Eye injections: Legal for tattoo artists, illegal for optometrists

[Shnurek]

http://www.youtube.com/watch?v=XrHgAqkPSQE&feature=related

Street tattoo artists giving eye injections. How dare an optometrist with four years of studying the eye plus additional residencies/fellowships ever want to do something similar to this to help patients?

---

Members don't see this ad.

 

[Visionary]

http://www.youtube.com/watch?v=XrHgAqkPSQE&feature=related

Street tattoo artists giving eye injections. How dare an optometrist with four years of studying the eye plus additional residencies/fellowships ever want to do something similar to this to help patients?

How dare a tattoo artist? Hey, if stupid people want to get eye tattoos, it's on them.

 

[MR1]

Agree exactly with Visionary, if you are stupid enough to do this, then so be it.

But to make a point, this is a sub-conj injection, what sub-conj injection are you wanting to get to be able to do? There is almost NEVER a case for a sub-conj only injection.

 

[ABaverage]

Watching that made me cringe.

 

[Kevin4Eyes]

http://www.youtube.com/watch?v=XrHgAqkPSQE&feature=related

Street tattoo artists giving eye injections. How dare an optometrist with four years of studying the eye plus additional residencies/fellowships ever want to do something similar to this to help patients?

O.D.s even do Avastin injections, perfectly legal in several states with proper credentials.

 

[Tippytoe]

O.D.s even do Avastin injections, perfectly legal in several states with proper credentials.

Man, PLEASE! You sound ******ed. No OD anywhere on the planet is doing Avastin injections into the eye (and none want to that I know of).

Please don't post crap when you have no idea what you are talking about.

 

[Shnurek]

I think some states technically have laws that allow ODs to do intravitreal injections but they are few and far between. Also the posterior pole is retina ophthalmologist territory (except for glaucoma) so I wouldn't be comfortable treating it. Plus you need to do FA's and OCT's constantly on patients receiving anti-VEGF medications to monitor their progress. Anterior pole is more like it for ODs.

 

[Tippytoe]

Listen, NO STATE allows ODs to do intravitreal injections. I will repeat. NO STATE ALLOWS OPTOMETRIST TO INJECT ANYTHING INTO THE EYE!!

NC is one of the more progressives states. In that state ODs can do FA injections (into the arm)(and almost no one does them) and eyelid injections (primarily kenolog steroid for chalazions). THAT's IT!

What is it with unknowing students spouting off non-sense on the web??! Just one more reason the profession is in a downslide.

 

[200UL]

Shnurek – I typically do not take anything you say seriously, but your train of thought is not far off from what organized optometry often uses. I can see it now: "Tattoo artists have given "eye injections" for centuries with zero complications. We actually know something about the eye and have "never had a single complication or complaint" to the "state optometry board" for any of the procedures we perform. Therefore we have the right to do "eye injections" because we can do it better than the tattoo artist (No offense, but I believe the tattoo artists would be better at this than you are).

Also, please tell everyone on this board how giving subconjunctival injections will help you in daily practice. Tell us how many times a day will you need to give the subconjunctival inections. This tattoo artist probably does it a couple times a day – will you have that type of volume in your fantasy procedure world?

At my residency program all residents graduate having given hundreds of intravitreal injections on human beings (how many intravitreal injections do optometry students perform on humans – or even live animals for that matter?). Yet the majority of the residents choose not to perform intravitreal injections in practice unless they perform a retina fellowship. It is interesting that actual experience (>100 injections on humans with a pulse) gives one respect for what they are doing.

A subconjunctival injection is very different than an intravitreal injection. Since you struggle to make this distinction (and choose to show a stupid youtube video in your argument, you prove you do NOT deserve the right to perform either). Start learning to speak like a real surgeon before you start paying off the lawmakers to make yourself a "surgeon."

 

[Shnurek]

A subconjunctival injection is very different than an intravitreal injection. Since you struggle to make this distinction (and choose to show a stupid youtube video in your argument, you prove you do NOT deserve the right to perform either).

Lol anyone that took basic college anatomy and took 1 minute to look on google can tell the difference between subconjunctival and intravitreal. Not to mention students that take Gross Anatomy classes with identical professors from MD Medical Schools. Don't be so ignorant. Sub = below, intra = within.

 

[speyeder]

At my residency program all residents graduate having given hundreds of intravitreal injections on human beings (how many intravitreal injections do optometry students perform on humans – or even live animals for that matter?). Yet the majority of the residents choose not to perform intravitreal injections in practice unless they perform a retina fellowship.

