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For all the Wal-Mart Doctors

Discussion in 'Optometry' started by stonegoat, Feb 28, 2007.

  1. stonegoat

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    I just received confirmation of a Wal-Mart in Alberta, Canada initiating a "pilot-project" in one of its locations. Wal-Mart is going to have a "sight-tester" (an optician using the Eyelogic System) to generate prescriptions for eyeglasses and CLs. No optometrist.
    Doesn't this scare you?? Don't think for a minute that this is only a Canadian problem. Opticians in many states are pushing for independant refraction. Wal-Mart will be all over it.
    Get the hell out of Wall-Mart and start promoting a PROFESSIONAL image of optometry. You are more replaceable in the big box stores than you would like to think.

    JP
     
  2. IndianaOD

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    Amen brother. Of course Wal-mart isn't the only offender. This would be a disaster, not only for the health of people's eyes but for the professions of Optometry and Ophthalmology. The only good thing would be to force ODs to practice medically and actually use their training.

    If it happens in Canada I hope walmart gets sued liike no tomorrow.
     
  3. Ben Chudner

    Ben Chudner Senior Member
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    While I have been predicting the end of optometry at the big boxes as soon as a refracting optician bill passes for a long time now, just where do you want these doctors to go? Are you looking to hire 5 new docs? Should they start up cold and starve for the next 3 years? It's easy to sit back and tell them to get out of the box, but the sad truth is the majority of them can't. If the boxes go with refracting opticians, the current docs are in big trouble and unfortunately there is not much they can do. We can't worry about these docs, as they have made their choice. We have to focus on the students before they graduate.
     
  4. eyedesire

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    Do you know where in Alberta?? I live in alberta :( and it frightening to know some optician is spitting out Rx's next door :(

    Can some one explain what the eyelogic system is? Is it sort of like an autorefractor/keratometer?
     
  5. qwopty99

    qwopty99 Optometrist
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    umm - we shouldn't be too short-sighted here on this subject.

    opticians refracting in wal-mart will have a profoundly negative effect on private practice docs as well. i wouldn't want to have some half-million dollars invested in a private practice in alberta right now...
     
  6. qwopty99

    qwopty99 Optometrist
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    eyelogic (as it has been described to me) is a fully-automated digitized phoroptor/chart system. apparently, it does refraction via algorithm - telling the operator what sequence of buttons to push. i'm sure there are more details - but that's the gist of it.

    anyone want to try googling?
     
  7. ML1983

    ML1983 PCO Class of 2010
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    Does anyone have a link to this article? I'm in Toronto and I'm curious about this.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  8. qwopty99

    qwopty99 Optometrist
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    actually, this has been reported over a YEAR ago...

    Rev Optom: Monday, January 16, 2006

    .... Last week, we ran a brief note about some of the issues our colleagues in British Columbia are facing regarding opticians' use of autorefractors to prescribe spectacles. The Eyelogic system "invented" by a Canadian ophthalmologist uses data from an autolensometer, an autorefractor and a computer-directed subjective refraction, signed off on by a remote ophthalmologist who can be hundreds of miles away and never lay eyes on the patient.

    With Wal-Mart Canada now planning to use the Eyelogic system in Alberta stores, this problem may soon be one that affects a good many ODs, MDs and patients throughout the United States as well as in Canada.


    http://www.revoptom.com/archive/OP/op_011606.htm
     
  9. qwopty99

    qwopty99 Optometrist
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    but true to form, from the Canadian Opticians Assoc. website:

    Job opportunities in:

    Alberta

    Posted February 5, 2007

    Newly renovated optical store in rapidly growing Red Deer. Downtown location with two Ophthalmologists in the building. Eyelogic and lab on premises. For more information please call: (403) 346-1522

    http://www.opticians.ca/professionals/classifieds.asp
     
  10. OP
    OP
    stonegoat

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    I don't know much about the Eyelogic system, but apparently the inventor stated that it is so easy to use "a monkey could use it".
    As for sight-testing opticians, they have been operating in Alberta and BC for several years. Wal-Mart bringing the system in, unfortunately would somewhat legitimize things.
    I own a successful private practice in an area where there are 2 "sight-testers", and I am very busy. Many times the sight-test results are crappy, so the patients come to see me anyway, regretting their effort to save a little money. Honestly, I think independent "refraction" by opticians is here to stay (BC and Alberta) and will spread to other juristictions in North America over the next several years. Will patients suffer?? Absolutely...they already have. I have seen patients with missed pathology who were sight-tested, and we have had some high-profile cases in BC that made the news. Unfortunatley this is about money...not about maintaining high standards of health care.

