finally we agree on something. Very few of my sister's classmates have a desire for the heavy resposibility that medicine entails. Most are very happy with the lifestyle and limited responsibility optometry permits compared to medicine. I never intended to imply that optometry students are med school rejects, rather, they self-select themselves OUT of the med school admission process because they simply don't want to do it.

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.

It's fine if all you ever want to do is refract, do health screening, and manage uncomplicated eye problems. The moment you start talking about prescribing systemic drugs and doing invasive procedures is when I start to question the adequacy of your training. Based on what I've seen so far of the curriculum at NECO, I am not impressed. They need way more clinical experience than they're getting, if only to practice basic optometry well, let alone expand their practice options.

Just so you are aware, I'm not going out of my way to make you feel bad. This is a perpetual problem in health sciences- less trained, less qualified practitioners/students often fail to see the limitations on them that more highly trained, more qualified practitioners see. Critical care nurses, CRNAs, and PAs/NPs sometimes think they are as qualified as doctors, yet every single time someone here on the forums who has done the training for BOTH careers posts their opinion, it always confirms that the less trained practitioners have no idea how much more education and experience physicians have. The poster usually talks about how blown away they were when they found out just how much they didn't learn about in training for their first career. I suspect if you switched over to med school, you would be similarly surprised just how much more there is to know than they teach you in optometry school. That's not a diss, I've seen the exams at NECO, I've seen the curriculum. It doesn't even come close.

 

[JennyW]

Thank you for this important clarification. I only intend to convey that <70% pass PART ONE of the optometry boards on the first try. Why is that not close to 100%? 98% of my med school class passed usmle step 1 on their first try. I don't think anyone has ever argued that step 1 is easy to pass. Maybe med students are a bit more serious about what they do than optometry students, as a group.

In a nutshell, geometric and physical optics. Part I is the hardest part of the 3.

Jenny

 

[UABopt]

POWERMD-

I am not in the mood to argue, besides no matter what you say and no matter what I say; neither is going to convince the other to adopt the opposing opinion. What the heck I?ll offer a rebuttal anyhow.

The first thing I would like to say is that there are most definitely huge differences between a medical education and an optometric education, but not in a bad way. The training of O.D?s and M.D?s is different just as the training of a D.D.S. is different from an M.D as well they should be. An M.D?s 3-5 years of residency gives them 3-5 years more formal training than an optometrist, I most definitely do not want to denigrate that. I applaud M.D?s and their will to go on after medical school is over to a rigorous residency (The husband of one of my classmates is a resident, so I have some tiny inkling of a clue as to just how ridiculously rigorous they really are). My main reason for writing this response is simply to try to set the record straight. This may not apply to you powermd, but I have spoken to several medical students who did not even know how long optometry school was, let alone our curriculum.

You are right, GPA is not the only measure of a student, but it is the only measure that can be compared easily, by that I mean quantitatively rather than qualitatively. I can assure you though, that optometry students (here at UAB) do not simply complete a BS at a community college and gain acceptance to the program because of their great GPA, as you imply. We graduated from undergraduate schools including Brigham Young, The University of Florida, The University of Georgia, Auburn University, The University of Alabama (the schools you would expect here in the south) among many, many, others and took undergraduate classes with tons of premeds. Yes perhaps even you sat next to a future optometry student in your Organic Chemistry, Biology, Biochemistry, or Cellular Biology class. The fact is, the admittance requirements as far as undergraduate coursework is concerned, is essentially identical for Optometry School, Dental School and Medical school, so it was not an inappropriate comparison. In addition, we all did things, including community service, and research beyond the classroom. As to whether or not I would have gotten into medical school, I never applied so I will never know for sure, but I have several friends who did with very similar academic and extracurricular records as I, and they were accepted. That though, is of course completely irrelevant, as I did not want to go to medical school.

Give me a break about there not being variations in the quality of medical students. Not everybody is the same, I am sure your class had gunners. Don?t all classes have gunners? You are trying to tell me that University of Missouri at Kansas City, or Howard Medical schools student bodies are just as well qualified (only in terms of numbers of course i.e. GPA and MCAT) as students at Harvard, Yale, or Johns Hopkins University? Not to say that any of these schools could not, and do not produce excellent Doctors because I am sure they do, numbers alone do not make doctors. But, there certainly is some difference between an average GPA of 3.0 and an average of 3.7, at least in my opinion.


As far as coursework is concerned, I cannot speak for NewEnCo, but UAB is in a unique situation, we have a medical school, an optometry school, and a dental school. Optometry students take some courses, including med neuro and histology, among others, with either medical students or dental students or both. That is right optometry students sit in the very same classroom with the very same professors and take the very same tests as medical students, as shocking as that might sound. So while you may have not taken any optometry school courses, we have taken medical school courses.

 

[Andrew_Doan]

We all agree that optometry education is different and serves a purpose that is different than medical education leading to the training of an ophthalmologist.

For the most part, we also agree that optometry students pick their career path because they enjoy the life-style and responsibilites associated with being an optometrist.

However, we seem to ignore that optometry education does not prepare students to do these procedures:

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

I agree optometrists serve society well in their current capacity. There is a great need for doctors of optometry to refract, examine, screen, diagnose, and treat common ophthalmic diseases medically. However, legislating for increased surgical scope of practice, like your colleagues in Oklahoma, will be destructive to your profession, careers, and life-styles. Seriously think about where your optometric leaders are taking your field. Some in the optometry forum have complained about 'malpractice'; although, the average optometrist pays a cheap premium of ~$400/year for a $2 million dollar policy. Wait until you must fork over $20,000 for malpractice insurance.

Regardless, the current state of optometric education is far from being adequate to allow optometrists to perform any of the listed procedures approved in Oklahoma. How many optometrists would have one of their colleagues remove their pterygium, perform intravitreal injections, or radial keratotomy? Like David Zumbro stated above, nothing good will come of this.

 

[JennyW]

However, we seem to ignore that optometry education does not prepare students to do these procedures:

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

Regardless, the current state of optometric education is far from being adequate to allow optometrists to perform any of the listed procedures approved in Oklahoma. How many optometrists would have one of their colleagues remove their pterygium, perform intravitreal injections, or radial keratotomy? Like David Zumbro stated above, nothing good will come of this.

I would agree with your concerns about every procedure listed with the exception of chalazion removal and laser iridotomy.

But again, I think you are making much ado about nothing. Are there ODs doing scleral buckles?

We've discused this before. A medical license is carte blanche to do any procedure that you want to do. Orthopedic surgeons are licensed to perform heart trasplants. Does that mean that they run around doing them? Of course not! Simply because one is licensed to do a procedure doesn't mean that every OD is going to run around and start doing them on unsuspecting Okies.

Jenny

 

[Tony.]

