Eye injections: Legal for tattoo artists, illegal for optometrists

[Meibomian SxN]

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 injections on patients in Texas on a military base.

Its not the injections that I'm scared of, its the adverse outcomes. Not even many comprehensive oMDs give these injections without referring them to retina. If a patient ends up with endophthalmitis, how would the OD explain to retina what just happened? Or do they treat the adverse events as well?

Also, I can't believe insurance companies reimburse them for these injections?

---

Members don't see this ad.

 

[Shnurek]

Its not the injections that I'm scared of, its the adverse outcomes. Not even many comprehensive oMDs give these injections without referring them to retina. If a patient ends up with endophthalmitis, how would the OD explain to retina what just happened? Or do they treat the adverse events as well?

Also, I can't believe insurance companies reimburse them for these injections?

Sorry, didn't clarify. I meant non-intravitreal injections, periocular, subconj etc. that he gave on the military base.

 

[Meibomian SxN]

Sorry, didn't clarify. I meant non-intravitreal injections, periocular, subconj etc. that he gave on the military base.

I see. The same is with the VA hospital. If I have an Oklahoma license then all of my state privileges are transferred with me to the hospital. Hence they can perform PRK or SLT on a patient in NY.

 

[Shnurek]

I see. The same is with the VA hospital. If I have an Oklahoma license then all of my state privileges are transferred with me to the hospital. Hence they can perform PRK or SLT on a patient in NY.

Wasn't that blocked?

 

[Kevin4Eyes]

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

Pretty sure in TN the only thing ODs CANT inject for medically necessary eye care is anesthetics. So ODs don't remove "lumps and bumps" in TN like they do in KY.

http://www.tn.gov/sos/rules/1045/1045-02.20100620.pdf

Paragraph
1045-02-.12

"...the treatment of conditions or diseases of the eye or eyelid is determined by the board to be those procedures that could be performed in the optometrist's office or other health care facilities that would require no more than a topical anesthetic. Laser surgery and radial keratotomy are excluded."

Paragraph
1045-02-.07

" Attaining therapeutic certification must include attaining certification to use pharmaceutical agents by injection."

"No therapeutically certified optometrist shall use pharmaceutical agents by injection
except to counter anaphylaxis until they have received approval from the board. The
board will not approve the use of injections until the optometrist demonstrates to the
board's satisfaction sufficient educational training and/or clinical training, and submits
proof of current certification in cardiopulmonary resuscitation (CPR). The education
must be obtained from board approved courses."

As far as adverse outcomes is concerned, I would imagine that is why very few ODs do them, I'm just arguing that they legally can. The ODs that do them have received extensive training in this, and it wouldn't surprise me if they practiced alongside retina specialists who could potentially also assist in the management of the patient's pathology. I would venture that most ODs don't even do any injections in TN, but legally they are allowed to. Pretty much every MD/DO are legally allowed to do many things they don't do in their practice either.

 

[Shnurek]

Exactly, every MD/DO is legally allowed to perform neurological surgery but that doesn't mean they will go out there and do it just for the heck of it. Same thing with ODs, they should have room to maneuver and practice in a way that seems fit for their patient base.

 

[Meibomian SxN]

Wasn't that blocked?

No. When you work in the VA you have the same privileges as your state license, regardless of the state the VA is in.

 

[Shnurek]

Lol comedic interactions between professionals: http://video.ket.org/video/1848161681/

Go to 32 minutes and 45 seconds and they mention that the VA laser privileges to ODs outside of OK/KY were banned.

 

[Visionary]

Exactly, every MD/DO is legally allowed to perform neurological surgery but that doesn't mean they will go out there and do it just for the heck of it. Same thing with ODs, they should have room to maneuver and practice in a way that seems fit for their patient base.

Ignorant post. Yes, every MD/DO has the training foundation that allows them the opportunity to perform neurosurgery, but they cannot get privileges to do such surgery without a neurosurgery residency. Same holds for eye surgery.

 

[Visionary]

Pretty sure in TN the only thing ODs CANT inject for medically necessary eye care is anesthetics. So ODs don't remove "lumps and bumps" in TN like they do in KY.

http://www.tn.gov/sos/rules/1045/1045-02.20100620.pdf

Paragraph
1045-02-.12

"...the treatment of conditions or diseases of the eye or eyelid is determined by the board to be those procedures that could be performed in the optometrist’s office or other health care facilities that would require no more than a topical anesthetic. Laser surgery and radial keratotomy are excluded."