I have noticed this as well. I truly believe that patients who need intravitreal injections are best served by having them performed by retina specialists. It's not the physical act of performing injections that is difficult but rather the management of the underlying disease requiring the injections. In recent years there has been an explosion of information in the treatment of edema and NV in the setting of DR, ARMD & RVOs. There are so many nuances regarding the use and interpretation of various imaging modalities and injection schedules. Almost monthly there are new articles being published. Without being retina-fellowship trained, it is difficult for anyone to keep up-to-date with this information.

 

[Shnurek]

speyeder, thank you for a rational and non-attacking response. I also believe ODs should first master the anterior segment as I've stated earlier. I only pointed out this legal loophole for sake of argument. I doubt any ODs are currently doing intravitreal injections and it wouldn't be feasible at this stage.

 

[KHE]

[*]Laser procedures, including laser trabeculoplasties, iridoplasties, peripheral iridotomies, YAG capsulotomies, LASEK and laser “only” clear-lens extraction.
[*]Incisional surgery (“scalpel procedures”), with some exceptions.
[*]Intraocular injections (except the “posterior chamber”), technically allowing injections into the vitreous or posterior segment.
[*]All methods of administering pharmaceutical agents, including injection procedures, except Schedule I and II drugs.
[*]Local and regional anesthesia.
[/LIST]

That makes less than zero sense. When would you ever need to make an injection into the "posterior chamber?"

 

[Shnurek]

You are right, I did a little bit more digging and Section 1 of KRS 320.210 states:

"The following procedures are excluded from the scope of practice of optometry, except for the pre-operative and post-operative care of these procedures:
"16. Laser or nonlaser injection into the posterior chamber of the eye to treat any macular or retinal disease; and"

Source: http://www.lrc.ky.gov/record/11rs/SB110/bill.doc


The first website I got the info from was an American Academy of Ophthalmology Web Site and they misread or misrepresented the bill.
http://www.aao.org/yo/newsletter/201103/article03.cfm?RenderForPrint=1&


My mistake on the intravitreal injections, Kevin4Eyes do you know what states allow them if any?

 

[Jason K]

That makes less than zero sense. When would you ever need to make an injection into the "posterior chamber?"

I hate to say this, but is it possible that it is simply a wording mistake - referring to the posterior segment as the posterior chamber? These bills are usually slapped together in 15 minutes and pushed through at some odd hour of the day or night so it doesn't seem impossible.

I'm really bummed, though. I wanted to offer my patients the option of getting cosmetic tattoos on the iris pigment epithelium, but according to the bill, I guess I'll just have to wait. I figure, most people keep their tattoos hidden anyway, so this could be a real game-changer for ODs.

 

[200UL]

I hate to say this, but is it possible that it is simply a wording mistake - referring to the posterior segment as the posterior chamber? These bills are usually slapped together in 15 minutes and pushed through at some odd hour of the day or night so it doesn't seem impossible.

I'm really bummed, though. I wanted to offer my patients the option of getting cosmetic tattoos on the iris pigment epithelium, but according to the bill, I guess I'll just have to wait. I figure, most people keep their tattoos hidden anyway, so this could be a real game-changer for ODs.

Shnurek - do you really believe it takes a "college anatomy" or "professional school" gross anatomy to know the difference between the two? My 6 year old could articulate the difference between the two after 30 seconds of explanation - yet I do not think they are ready to head into the procedure suite with a patient.

Thank you for pointing out that some of those in your profession can not even articulate basic ocular anatomy in an important bill that grants every surgical procedure involving the eye to optometry (I have said before - it is obvious to most ophthalmologists reading these bills that the authors have no clue what they are asking for. We have a hard time understanding some of what you are asking for as many of the things in the KY bill are "science fiction" in 2011. The KY bill basically says, "if a procedure can have the wording "LASER" placed in front of it, it is in scope of practice for optometry").

Sorry, "we put this together late at night and used the wrong wording - our bad - we actually know what we are talking about" does not cut it. If you are asking to be taken seriously in a matter regarding patient care and your expertise in surgery, you must be accurate. Next time ben gaddie should pay someone to proof the bill and he will not look so stupid.

Jason K - I do appreciate your humor on the topic. If I wasn't scared of infection, I too would be offering these tattoos to all of my patients.

 

[Jason K]

Thank you for pointing out that some of those in your profession can not even articulate basic ocular anatomy in an important bill that grants every surgical procedure involving the eye to optometry.