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?

powermd,
please dont bash my school (NECO). I work very hard here and its my first year. I love my classmates and my professors........
I still stay in touch with my friends that have gone to medical school and dental school...we stay in touch and share our experiences in our school......
my friend in med school (he's in Tuffts now) he tells me how much he loves his class and i tell him how much i love mine.......
please dont start making divisions by calling my schools program a 'frightening joke'.....it doesnt help anything ok. I know you understand, just wanted to tell you....
Since its my first year in opt. school, I cant respond to most of your concerns ......but, just realize, please, that this forum is for DISCUSSIONS, questions and answers....not bashing my school......ok.

be good...
Tony

 

[UABopt]

We all agree that optometry education is different and serves a purpose that is different than medical education leading to the training of an ophthalmologist.

For the most part, we also agree that optometry students pick their career path because they enjoy the life-style and responsibilites associated with being an optometrist.

However, we seem to ignore that optometry education does not prepare students to do these procedures:

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

I agree optometrists serve society well in their current capacity. There is a great need for doctors of optometry to refract, examine, screen, diagnose, and treat common ophthalmic diseases medically. However, legislating for increased surgical scope of practice, like your colleagues in Oklahoma, will be destructive to your profession, careers, and life-styles. Seriously think about where your optometric leaders are taking your field. Some in the optometry forum have complained about 'malpractice'; although, the average optometrist pays a cheap premium of ~$400/year for a $2 million dollar policy. Wait until you must fork over $20,000 for malpractice insurance.

Regardless, the current state of optometric education is far from being adequate to allow optometrists to perform any of the listed procedures approved in Oklahoma. How many optometrists would have one of their colleagues remove their pterygium, perform intravitreal injections, or radial keratotomy? Like David Zumbro stated above, nothing good will come of this.

While I certainly do understand why a physician would be concerned about a broad legislative expansion to the scope of optometric practice, both from a personal-economic standpoint (intrusion of another practitioner on a former monopoly held by MDs), and also from the standpoint of patient safety. I still have to agree with Jenny, wholeheartedly. MD's should also be able to step back and look at things from the perspective of an optometrist. Optometrists live everyday knowing that they have dedicated much of themselves to a profession, that if many OMDs had their way, would at very worst be legislated out of existence or, at very best, not be able to evolve freely as most other professions do, and possilby die as a result.

I think that everybody would agree that the practice of eye care, like much of medicine is, to an extraordinary extent, driven by advances in technology. As technology changes so do the standards. Eye care today is certainly not identical to eye care in 1950, and the eye care provided in 1950 was not the same as that provided in 1900. It is in fact my opinion that changes in technology move at an exponential pace.

As such, 50 years ago, a limited scope of practice for optometry was okay. But today, while I certainly cannot speak for the profession as a whole, I feel that it is unreasonable for our profession to have to ask the legislature for permission to perform each and every single new procedure, or use a new technology, especially when such advances are being made at an ever increasing pace.

Like it or not legislatures are filled with politicians, who I would venture to say, in general, know very little about eye care. I would like to think that Optometrists, after 8 years of post-graduate education know enough, to know the extent of their abilities (they certainly know more about their own abilities than the legislature does).

It is thus, in my opinion, reasonable to allow optometrists and the optometric profession to regulate itself to a certain extent, just as MD's and Dentists regulate themselves. It makes more sense today to regulate the optometric scope of practice, at the legislative level, with exclusions to scope, rather than inclusions.


I find no merit in the argument that optometrists would be reckless. I think we all know our limitations, and hope that we would never ever step beyond those limitations, especially at the risk of patient safety. If an optometrist did not know his or her own limitations his licence to practice should be revoked just like any other practitioner. I think that the will of optometry to change the language of the law especially with respect to Oklahoma but indeed in all states, is more a derivative of a wish to insure the future of optometry. The will of optometry is the inclusion of future procedures yet to even be conceived, that would, hypothetically, fall within the optometric scope. To believe optometrists want to transform themselves into surgeons and take over the field of opthalmology is a bit of a stretch. In fact most of us picked optometry for that very reason, we had no desire to perform surgery. Optometry by definition, and historically is a nonsurgical field (but then again so was "medicine" in its infancy when "surgeons" performed surgery), the very debate lies in the manner in which "surgery" is defined.

 

[Mirror Form]

I find no merit in the argument that optometrists would be reckless. I think we all know our limitations, and hope that we would never ever step beyond those limitations, especially at the risk of patient safety. If an optometrist did not know his or her own limitations his licence to practice should be revoked just like any other practitioner. I think that the will of optometry to change the language of the law especially with respect to Oklahoma but indeed in all states, is more a derivative of a wish to insure the future of optometry. The will of optometry is the inclusion of future procedures yet to even be conceived, that would, hypothetically, fall within the optometric scope. To believe optometrists want to transform themselves into surgeons and take over the field of opthalmology is a bit of a stretch. In fact most of us picked optometry for that very reason, we had no desire to perform surgery. Optometry by definition, and historically is a nonsurgical field (but then again so was "medicine" in its infancy when "surgeons" performed surgery), the very debate lies in the manner in which "surgery" is defined.

Thank you for contributing to the debate in a professional fashion. I disagree with the above paragraph though. While most optometrists will not perform recklessly, there definitely are some that are willing to for a higher income. It's not just optometrists either. For example, there are some ophthalmology trained occuloplastic surgeons that have been doing full face lifts, and occasionally even breast augmentation. Most ophthalmologists look down on this as going beyond our scope. However, I doubt we'll ever totally police our own. That battle would have to be fought by the plastic surgeons. Similarly, if some optometrists decide they want to practice beyond their scope as full surgeons, the only people who are going to stop them are ophthalmologists, not other optometrists.

 

[Richard_Hom]

Thank you for contributing to the debate in a professional fashion. I disagree with the above paragraph though. While most optometrists will not perform recklessly, there definitely are some that are willing to for a higher income..."

Dear Sledge2005,

Your thoughts are generally relevant on "higher income" but I believe that the ROI (just from hard dollars) would hardly encourage most (99% IMHO) to even invest in an outpatient surgical environment necessary to perform these procedures.

Therefore, it may appear to be simplistic to assume that optometrists interested in surgery would do so with that in mind. In other words "the planets have to line up" generally to even enable any optometrist to profit from this.

However, I wish not to debate on whether or not optometrists should or should not have surgical privilege by legislative decrees. I'm only commenting on the "motive" or stimuli for doing so which you had presented.

Richard Hom,OD,FAAO
San Mateo, CA

 

[powermd]

powermd,
please dont bash my school (NECO). I work very hard here and its my first year. I love my classmates and my professors........
I still stay in touch with my friends that have gone to medical school and dental school...we stay in touch and share our experiences in our school......
my friend in med school (he's in Tuffts now) he tells me how much he loves his class and i tell him how much i love mine.......
please dont start making divisions by calling my schools program a 'frightening joke'.....it doesnt help anything ok. I know you understand, just wanted to tell you....
Since its my first year in opt. school, I cant respond to most of your concerns ......but, just realize, please, that this forum is for DISCUSSIONS, questions and answers....not bashing my school......ok.

be good...
Tony

Tony,
Ask the third year students at your school how many patients they are seeing in clinic on a typical day. Some students will see 5 patients, but most are seeing 1-2 per day. On a typical day when I rotated through ophthalmology in my fourth year of med school, I was seeing 10-15 patients per day, five days per week, and that was with an easy 9am-2pm schedule. Ask your administration why they don't have enough good clinical sites where students can see a reasonable number of patients.