Paragraph
1045-02-.07

" Attaining therapeutic certification must include attaining certification to use pharmaceutical agents by injection."

"No therapeutically certified optometrist shall use pharmaceutical agents by injection
except to counter anaphylaxis until they have received approval from the board. The
board will not approve the use of injections until the optometrist demonstrates to the
board's satisfaction sufficient educational training and/or clinical training, and submits
proof of current certification in cardiopulmonary resuscitation (CPR). The education
must be obtained from board approved courses."

As far as adverse outcomes is concerned, I would imagine that is why very few ODs do them, I'm just arguing that they legally can. The ODs that do them have received extensive training in this, and it wouldn't surprise me if they practiced alongside retina specialists who could potentially also assist in the management of the patient's pathology. I would venture that most ODs don't even do any injections in TN, but legally they are allowed to. Pretty much every MD/DO are legally allowed to do many things they don't do in their practice either.

Show me one optometrist, anywhere in the world, who is doing intravitreal injections. If any optometrist did so and used this ambiguous legal wording to justify it, they would be hung out to dry. Get real. Heck, almost all ophthalmology residents are trained (and qualified) to do intravitreal injections, but how many non-retina trained ophthalmologists actually do it? A minority who typically practice in rural areas and co-manage with retina specialists in nearby cities.

 

[optom123]

Show me one optometrist, anywhere in the world, who is doing intravitreal injections. If any optometrist did so and used this ambiguous legal wording to justify it, they would be hung out to dry. Get real. Heck, almost all ophthalmology residents are trained (and qualified) to do intravitreal injections, but how many non-retina trained ophthalmologists actually do it? A minority who typically practice in rural areas and co-manage with retina specialists in nearby cities.

lmao. Goodness, this is one of the greatest pictures I've ever seen.

 

[Meibomian SxN]

Lol comedic interactions between professionals: http://video.ket.org/video/1848161681/

Go to 32 minutes and 45 seconds and they mention that the VA laser privileges to ODs outside of OK/KY were banned.

Not banned. One practices under one's scope in licensed state in a VA, not the scope of the state. OK is the only license at this point that would allow such. In other states they can perform angiography if the their state license allows for that CPT.

 

[Kevin4Eyes]

Show me one optometrist, anywhere in the world, who is doing intravitreal injections. If any optometrist did so and used this ambiguous legal wording to justify it, they would be hung out to dry. Get real. Heck, almost all ophthalmology residents are trained (and qualified) to do intravitreal injections, but how many non-retina trained ophthalmologists actually do it? A minority who typically practice in rural areas and co-manage with retina specialists in nearby cities.

So your last point is sort of the same as my last point, lots of eye doctors (OD/MD/DO) do not do things they are legally allowed to. Additionally, I know a few ODs in TN do anti veg-f intravitreal injections as stated in my earlier post. Once again the problem in TN isn't the legality (which was my entire point of the first post I made at the very beginning of this post), it's more getting the training for it, getting malpractice insurance to cover it, and getting health insurances to reimburse for it.

Visionary, with KY getting board autonomy, and other states moving for it, what ODs can legally do will broaden, and I imagine more ODs will be doing intravitreal injections. I do not disagree with you that extensive specialized training needs to take place for all eye doctors wanting to perform specialized surgery. I also imagine that, like you stated above regarding OMDs, just because an OD in another state will legally be allowed to perform these procedures, most will elect not to.

 

[Visionary]

So your last point is sort of the same as my last point, lots of eye doctors (OD/MD/DO) do not do things they are legally allowed to. Additionally, I know a few ODs in TN do anti veg-f intravitreal injections as stated in my earlier post. Once again the problem in TN isn't the legality (which was my entire point of the first post I made at the very beginning of this post), it's more getting the training for it, getting malpractice insurance to cover it, and getting health insurances to reimburse for it.

Visionary, with KY getting board autonomy, and other states moving for it, what ODs can legally do will broaden, and I imagine more ODs will be doing intravitreal injections. I do not disagree with you that extensive specialized training needs to take place for all eye doctors wanting to perform specialized surgery. I also imagine that, like you stated above regarding OMDs, just because an OD in another state will legally be allowed to perform these procedures, most will elect not to.