I'm certainly not sure this is actually what happened, but it seems logical. I don't hide the fact that I think optometry's insistence on forcing itself into surgical practice without the necessary practical training is going to hurt the profession ultimately. Optometry, from a training standpoint, is nowhere near the place it needs to be in order to start playing around with lasers and scalpels.

Personally, I think optometry is, and has been sinking itself with its absolute lack of direction and leadership so I think a lot of this "ground" that we're supposedly taking will be for nothing anyway - it's just a bunch of hot air. I think the profession will be mostly commercial in 10-15 years and I highly doubt there will be therapeutic lasers in Walmart or Costco anytime soon. Total nonsense, all of it.

 

[Shnurek]

Thank you for pointing out that some of those in your profession can not even articulate basic ocular anatomy in an important bill that grants every surgical procedure involving the eye to optometry

I don't know the difference between posterior segment and posterior chamber yet. I just started OD school a few months ago but the bill clearly asked for this change: Retain original provisions of the bill; replace the term "posterior chamber" with the term "posterior segment."
so they were seeking to create a legal loophole probably.

So what's the final decision are the intravitreal injections legal or not in Kentucky? Who is right AAO or Ben Gaddie?

And I think whoever wrote the bill knew exactly what he/she was asking for. Instead of writing a bill that lists what optometrists CAN do it protects ODs rights for future procedural innovations by saying what they currently CANNOT do.

 

[speyeder]

I hate to say this, but is it possible that it is simply a wording mistake - referring to the posterior segment as the posterior chamber? These bills are usually slapped together in 15 minutes and pushed through at some odd hour of the day or night so it doesn't seem impossible.

I think this is exactly what happened.

 

[Jason K]

I think this is exactly what happened.

I can't say I think otherwise, myself. Whether intentional or unintended, it's one seriously lame step for optometry.

 

[Shnurek]

I can't say think otherwise, myself. Whether intentional or unintended, it's one seriously lame step for optometry.

Man, get over it. Stop being a self-hating optometrist.

 

[Jason K]

Man, get over it. Stop being a self-hating optometrist.

Pull your head out of the sand, Shnurek. Be objective and look at the most likely reasons for what's in front of you. Whether you're in optometry or not, you should be able to look at a situation and evaluate it without inserting your own bias. My assertions that ODs should not be pursuing surgical practice is not rooted in "self-hatred." If you actually understood what's happening to the profession you've yet to enter, and what is certain to come in the next decade or so, you might understand that.

 

[Tippytoe]

We learned how to do subconj injection in optometry school. How many times have I done it in 12 years of practice. NEVER! Why? There is no call for it. Sure you could in theory inject a little steriod into the subconj space for a little inflammatory work......but no one does it. Topicals and orals work for 99% of what we see daily. The only injection I do (or ever need to do) is a little kenolog into a lid chalazion. That resolves them most of the time and if not, they get referred out for excision.

Let the tattoo freaks do their tattoos. The real money will be opening tattoo removal clinics for 50 year old Tiffany to get her 'tramp stamp' removed when she is a grandma and Billy-bob to have his facial tats removed when he figures out he can't even get a job a McDonalds with a Mike Tyson thing on his face.

Tattoos are such a stupid fad now for the 20-30 year old somethings that removing them will be BIG business in 10-20 years.

Now WHO is qualifed to removed tattoos? The person that put them there? The PA at the urgent care clinic? The Nurse Practitioner in Target? Only a Board Certifed dermatologist? Anyone who can afford a laser?

P.S. and BTW, anyone who has a tattoo currently has serious psychological issues that need to be addressed. Only a fool would intentionally scar their body. If you get one on your eye, you need to be killed to cleanse the gene pool.

 

[Shnurek]

 

[optom123]

thumbdown

 

[Visionary]

I think this is exactly what happened.

Yes, this is exactly what happened in the KY bill. They incorrectly used the term "posterior chamber," which is the small space between the posterior lens capsule and the hyaloid face, instead of "posterior segment." Thus, there is technically a loophole for injections into the posterior segment. The KOA has repeatedly stated, however, that it was an error and they have no plans to certify any optometrist to perform intravitreal injections. Similarly, they did not include all forms of laser refractive surgery (e.g., LASEK) in the portion of the bill limiting laser use by optometrists. The KOA has also repeatedly stated that they have no plans to certify any optometrists to perform refractive surgery of any kind. Of course, the KY Optometric Board has the power to determine all future scope, so if they want to...