As for the pre-clinical stuff you will do- it's not nearly as rigorous as med school. Come to think of it, neither is the clinical work. That's not bashing. It's simply true. Optometrists are trying to move in on MD territory blind to what they didn't learn by not going to medical school, and not doing a full medical residency. That is why we are having this discussion. It's not about bashing optometry schools. If optometrists would stick to what they're good at, and leave medicine/surgery to the MDs, I wouldn't be writing this post.

 

[Andrew_Doan]

We've discused this before. A medical license is carte blanche to do any procedure that you want to do. Orthopedic surgeons are licensed to perform heart trasplants. Does that mean that they run around doing them? Of course not! Simply because one is licensed to do a procedure doesn't mean that every OD is going to run around and start doing them on unsuspecting Okies.

Jenny,

If optometrists want a "carte blanche" medical license, then optometrists should have a broad medical AND surgical education. Unfortunately, your argument for a carte blanche optometry license is ridiculous when your training entails ZERO surgical training.

O.D. does not equate to M.D. I know it's difficult to accept.

Remember, orthopedic and ophthalmic surgeons complete an intensive surgical and medical internship and residency to prepare them for surgical management of patients; thus, society can trust these surgeons with a carte blanche license.

 

[aphistis]

Remember, orthopedic and ophthalmic surgeons complete an intensive surgical and medical internship and residency to prepare them for surgical management of patients; thus, society can trust these surgeons with a carte blanche license.

I hope I'm just intercepting a potential point of confusion, but this reads as though you're suggesting an orthopod could knock out a few PRK's, or that you'd be up to doing a hip reconstruction if nobody else was in the break room.

 

[Andrew_Doan]

"Remember, orthopedic and ophthalmic surgeons complete an intensive surgical and medical internship and residency to prepare them for surgical management of patients; thus, society can trust these surgeons with a carte blanche license."

I hope I'm just intercepting a potential point of confusion, but this reads as though you're suggesting an orthopod could knock out a few PRK's, or that you'd be up to doing a hip reconstruction if nobody else was in the break room.

No, I'm not suggesting that. Because we are trained as surgeons, ophthalmologists know enough to be careful, and we can judge what is surgically appropriate based on our training. Thus, society can trust us to regulate ourselves.

However, optometry, without the surgical training and education, cannot argue for self-regulation of surgical procedures and a "carte blanche" license.

 

[Mirror Form]

Dear Sledge2005,

Your thoughts are generally relevant on "higher income" but I believe that the ROI (just from hard dollars) would hardly encourage most (99% IMHO) to even invest in an outpatient surgical environment necessary to perform these procedures.

Therefore, it may appear to be simplistic to assume that optometrists interested in surgery would do so with that in mind. In other words "the planets have to line up" generally to even enable any optometrist to profit from this.

However, I wish not to debate on whether or not optometrists should or should not have surgical privilege by legislative decrees. I'm only commenting on the "motive" or stimuli for doing so which you had presented.

Richard Hom,OD,FAAO
San Mateo, CA

I strongly disagree. Many groups of optometrists could easily make the investment and would subsequently get a great return (in terms of profit). Also, there are actually optometrist owned surgical centers already! For example, when I rotated in San Antonio this summer, some of the ophthalmologists used to moonlight at a LASIK center owned by optometrists. The optometrists would do most of the pre-op and post-op care, and they'd pay the ophthalmologists to come in and do the surgeries. It's easy to see that they would stand to profit immensely from gaining surgical rights.

 

[VA Hopeful Dr]

I don't think anyone is equating ODs with MDs with the a few general exceptions (both have basic science classes in their respective professional schools, but have some form of clinical time while in school, and so on). I also think we can all agree that most of this debating going on is a result of this OK legislation. Nothing new so far. Now, regretfully, I don't have a source to cite for this, but I had heard that Gov. Henry of OK agreed to sign the bill merely to ensure that ODs in the state did not lose any of the rights they already had. If anyone can find a source (not MD or OD) that confirms/contradicts this, please let me know. At any rate, even ignoring that, I'm not sure all of this is as serious as its made out to be.

First, as Dr. Hom said, many of the procedures Dr. Doan listed require some type of surgical center. So ODs would have to either build their own or get privileges at an existing center. Dr. Hom addressed the problems with an OD owning his/her own center, so I won't discuss that further. Now I'll admit that I don't know much about how ambulatory centers or hospitals grant privileges nor what kind of records they require for each surgery, but I'd be willing to bet that any OD wanting to do scleral buckles would have a fairly difficult time finding a place to do them. I hope this in itself would be a fair hinderance on any ODs wishing to work outside their scope (which for the case in OK will include what laser surgery they obtained in the early 90s).

Second, as was stated earlier also, I tend to think that most ODs have little to no interest in doing any procedures more involved than punctal plugs, foreign bodies, and possibly YAGs/ALTs and the like. There will always be doctors in various fields who want to go beyond their training and ODs are no different. However, once they get into more complex procedures (read: anything much past what I mentioned three lines up) I suspect you'll see an increase in poor outcomes from these procedures. I like to think that a drastic increase like that would discourage OK ODs from abusing the current wording in the law, and it would certainly give MDs something to take to the governor and encourage him to make changes in the scope of practice.

That all said, I have an idea. Rather than foretell the doom of our time, it might make sense to just keep a very close eye on any ODs who do surgery. If ODs are observed to have fouled up a significant number of surgeries, you'd have a much better chance, politically, of making the laws more restrictive. Its a bit reactionary, but I suspect it would work far better than fighting ODs as MDs have been doing (seeing as its really not working right now). Just my thoughts, to which I'm sure I'll get lots of "I disagrees" and "You're wrongs". Maybe we'll get some interesting discussion at least.

As a side note, Dr. Doan: you mentioned the possibility of lasers being used in cataract surgery, is this something actually being researched? If so, explain? Thanks in advance.

 

[mdkurt]

Because we are trained as surgeons, ophthalmologists know enough to be careful, and we can judge what is surgically appropriate based on our training. Thus, society can trust us to regulate ourselves.

However, optometry, without the surgical training and education, cannot argue for self-regulation of surgical procedures and a "carte blanche" license.

I think that an important point to make is that yes, an MD is a carte blanche license. I could probably walk into an OR tomorrow and take out someone's appendix. I would probably even do a decent job. I wouldn't, however, because I am able to self-regulate myself. Not every MD can, so we rely on the community standard. Every MD knows that if he or she is working outside the community standard, any complication is indefensible.

What optometry is attempting to do is legislate a new community standard. This standard isn't based on training, and it's wrong.