Again, I will ask who? Provide names. If this were happening, it would be well known in the ophthalmology community. I think you're just mistaken as to the type of injections being performed.

 

[Shnurek]

Ignorant post. Yes, every MD/DO has the training foundation that allows them the opportunity to perform neurosurgery, but they cannot get privileges to do such surgery without a neurosurgery residency. Same holds for eye surgery.

Isn't the neurosurgery residency just so they won't get sued? I thought once you get your MD/DO you have an unlimited license to practice medicine and surgery.

That's why some ODs go get their credits transferred to a Caribbean MD school and get their MD+internship year there in ~3 years just so they don't have to deal with the bullcrap laws.

 

[Visionary]

Isn't the neurosurgery residency just so they won't get sued? I thought once you get your MD/DO you have an unlimited license to practice medicine and surgery.

That's why some ODs go get their credits transferred to a Caribbean MD school and get their MD+internship year there in ~3 years just so they don't have to deal with the bullcrap laws.

Maybe several decades ago, but not now. You actually must complete some sort of residency training to even obtain a full-fledged medical license. Until then, you carry a training or R license. You can't practice any medicine outside of a training program with that. As for surgery, in order to obtain surgical privileges for any procedure at any facility you must first be credentialed there. For any hospital (and I imagine most ASCs), that means you must provide evidence of specific training in that surgical procedure. Some procedures are actually taught in IM or family practice residencies, but those are typically non-surgical procedures, such as colonoscopy. The only way to become credentialed in neurosurgical procedures, for instance, is through documented residency training in that field.

 

[VA Hopeful Dr]

Maybe several decades ago, but not now. You actually must complete some sort of residency training to even obtain a full-fledged medical license. Until then, you carry a training or R license. You can't practice any medicine outside of a training program with that. As for surgery, in order to obtain surgical privileges for any procedure at any facility you must first be credentialed there. For any hospital (and I imagine most ASCs), that means you must provide evidence of specific training in that surgical procedure. Some procedures are actually taught in IM or family practice residencies, but those are typically non-surgical procedures, such as colonoscopy. The only way to become credentialed in neurosurgical procedures, for instance, is through documented residency training in that field.

Not always true. I'm a 2nd year FM resident and the only reason I don't have an unrestricted license in my state already is because FCVS is a thousand dollar pile of donkey ****. For US grads in my state, and others I'd suspect, all you need is an internship year and to pass Step 3. Getting hospital privileges/insurance panel coverage is a totally different ballgame though.

 

[Visionary]

Not always true. I'm a 2nd year FM resident and the only reason I don't have an unrestricted license in my state already is because FCVS is a thousand dollar pile of donkey ****. For US grads in my state, and others I'd suspect, all you need is an internship year and to pass Step 3. Getting hospital privileges/insurance panel coverage is a totally different ballgame though.

True, but that rarely happens nowadays outside of the military/VA (see below) for the exact reasons you list at the end. Doesn't matter whether you can practice, if you can't get on staff at hospitals and, more importantly, can't get paid. The days of true fee-for-service medicine are gone. You have to be on insurance panels.

I nearly took an Air Force scholarship to attend med school, until I talked to a USAF ophthalmologist. He was blocked from residency match after med school and was pulled into service as a practicing flight surgeon after his internship. A couple of years later, he managed to get into an ophthalmology residency, but it was Wilford Hall.

 

[VA Hopeful Dr]

True, but that rarely happens nowadays outside of the military/VA (see below) for the exact reasons you list at the end. Doesn't matter whether you can practice, if you can't get on staff at hospitals and, more importantly, can't get paid. The days of true fee-for-service medicine are gone. You have to be on insurance panels.

I nearly took an Air Force scholarship to attend med school, until I talked to a USAF ophthalmologist. He was blocked from residency match after med school and was pulled into service as a practicing flight surgeon after his internship. A couple of years later, he managed to get into an ophthalmology residency, but it was Wilford Hall.

S'why you don't see many GPs these days.

 

[optojourno]

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?

Hi, I am a freelance medical journalist working on an article for Primary Care Optometry News about injection privileges for optometrists. I found this thread and thought it was an interesting discussion. I am wondering if you would be willing to be interviewed (and quoted by name) for this article. If so, please contact me at [email protected]. Thanks.
Jennifer Byrne