 

[KHE]

Yes, this is exactly what happened in the KY bill. They incorrectly used the term "posterior chamber," which is the small space between the posterior lens capsule and the hyaloid face, instead of "posterior segment." Thus, there is technically a loophole for injections into the posterior segment. The KOA has repeatedly stated, however, that it was an error and they have no plans to certify any optometrist to perform intravitreal injections. Similarly, they did not include all forms of laser refractive surgery (e.g., LASEK) in the portion of the bill limiting laser use by optometrists. The KOA has also repeatedly stated that they have no plans to certify any optometrists to perform refractive surgery of any kind. Of course, the KY Optometric Board has the power to determine all future scope, so if they want to...

I've been telling you all for years on here now that all of these battles have nothing to do with LASIK, or YAGs or PIs, or Lucentis or any of that crap.

 

[Shnurek]

Yes, not fighting for every new eye drop bottle or procedure that comes out and getting ODs onto medical panels.

 

[Visionary]

I've been telling you all for years on here now that all of these battles have nothing to do with LASIK, or YAGs or PIs, or Lucentis or any of that crap.

You keep saying that, but the fact is this bill did specifically ask for YAG cap/PI and SLT. Maybe you and the majority of the optometric community are not seeking such procedures, but clearly someone is. Why else would it be spelled out in the bill? They could have just asked for the power to determine future scope and left it at that.

 

[Meibomian SxN]

Yes, this is exactly what happened in the KY bill. They incorrectly used the term "posterior chamber," which is the small space between the posterior lens capsule and the hyaloid face, instead of "posterior segment." Thus, there is technically a loophole for injections into the posterior segment. The KOA has repeatedly stated, however, that it was an error and they have no plans to certify any optometrist to perform intravitreal injections. Similarly, they did not include all forms of laser refractive surgery (e.g., LASEK) in the portion of the bill limiting laser use by optometrists. The KOA has also repeatedly stated that they have no plans to certify any optometrists to perform refractive surgery of any kind. Of course, the KY Optometric Board has the power to determine all future scope, so if they want to...

I highly doubt it was "accidental". Bills are "carefully" crafted for a reason....

Also, is there a real difference between posterior segment vs posterios chamber? Just seems like synonymous wording.

 

[Visionary]

I highly doubt it was "accidental". Bills are "carefully" crafted for a reason....

Also, is there a real difference between posterior segment vs posterios chamber? Just seems like synonymous wording.

Yes, it was. They have admitted as much.

And, yes, there is. The posterior segment is synonymous with the vitreous cavity, but not the posterior chamber (which lies anterior to it). BTW, I described it incorrectly in my prior post. The posterior chamber is actually the space between the posterior iris and the ciliary processes, not between the posterior lens and the anterior hyaloid. The anterior and posterior chambers are where the aqueous is distributed.

 

[KHE]

You keep saying that, but the fact is this bill did specifically ask for YAG cap/PI and SLT. Maybe you and the majority of the optometric community are not seeking such procedures, but clearly someone is. Why else would it be spelled out in the bill? They could have just asked for the power to determine future scope and left it at that.

By saying we can do YAGs, it's much much easier to argue that we can prescribe Latisse.

By saying we can to SLTs, it's much much easier to argue that we can fit medicaided contact lenses.

By saying that we can remove a chalazion, it's much easier to argue that we can remove a superficial conjunctival foreign body.

 

[Visionary]

By saying we can do YAGs, it's much much easier to argue that we can prescribe Latisse.

By saying we can to SLTs, it's much much easier to argue that we can fit medicaided contact lenses.

By saying that we can remove a chalazion, it's much easier to argue that we can remove a superficial conjunctival foreign body.

Guess that's why Dr. Ben Gaddie, Pres-elect of the KOA, stated in an interview that when he came back to Louisville to join his father's practice after his glaucoma laser training in OK, he realized the KY laws regarding optometric scope were outdated and didn't allow him to offer patients services he had been trained to perform. That's why it was in the bill. And he will be the first optometrist performing them in KY. No access to care or we just want respect so we can prescribe Latisse mumbo-jumbo. Sorry.

 

[KHE]

Guess that's why Dr. Ben Gaddie, Pres-elect of the KOA, stated in an interview that when he came back to Louisville to join his father's practice after his glaucoma laser training in OK, he realized the KY laws regarding optometric scope were outdated and didn't allow him to offer patients services he had been trained to perform. That's why it was in the bill. And he will be the first optometrist performing them in KY. No access to care or we just want respect so we can prescribe Latisse mumbo-jumbo. Sorry.

I know you all have hard-ons over the evil Ben Gaddie but I'm telling you that the main reason for these laws is not so optometrists can do YAGs and PIs but so that optometry can be the one that determines the destiny of optometry and so that we don't have to go grovel before the medical board everytime some new prostaglandin comes out or some new theraputic modality comes out.