 

[JennyW]

Jenny,

If optometrists want a "carte blanche" medical license, then optometrists should have a broad medical AND surgical education. Unfortunately, your argument for a carte blanche optometry license is ridiculous when your training entails ZERO surgical training.

O.D. does not equate to M.D. I know it's difficult to accept.

Remember, orthopedic and ophthalmic surgeons complete an intensive surgical and medical internship and residency to prepare them for surgical management of patients; thus, society can trust these surgeons with a carte blanche license.

No. I did not say that optometrists wanted a carte blanche license, and I was not arguing for one.

The point that I was making was that MDs DO have a carte blanche license, but most of them know what they can handle. What makes you think that ODs would be any different, even if this law in OK were to hypothetically allow scleral buckles? Do you really think that ODs would immediately start doing them?

Jenny

 

[Microdish]

POWERMD-

I can assure you though, that optometry students (here at UAB) do not simply complete a BS at a community college and gain acceptance to the program because of their great GPA, as you imply. We graduated from undergraduate schools including Brigham Young, The University of Florida, The University of Georgia, Auburn University, The University of Alabama (the schools you would expect here in the south) among many, many, others and took undergraduate classes with tons of premeds.


I do not mean to bash the merits of optometry as a profession (in fact, I have suggested it to high school friends who I respect)...but I would assert that at my very selective undergraduate school you would have been laughed off campus if you stated that you wanted to go into optometry and it was the same as med school. (In fact, I know no one who ever decided to do optometry) Not because it wasn't a worthwhile career, but because it is very different, in terms of knowledge base, assumption of risk, training and expectations. What does that mean? That people select themselves for different careers because they ARE different, and we should not treat them as the same thing.

 

[chaldobruin]

As a Pre-Optometry student, I just want to say that the legislation in OK does not represent the majority of optometrists. I, like many other people, am choosing optometry because of the lifestyle and the freedom from having to do delicate surgeries. The comfortable, non-hospital setting, the flexible hours, and easy lifestyle is the basis of why I chose the profession. I have worked for 3 different optometrists who feel the same way. If we wanted to do surgeries we would have attended medical school and gotten the proper training that comes along with it. Don't hate all optometrists just because of this. I assure you that there is no way optometrists will be able to do surgeries in the future, the OK legislation is just a loophole in the system. It has to do with the shortage of ophthalmalogists in rural areas, and it is highly unlikely that it will spread to other states. Your jobs are safe, stop worrying. Stop bashing optometry...saying that medical school is so much "harder" blah blah is so irrelevant to anything. Ophthalmalogists such as yourselves have much more training, your services are more valuable and therefore you make more money. We should be working together to serve the needs of our patients. We are allies.

 

[Andrew_Doan]

As a Pre-Optometry student, I just want to say that the legislation in OK does not represent the majority of optometrists. I, like many other people, am choosing optometry because of the lifestyle and the freedom from having to do delicate surgeries. The comfortable, non-hospital setting, the flexible hours, and easy lifestyle is the basis of why I chose the profession. I have worked for 3 different optometrists who feel the same way. If we wanted to do surgeries we would have attended medical school and gotten the proper training that comes along with it. Don't hate all optometrists just because of this. I assure you that there is no way optometrists will be able to do surgeries in the future, the OK legislation is just a loophole in the system. It has to do with the shortage of ophthalmalogists in rural areas, and it is highly unlikely that it will spread to other states. Your jobs are safe, stop worrying. Stop bashing optometry...saying that medical school is so much "harder" blah blah is so irrelevant to anything. Ophthalmalogists such as yourselves have much more training, your services are more valuable and therefore you make more money. We should be working together to serve the needs of our patients. We are allies.

I agree with the above. We should stop OD bashing. However, we do need to discuss the merits of the recent OK legislation and why optometry is NOT qualified to perform surgery or have a law stating they can do surgery. This "loophole" in the system is dangerous. It may not spread to other states now, but as I know from experience, it WILL spread in the future. My job is safe. I'm going to be an ocular pathologist. Someone will need my services. On the other hand, I'm looking out for the next generation of general ophthalmologists, patients' safety, and the integrity of my profession for the future.

VA Hopeful DR, the mention of lasers was in the ASCRS news release. Look at the abstract below.

Jenny, I don't think non-surgeons can regulate themselves in regards to surgical procedures. The answer to your question is NO. The less one knows, the more likely s/he will do more. Just watch a 15 minute cataract surgery video. It looks "so easy"; however, this deceivingly "easy" surgery can be a nightmare in less than a second!

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15056067

J Long Term Eff Med Implants. 2003;13(6):503-8.

Erbium:YAG laser in cataract extraction.

Bowman DM, Allen RC.

Virginia Commonwealth University School of Medicine, Department of Ophthalmology, Richmond, Virginia 23298, USA.

Erbium:yttrium-aluminum-garnet (Er:YAG) cataract extraction has shown considerable promise as a new technique for lens nucleus removal prior to intraocular lens (IOL) implantation for the treatment of cataracts. Recent studies suggest that the laser energy is dissipated much more locally and heats surrounding intraocular tissues less than traditional ultrasonic phacoemulsification does. Clinical studies demonstrate the safety of the procedure in human cataract patients, and a randomized study found little difference in outcomes when compared to conventional cataract surgery. Further advances in fiber optic delivery systems and handpiece development may make this approach even more attractive in the future.

Do you really think that ODs would immediately start doing them?

Yes. ODs would set up weekend "wet labs" and then certify others for specific procedures. Many argue that MDs do the same when new surgical procedures become available. However, the major difference is that ophthalmologists are trained surgeons with years and often decades of experience with surgical techniques. Surgery is similar to learning how to master a sport or martial arts. You learn basic moves that will lead to learning more advanced moves. Once the fundamental skills are mastered, then the athlete can learn new techniques with ease, for instance, with a weekend seminar. On the other hand, non-surgeons being certified with weekend courses is a frightening thought.

One more thing, it's disturbing when I think about the current poll. Many of you state openly that "ODs aren't interested in surgery b/c ODs picked optometry for the life-style and numerous reasons that medicine can't offer". However, based on this poll, 5 oppose surgical rights and 16 approve of surgical rights.

 

[kelly punch]

POWERMD-
As far as coursework is concerned, I cannot speak for NewEnCo, but UAB is in a unique situation, we have a medical school, an optometry school, and a dental school. Optometry students take some courses, including med neuro and histology, among others, with either medical students or dental students or both. That is right optometry students sit in the very same classroom with the very same professors and take the very same tests as medical students, as shocking as that might sound. So while you may have not taken any optometry school courses, we have taken medical school courses.

Having attented UAB medical school and taken neuroanatomy and phys with optometry students, I can attest to the overall quality of their student body. Almost all were amiable and intelligent. The major difference I noted was that even in one of the most demanding courses during the preclinical years, I rarely saw more than two or three optometry students outside of class in the frequent review sessions, study groups, labs, or library. There was a definate disconnect between the two groups in the time spent after hours learning the material for neuro. Our coursemaster commented on this several times, and it was reflected in the breakdown of course grades with many more failing scores.

My impression was that (in general) the medical students were intent on mastering the material, were more self motivated, and seemed to enjoy the process. The optometry students, although very nice and smart people, were percieved as merely wanting to survive the course. (And there were no optoms in histology or other classes for comparison at UAB.) Our neuro class had the lowest composite class average of any in the preclinical years as a result. One optom student (out of 40+) showed up for the coursemaster's party after the final.

When I begin my ophthalmology residency in 2005 I will again have the oportunity to work alongsite some optometry students and professors, most notably at the VA. I'm hoping that my past perceptions are proven wrong, although the recent surge of optometry belligerence my not make the environment warmer and fuzzier.

UAB Medical School
Baptist Health Sytems Transitional Internship
Univeristy of Tennessee Memphis Ophthalmology

 

[MS3NavyFS2B]

As a Pre-Optometry student, I just want to say that the legislation in OK does not represent the majority of optometrists. I, like many other people, am choosing optometry because of the lifestyle and the freedom from having to do delicate surgeries. The comfortable, non-hospital setting, the flexible hours, and easy lifestyle is the basis of why I chose the profession. I have worked for 3 different optometrists who feel the same way. If we wanted to do surgeries we would have attended medical school and gotten the proper training that comes along with it. Don't hate all optometrists just because of this. I assure you that there is no way optometrists will be able to do surgeries in the future, the OK legislation is just a loophole in the system. It has to do with the shortage of ophthalmalogists in rural areas, and it is highly unlikely that it will spread to other states. Your jobs are safe, stop worrying. Stop bashing optometry...saying that medical school is so much "harder" blah blah is so irrelevant to anything. Ophthalmalogists such as yourselves have much more training, your services are more valuable and therefore you make more money. We should be working together to serve the needs of our patients. We are allies.

Why do so many pre-meds magically change to pre-dental, pre-opt, pre-podiatry, and pre-[insert non-medical field]?

 

[mdkurt]

Why do so many pre-meds magically change to pre-dental, pre-opt, pre-podiatry, and pre-[insert non-medical field]?

I think very few ODs started out wanting to be MDs. It's a distinctly different career path, and most of the OD students I have met chose their profession for all the reasons chaldobruin highlighted.

 

[MS3NavyFS2B]

I think very few ODs started out wanting to be MDs. It's a distinctly different career path, and most of the OD students I have met chose their profession for all the reasons chaldobruin highlighted.

"very few"...I really don't think so. The ancillary reasons may have been blah blah blah above, but the primary reason--from my experience--was that they, for whatever reason (lack of academic accomplishments or intellectual prowess), were freshman pre-meds in college leading to pre-whatever come the second and third year.

I can't see anyone wanted to check visual acuity forever, with minimal renumeration, notwithstanding the so-called "great hours."

Don't get me wrong, however: Ophthalomogists need opts (because they don't need to check visual acuity all day), orthopaedists need podiatrists (because they don't want to play with diabetic feet all day, and they want a reliable source of mess-ups), FPs need FNPs, anesthesiologists need CRNAs, etc...but they should KNOW THEIR ROLE and be grateful MDs were gracious enough to give them one.

 

[VA Hopeful Dr]

First off, I find your statement that OD students are basically pre-MDs who didn't have a chance at med school fairly offensive. Please tell me I misunderstood what you said there. While I tend to think that med school is harder than OD school overall (though having no direct knowledge of either, my opinion may not matter much), that hardly means that OD students are there merely because they couldn't get into med school.

Second, mdkurt is, I believe, at least in an OMD residency if not past that state (any clarification would be helpful), so I would value his experience over yours in this case. Note: I don't mean this as any kind of insult, merely pointing out that he has more experience as of this moment.

Third, I'm not sure where you get your information, but ODs and OMDs follow the same basic procedure when it comes to examinations. Both use slit lamps, ophthalmoscopes, phoroptors (is there any major difference in the number of ODs that refract their patients and MDs that do versus having a nurse do it?) and so on.

That all being said, I've got one last (apologies in advance, this is very unprofessional). Do you really believe that all those non-MD doctors should be grateful that their professions are allowed to exist? If I misunderstood you there, my apologies. If I read that right, I have a suggestion. When you're out practicing, or maybe even residency, why don't you ask these other professionals to write you a thank you note for your gracious acceptance of them. Let me know how that goes.

 

[mdkurt]

"very few"...I really don't think so. The ancillary reasons may have been blah blah blah above, but the primary reason--from my experience--was that they, for whatever reason (lack of academic accomplishments or intellectual prowess), freshman pre-meds in college leading to pre-whatever come the second and third year.

I'm probably one of the last people to come to the defense of optometrists, but this line of reasoning is just wrong. Optometry students understand how difficult medical school, internship, and residency are and many chose (not settled for) their profession to avoid this hardship. Most of these people are not slackers. I've even heard that some of them enjoy refracting all day long and (ick) like low vision evaluations. Not my cup of tea, but I'm not an optometrist. Unfortunately, not wanting to go to medical school does not seem to translate to not wanting to do surgery.

 

[Andrew_Doan]

November 12, 2004

"Surgery by Surgeons" Effort Leads to Gains in Oklahoma Legislature

The Academy's "Surgery by Surgeons" public awareness campaign has helped elect a legislature in Oklahoma that will be far more receptive to concerns about patient surgical care. With the support of Eye M.D.'s contributions to the Surgical Scope Fund, we have made significant strides in changing public and political perceptions in Oklahoma about this issue.

Many of the new legislators who will take their seats in January 2005 support the concept of "Surgery by Surgeons," because the Academy-led coalition successfully injected the issue into campaigns across the state.

Surgical Scope Fund contributions allowed the Academy to:
Develop and implement a long-term strategy to restore patient surgical safety in Oklahoma
Advance a strong patient safety agenda through the creation of an effective coalition of medical allies, including the American Medical Association, the American Osteopathic Association, the Oklahoma State Medical Society and the Oklahoma Osteopathic Association
Educate legislative candidates and Oklahoma citizens on the patient safety risks of surgery performed by non-surgeon and the training differences between ophthalmologists and optometrists
Oklahoma Gov. Brad Henry's recent approval of a regulation that allows optometrists to perform surgery with a scalpel further demonstrates the optometric lobby's current strong influence in that state.

But a new day has begun. We continue our relentless pursuit of the ?Surgery by Surgeons? goal: quality surgical eye care by surgeons who have completed a medical or osteopathic education, a one-year internship and a three-year hospital residency. Success depends on your continued support.

Contribute to the Surgical Scope Fund today!

 

[John_Doe]

[. . . but I had heard that Gov. Henry of OK agreed to sign the bill merely to ensure that ODs in the state did not lose any of the rights they already had. If anyone can find a source (not MD or OD) that confirms/contradicts this, please let me know. At any rate, even ignoring that, I'm not sure all of this is as serious as its made out to be. . . .Second, as was stated earlier also, I tend to think that most ODs have little to no interest in doing any procedures more involved than punctal plugs, foreign bodies, and possibly YAGs/ALTs and the like . . . ]

CRSToday: What, in your opinion, is optometry?s motivation for pursuing these laws?