Are you suggesting that if the KY law had left out YAGs and PIs but said that the optometry board is the sole determiner of optometric scope of practice that you wouldn't have the same level of outrage?

 

[Shnurek]

BTW, I described it incorrectly in my prior post. The posterior chamber is actually the space between the posterior iris and the ciliary processes, not between the posterior lens and the anterior hyaloid. The anterior and posterior chambers are where the aqueous is distributed.

Lol even you an MD/PhD. misinterpreted it so imagine lawmakers :O

 

[Visionary]

I know you all have hard-ons over the evil Ben Gaddie but I'm telling you that the main reason for these laws is not so optometrists can do YAGs and PIs but so that optometry can be the one that determines the destiny of optometry and so that we don't have to go grovel before the medical board everytime some new prostaglandin comes out or some new theraputic modality comes out.

Are you suggesting that if the KY law had left out YAGs and PIs but said that the optometry board is the sole determiner of optometric scope of practice that you wouldn't have the same level of outrage?

I don't think he's evil. You ought to learn a little about him, as I suspect he'll be your fearless leader within the next 5 years. With what he accomplished in KY, I'm sure he's a rising star in the AOA.

As to your question, my answer is yes. Unlike some ophthalmologists, I don't think optometrists are incompetent goons. I have no problem with you expanding your role in medical management of ocular diseases. I do have a problem with optometrists performing surgical procedures, however. That's been beaten to death, though, so let's not go there please.

 

[Visionary]

Lol even you an MD/PhD. misinterpreted it so imagine lawmakers :O

Did you say something?

 

[speyeder]

Also, is there a real difference between posterior segment vs posterios chamber? Just seems like synonymous wording.

Yes there is. We don't give injections in the posterior chamber. We do give them in the posterior segment. It is not just a case of semantics.

 

[Shnurek]

Did you say something?

 

[Meibomian SxN]

Yes there is. We don't give injections in the posterior chamber. We do give them in the posterior segment. It is not just a case of semantics.

Hmm, could they have worded it as such in order to be able to inject a lens in that space???? I'm surprised they did not just say vitreous chamber injection. Interesting....

 

[Shnurek]

Technically, the legislation allows for laser cataract surgery

 

[Visionary]

Technically, the legislation allows for laser cataract surgery

Not exactly, though the ophthalmology community was banging the drum on this. According to the wording, an optometrist could perform laser emulsification of the lens, but could not extract the material. Not recommended.

 

[Shnurek]

Not exactly, though the ophthalmology community was banging the drum on this. According to the wording, an optometrist could perform laser emulsification of the lens, but could not extract the material. Not recommended.

Ah I see, so a useless loophole.

 

[Kevin4Eyes]

Man, PLEASE! You sound ******ed. No OD anywhere on the planet is doing Avastin injections into the eye (and none want to that I know of).

Please don't post crap when you have no idea what you are talking about.

Tippytoe, there's optometrists near Memphis doing anti-vegf intravitreal injections. Guess I don't technically know if it's Avastin. They received specialized training in it. Not sure if ODs in Kentucky are doing them yet, but I'm sure they will be.

 

[Visionary]

Tippytoe, there's optometrists near Memphis doing anti-vegf intravitreal injections. Guess I don't technically know if it's Avastin. They received specialized training in it. Not sure if ODs in Kentucky are doing them yet, but I'm sure they will be.

Then they're breaking the law. No optometrist is authorized to perform intravitreal injections in any state.

 

[optom123]

Then they're breaking the law. No optometrist is authorized to perform intravitreal injections in any state.

 

[KHE]

Tippytoe, there's optometrists near Memphis doing anti-vegf intravitreal injections. Guess I don't technically know if it's Avastin. They received specialized training in it. Not sure if ODs in Kentucky are doing them yet, but I'm sure they will be.

That seems incredibly unlikely. Can you specify the clinic or who these doctors are??

 

[Visionary]

Awww, you and Shnurek use the same jpg! You optometry students are simply the cutest!

 

[Visionary]

That seems incredibly unlikely. Can you specify the clinic or who these doctors are??

Yeah, I'd like to know as well, so I can report them to the Feds.

 

[Shnurek]

Yeah, I'd like to know as well, so I can report them to the Feds.

Lol, the feds actually help optometrists out. You can practice at the highest state level that you have a license in, in any military base. Reminds me of a quote off of ODWire where one OD said he was pissing off ophthalmologists left and right by doing non-intravitreal injections on patients in Texas on a military base.