Dr. Bradford: I cannot say what motivates anybody other than myself. Before HB 2321 was passed, however, I talked directly with the optometric activists and told them, if punctal plugs, lash epilation with forceps, and superficial corneal foreign body were the problem, that they could first address it directly with the medical directors. I was certain that medical directors would be willing to pay for those codes because they had historically done so. I suspect that all state ophthalmologists would agree that punctal plugs, lash removal, and foreign body removal are appropriate for optometrists to perform. The activists? response was that they did not trust ophthalmology and that they wanted to have a law. ***I thought that a law would be fine and proposed replacing the ambiguous wording with language that specifically listed punctal plugs, lash removal, and superficial corneal foreign bodies. I saw this compromise as in the best interest of both patients and providers. My proposal, however, was unacceptable to the optometrists.*** Why would a group turn down what it stated it needed? That is the current state of affairs, and I think that most people can draw their own conclusions.
------------------------
Excert from a 1994 PAC solicitation letter from the OK ODs in Action:

"We can eliminate ophthalmology from this state and prove to the nation that optometry can provide total medical and surgical treatment for the eye . . . We honestly believe that optometry can provide most (if not all) surgical eye care by 2000 . . . Ophthalmology is so weak politically that we see smooth sailing to the control of eye care in this state . . . In order to place our people in key decision making posiitions, we need your support now. Fortunately, ophthalmology is well behind us. As usual they're too busy making the big bucks to think past the first base. Our sources tell us they've done nothing at the state level regarding legislation. We'll trounce them."
AND THEY DID
------------------------------

[First, as Dr. Hom said, many of the procedures Dr. Doan listed require some type of surgical center. ]

CRSToday: What additional efforts have been made or are underway to broaden optometry?s scope of practice elsewhere?

Dr. Bradford: In North Carolina, the Board of Optometry has sued the Board of Medicine over injections. Similar legislation was introduced in New Jersey last year but failed. ***In some states, such as New York and Illinois, optometrists are trying to build ASCs at optometry schools. They want their students to perform all pre- and postoperative care, an effort I view as a foray into surgery.

 

[Andrew_Doan]

With the recent ruling at the VA prohibiting optometric laser surgery at the VA, it is clear that veterans do not want non-surgeons performing laser and scalpel surgeries on their colleagues. It is wonderful when our opinions are heard and considered!

http://forums.studentdoctor.net/showthread.php?t=167910

 

[KellyF]

My name is Kelly, I am a 25 year-old woman who suffers from P.I.C. Sorry, i can't help myself and have to add my comments. I have to say that there is no way known that I would allow an optometrist to operate on me; I do not intend to insult by this remark.

Quite simply, surgeons undergo extensive education and training in what is a highly specialised area. Vision would have to be the most important of all our senses and I would not risk losing any more than I have already.

Both myself and some other sufferers, were told we were 'wearing our contact lenses for too long and not cleaning them properly' by optometrists quite sometime prior to our disease being diagnosed - which is usually after visual loss has occurred. One would assume that the optometrists could see that something was abnormal, yet we were not sent for tests. We do not cast blame - rather, part of our plan for next year is to implement some type of campaign which might alert optometrists to warning signs of disease such as ours - increased light sensitivity etc.

One sufferer, who was seeing an optometrist?! in relation to her P.I.C. was simply sent for regular blood tests. Seeing as the aetiology of P.I.C. is not known I'm really not sure what this was supposed to achieve.

We always recommend that sufferers see not just a Ophthamologist (there are some who have never heard of this disease), but a Retinal Ophthamologist.

The point of the above stories are to indicate, from a grass-roots level, that the knowledge of an optometrist is not so vast as that of a Ophthamologist. An opthamologist must have at least 4-6 years of additional structured clinical training than that of an optometrist. We pay very high fees to see an Ophthamologist - one would hope that it is a case of 'we get what we pay for' and that we are paying for clinical knowledge and experience. From my understanding, some ocular operations are as intricate as neurosurgery; perhaps an appropriate analogy would be that it is the equivalent of the GP performing brain surgery....... could they perform the operation - most probably. However, would you want to be the one on the operating table?

 

[Andrew_Doan]

My name is Kelly, I am a 25 year-old woman who suffers from P.I.C. Sorry, i can't help myself and have to add my comments. I have to say that there is no way known that I would allow an optometrist to operate on me; I do not intend to insult by this remark.

Quite simply, surgeons undergo extensive education and training in what is a highly specialised area. Vision would have to be the most important of all our senses and I would not risk losing any more than I have already.

Both myself and some other sufferers, were told we were 'wearing our contact lenses for too long and not cleaning them properly' by optometrists quite sometime prior to our disease being diagnosed - which is usually after visual loss has occurred. One would assume that the optometrists could see that something was abnormal, yet we were not sent for tests. We do not cast blame - rather, part of our plan for next year is to implement some type of campaign which might alert optometrists to warning signs of disease such as ours - increased light sensitivity etc.

One sufferer, who was seeing an optometrist?! in relation to her P.I.C. was simply sent for regular blood tests. Seeing as the aetiology of P.I.C. is not known I'm really not sure what this was supposed to achieve.

We always recommend that sufferers see not just a Ophthamologist (there are some who have never heard of this disease), but a Retinal Ophthamologist.

The point of the above stories are to indicate, from a grass-roots level, that the knowledge of an optometrist is not so vast as that of a Ophthamologist. An opthamologist must have at least 4-6 years of additional structured clinical training than that of an optometrist. We pay very high fees to see an Ophthamologist - one would hope that it is a case of 'we get what we pay for' and that we are paying for clinical knowledge and experience. From my understanding, some ocular operations are as intricate as neurosurgery; perhaps an appropriate analogy would be that it is the equivalent of the GP performing brain surgery....... could they perform the operation - most probably. However, would you want to be the one on the operating table?

Thank you for your comments. We need more patients to be educated like you and demand a high standard of care!

 

[JennyW]

My name is Kelly, I am a 25 year-old woman who suffers from P.I.C. Sorry, i can't help myself and have to add my comments. I have to say that there is no way known that I would allow an optometrist to operate on me; I do not intend to insult by this remark.

Quite simply, surgeons undergo extensive education and training in what is a highly specialised area. Vision would have to be the most important of all our senses and I would not risk losing any more than I have already.

Both myself and some other sufferers, were told we were 'wearing our contact lenses for too long and not cleaning them properly' by optometrists quite sometime prior to our disease being diagnosed - which is usually after visual loss has occurred. One would assume that the optometrists could see that something was abnormal, yet we were not sent for tests. We do not cast blame - rather, part of our plan for next year is to implement some type of campaign which might alert optometrists to warning signs of disease such as ours - increased light sensitivity etc.

One sufferer, who was seeing an optometrist?! in relation to her P.I.C. was simply sent for regular blood tests. Seeing as the aetiology of P.I.C. is not known I'm really not sure what this was supposed to achieve.

We always recommend that sufferers see not just a Ophthamologist (there are some who have never heard of this disease), but a Retinal Ophthamologist.

I'm sorry to hear of your difficulties but in defence of optometrists (since I am one) punctate inner choroidopathy can have symptoms of light sensitivity for many weeks before the appearance of the lesions. So it's quite possible that there really was nothing for your optometrist to see. You are right to see a retinal specialist though because many general OMDs will miss this condition as well. I'm not sure what the blood tests were all about unless they were looking for some sort of inflammatory cause. But if the patient was already diagnosed with PIC, then I'm not sure what the reason for the blood tests would have been.

IIRC, There is generally no treatment needed unless CNV develops.

Jenny

 

[AnnuitCoeptis]

Absolutely not. Surgeons should be doing all surgery.

Medical background

Reposting poll since previous attempt didn't work.

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

 

[kugs10]

I am a fourth year resident in ophthalmology, and in my opinion optometrists should not be allowed to perform surgery of any type, including lasers. To me, the reasons are complicated and very difficult to quantify and measure in any way that is easily conveyed to non-MDs and/or the general public.

In medical school doctors spend two years studying basic sciences down to the molecular level, including anatomy, physiology, pathology, microbiology, statistics, and pharmacology. We also spend months learning skills of physical diagnosis, including the process of diagnosing disease by corelating history with physical exam and testing. We also learn the ethics of medicine, including how to break bad news, deal with families in difficult situations, and deal with the psychological impact of chronic disease. We learn how to read medical journals and evaluate the statistics objectively.

In the third and fourth year of medical school this basic science knowledge is enhanced at the clinical level. We learn from brilliant diagnosticians in every field, and learn skills such as the interpretation of radiographic images (contrary to popular belief, you cannot simply rely on a radiologist's inerpretation...you need to be able to read your own films.) The thousands of patients we see enhance our ability to take a detailed medical history, correlate with physical exam, and order appropriate tests. The art of forming a differential diagnosis takes years. We learn how to take blood pressures (thousands of them), draw blood, start IV's, talk to families, protect patient confidentiality from prying eyes of friends/family, defuse tempers, be available at a moment's notice, perform cardiac life support, change dressings, wound care, etc. etc. etc. There is no legislation that can be passed to replace these skills.

Many non-MD's would argue that this information is not necessary to take care of eyes. I argue that although this knowledge is often not applied directly to our eye patients day-to-day, a fundamental knowledge of these sciences makes one a better eye doctor. It is a thought process which one refines with experience. Although I have never said to a patient "There is a problem with your cell-mediated immune system's response to host antigens," if I did not understand immunology at the molecular level then I would be doing my patient a disservice by not fully understanding their autoimmune disease. Similarly, can someone who has never cared for a patient with severe peripheral vascular disease truly understand ocular ischemic syndrome? Can one reliably detect a bruit or understand when carotid disease is symtomatic? Can one reliably perform a review of systoms for giant cell arteritis? Can one reliably detect risk factors for CVA? Can one truly understand diabetes and its effect on tissues without ever prescribing insulin or taken care of a patient with a non-healing ulcer? Can one truly understand the dangers of steroid-induced hyperglycemia without ever having treated diabetic ketoacidosis? Can one safely tell a paitent with atrial fibrillation to stop his warfarin for two days without understanding the risk/benefit ratio of such an order? Can one appropriately break the news to a patient that he may have choroidal melanoma without having considered and discussed with experts the hundreds of ways that such a diagnosis should be conveyed? Can one correctly counsel an asthma or CHF patient on the dangers of timolol? Can one communicate effectively with the patient's internist when discussing perioperative risk factors for surgery?

Surely the four years of medical school (plus one of internship) must be worth something. Surely the high-volume rigorous training of ophthalmology residency must be worth something. MDs know the differences and see them in daily interactions with non-MDs. The only way that this MD vs. non-MD debate will end is when the worth of medical school+residency is proven objectively.

Studies have already been done which show that ophthalmology residents who complete an internship in internal medicine perform better in ophthalmology residency than those who complete an internship in a "transitional" program, which would suggest that rigorous study of systemic disease makes one a better eye doctor. At this point studies comparing ophthalmologists to non-MDs have not been adequately completed in an objective way that legislatures can understand. Recently journal articles are starting to compare outcomes between the two, but usually as a secondary outcome to the main study. The sad fact is that precious research funding is going to be used to prove the benefit of MDs, instead of advancing medical knowledge. This unfortunate reality comes at the expense of a few overzealous optometrists.

Over the next years to decades such studies will identify which skill sets are needed for particular problems. There will probably be surprises from both ends. Until then we have to rely on common sense.

 

[medduck]

Great post kugs10! Out of curiosity, what studies have shown that residents with internal med training vs. transitional perform better in ophthalmology? I had previously only heard anecdotal evidence.

 

[Andrew_Doan]

kugs10, thanks for posting!!!

I want to see more residents AND physicians get involved and voice our opinions. Too long have we been quiet about optometric scope expansion into surgery. These public forums are the perfect medium for expressing our concerns and experience. Trust me, the leaders in ophthalmology are browsing and taking notice. Likewise, patients are taking notice!

Bravo Kugs10!

 

[kugs10]

Great post kugs10! Out of curiosity, what studies have shown that residents with internal med training vs. transitional perform better in ophthalmology? I had previously only heard anecdotal evidence.

I will have to get back to you with the exact reference. Our program director showed me an article a few years ago that looked at several factors of ophthalmology residency applicants (board scores, class rank, etc.) to determine which ones were relevant to their performance in residency, and the only factor that was statistically significant was the field in which they completed their internship.

 

[PDT4CNV]

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.

I disagree. There is an optometry school adjacent to the medical school I attended. None of the classes that optometry and the medical students take are comparable. They may have the same course titles, but most of these courses for optometry are "overviews" of topics that are dealt with in depth in medical school. Having been a teaching aide for optometry anatomy, I can attest that their anatomy course was VERY dumbed down relative to that which the medical students go through. Of course, any sort of training in clinical management of patients is virtually absent in optometry. One does not learn to be a physician solely from lectures and textbook reading, this is merely the foundation for what medical students learn in their clinical rotations, internship, and residency.

 

[PBEA]

Of course, any sort of clinical management training is virtually absent in optometry. I am amazed they are allowed to prescribe drops, dumbfounded they are allowed prescribe oral medication--where do they grain clinical experience with these medications?? From the BRS pharmacology review book??[/QUOTE]


What the heck are you talking about? Virtually absent? We may not manage 10000000 sick and dying people like med school, BUT I did see between 2-3 thousand eye cases during my training. Comparing med school with OD school is silly, I've said it before and I'll say it again. With all the "in-depth" training med school students get, I still laugh when I compare it to what OD students know about the eye. Fact is PDT4CNV, what you learn in med school about the eye amounts to a FART in a HURRICANE. As well your clinical eye training in med school amounts to basically nothing, yet any MD can write rx for any eye condition, what a friggin' joke that is. It is misleading, ignorant comments like yours that fan the flames baby. Bring it on.

 

[Andrew_Doan]

As well your clinical eye training in med school amounts to basically nothing, yet any MD can write rx for any eye condition, what a friggin' joke that is. It is misleading, ignorant comments like yours that fan the flames baby. Bring it on.[/COLOR]

This is why we have internship and residency.

 

[PBEA]

This is why we have internship and residency.

I agree, no doubting that fact, my point exactly, etc. I was only picking apart PDT4CNV's exceedingly weak arguments. I take pleasure in shredding anybody who discounts eyecare on any level.

 

[kugs10]

What the heck are you talking about? Virtually absent? We may not manage 10000000 sick and dying people like med school, BUT I did see between 2-3 thousand eye cases during my training. Comparing med school with OD school is silly, I've said it before and I'll say it again. With all the "in-depth" training med school students get, I still laugh when I compare it to what OD students know about the eye. Fact is PDT4CNV, what you learn in med school about the eye amounts to a FART in a HURRICANE. As well your clinical eye training in med school amounts to basically nothing, yet any MD can write rx for any eye condition, what a friggin' joke that is. It is misleading, ignorant comments like yours that fan the flames baby. Bring it on.[/QUOTE]

Having an MD without an ophthalmology residency does not qualify one to provide eye care. No one would ever argue that. The only eye conditions that a non-ophthalmologist MD would ever treat are viral conjunctivitis, and a few are willing to treat an abrasion, but most are not even comfortable with those two conditions.

An MD prepares you to take care of patients. People with health problems. Disease. You need to learn those esential skills prior to learning the specifics of an organ system such as the visual system. And if you think that the body as a whole--the pathophysiology of disease at the molecular and gross level--amounts to a "FART in a HURRICAINE" when it comes to diagnosing and treating eye conditions, then you are naive and doing a disservice to your patients.

 

[NDESTRUKT]

This debate has been rehashed so long. I'm so glad that OMD's have made progress on restricting OD's from laser surgery. It's just ridiculous. I respect OD's and I have friends who are OD's but just having knowledge and being able to do something (which is debatable in this case) doesn't mean you have the right to do it.

I have a degree in mechanical engineering. I know basically every detail of the theory of internal combustion engine design. Does that mean I can get ASE certification without going to a vocational school to train me as a car mechanic? NO.

Saying that an OD can do laser surgery because they "know" enough is like being able to recognize a song on the piano and not be able to play it - it's just superficial.

Bottom line? If you want to do what ophtho's can do, why didn't you (the OD's) just go to med school? I'm not gonna be whining about not being able to write eyeglass prescriptions. People need to learn to make the right choice the first time. Do it once, do it right...geez.

 

[PDT4CNV]

Of course, any sort of clinical management training is virtually absent in optometry. I am amazed they are allowed to prescribe drops, dumbfounded they are allowed prescribe oral medication--where do they grain clinical experience with these medications?? From the BRS pharmacology review book??

What the heck are you talking about? Virtually absent? We may not manage 10000000 sick and dying people like med school, BUT I did see between 2-3 thousand eye cases during my training. Comparing med school with OD school is silly, I've said it before and I'll say it again. With all the "in-depth" training med school students get, I still laugh when I compare it to what OD students know about the eye. Fact is PDT4CNV, what you learn in med school about the eye amounts to a FART in a HURRICANE. As well your clinical eye training in med school amounts to basically nothing, yet any MD can write rx for any eye condition, what a friggin' joke that is. It is misleading, ignorant comments like yours that fan the flames baby. Bring it on.[/QUOTE]

You are missing the point. You are right that most optometrists may know more about the eye than many physicians. But, you will not find an internist managing glaucoma or wishing to perform retinal laser. Because, they were not trained in this, it is beyond the scope of their practice. Nor will you find them using legal maneuvering and political lobbying to try to expand the scope of their practice beyond what they were trained to do.

Most physicians limit their care of the eye to viral conjunctivitis and small abrasions. But, you will find neurologists involved in the workup of patients with anesthetic corneas. Endocrinologists involved in the care of patients with pituitary tumors and visual field defects. The list goes on.

Optometrists should not be prescribing oral medication or intravenous medication. You do not receive adequate training in the use, side effects, and interactions of these medications. As mentioned previously, this is what medical school, and internship, and residency are for. To say that optometry school training is equivalent in this aspect would be false.

Optometrists should not be doing laser and non-laser surgery. Once again, not adequately trained for this.

Lastly, there are many systemic diseases that affect the eye. In fact many systemic diseases are often diagnosed based on ocular findings. Books have been written on the ocular manifestations of systemic disease. Having a good understanding of systemic diseases, their diagnostic workup, and treatment is important for anyone involved in eyecare. Once again, optometry school does not provide adequate training in this respect.

 

[waterski232002]

Everyone always wants to creep into medicine after they choose to train in something else... If you want to be an ophthamologist--go to medical school! The same goes for psychologists who want to perscribe meds, and CRNA's who want to run their own cases in the OR without supervision.

 

[EYESURG]

Everyone always wants to creep into medicine after they choose to train in something else... If you want to be an ophthamologist--go to medical school! The same goes for psychologists who want to perscribe meds, and CRNA's who want to run their own cases in the OR without supervision.

I agree with you "Go Blue." If optometrist want to do what Ophthalmologist do, please go to medical school and do a residency in Ophthalmology and stop posting on this thread. BTW, why do AAO allows optometrist do take courses at the national meetings? Optometrist need to accept the reality that they are optometrist and not Ophthalmologist. If you are not happy with it then go to medical school. Thank you.

GO TEXAS!!!

 

[smiegal]

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.

I also assumed that the "testing out of classes" claim would be shown to be part of RPIE's resume of deceit, but he MAY be telling the truth on this point. I spoke with Sandra Mosteller, Director of Curriculum at Keck School of Medicine (USC), and she verified that students were able to test out of certain courses (until 2001).

Unfortunately for RPIE, passing out of Biochemistry does not a surgeon make.

 

[Mirror Form]

I also assumed that the "testing out of classes" claim would be shown to be part of RPIE's resume of deceit, but he MAY be telling the truth on this point. I spoke with Sandra Mosteller, Director of Curriculum at Keck School of Medicine (USC), and she verified that students were able to test out of certain courses (until 2001).

Even if he did happen to go to one of the <1% of medical schools that allows people to test out of courses (I still am very skeptical of this), there is no way an optometry education would possibly let somebody test out of the kinds of basic science courses we went through the first year of medical school. In my biochem course there were people with masters degrees in biochem who still were only able to achieve a B. Therefore I tend to doubt that an optometry education would allow one to pass out of such classes. Besides, the vast majority of medical students have already taken a good amount of biochem in undergrad anyway.