    As for were all the Wal-Mart ODs will go? I don't know....Hopefully the OD schools will get their collective "heads out of ass" and reduce new OD #s. I doubt that will happen. I DO know that if optometry doesn't work hard to educate the public and change it's image (Americas Best, Costco, Wal-Mart...give me a frickin' break), the profession will suffer.

    I am glad I took the chance and entered private practice. I am making more money that ANY corporate OD and am well respected in the health care community. I am very satisfied with my job...I truly use all of my training. I am not a special OD....just one who adhered to his vision. By the way, I graduated with $170K debt...so don't cry me a river Wal-Mart Doc.

    JP
     
  11. jefguth

    jefguth Senior Member
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    Now I don't have any love of the image projected by OD's working in commercial enviroments, especially WalMart, but I thought part of the reason WalMart Canada was considering sight-testing was because they have had alot of difficulty finding optometrists to work with them. Thats what I believe an Alberta OD posted on ODwire last year anyways.

    It seems to me that in many areas of Canada, especially outside of urban areas, OD's stay pretty far away from WalMart. In fact, the walmart in my hometown has one of those eighty year old "refracting-MD's" instead.
     
  12. mille125

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    what is the difference between an optician and an optomitrist in terms of training? Please do not lynch me...I really don't know the answer but would like to in case one of my patients ask me.
     
  13. OP
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    stonegoat

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    You are correct. In rural areas of Canada there are few, if any, ODs working in Walmarts or other corporate entities. There are many excellent private practic opportunities for new ODs in rural Canada that pay very well, so there is no incentive to work in a box. Large cities are different, though, and there are ODs that work in "corporate" settings. I'll admit my comments were more for US ODs as they are far more likely to go corporate.....I made them because I was educated in the US and feel somewhat connected to optometry there. I also know that the phenomenon of Wal-Marts, Americas Best (Canada's Best??) Costco is spreading like a cancer, and rural Canada is not immune.

    The fact that Wal-Mart is considering bringing in a "sight-tester" because they cannot sell enough glasses without in-house Rx's should clearly demonstrate that eye health is NOT a priority, an profits are the only consideration for Wal-Mart. They should simply be content with the way things are or close the dispensary, rather than put the public at peril with poor health care......but hey, it's Wal-Mart were talking about.

    JP
     
  14. IndianaOD

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    An Optometrist has 4 years of undergrad usually majoring in Biology, chemistry, or pre-med (basically same as all other doctors) and 4 years of graduate/doctoral training at a school of Optometry earning a doctor of optometry degree (many classes identical to med-school with many others concentrating on the eye). I have a fifth year of residency training equaling 9 years of education after high-school. Most opticians have no formal training. Most are trained in Optometrist's offices and for the most part have a high school level education. Some can do a year or 2 after high school to get certified. Please see my post on Optometrist vs Ophthalmologist in the pre-optometry forum.

    Just curious since you mention patients, what profession are you in? If you are an MD then our medical community has a huge disconnect. Thanks for the question.
     
  15. mille125

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    thank you....i am an MD and yes our medical community does have a disconnect....i did not know the opticians were trying to do refractions...this is outrageous and I will let my medical society know
     
  16. Ben Chudner

    Ben Chudner Senior Member
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    I mean no disrespect, but the MD's in Washington State stayed away from this fight when we almost had a refracting optician bill pass a couple of years ago. It was believed that the MD's were happy to see us spend our PAC money on fighting this so we didn't have the resources to push for expanded scope. I hope that OD's and MD's can come together on more issues, and this is one that we both agree on, so I am very sincere when I wish you luck in getting MD support to fight this.
     
  17. IndianaOD

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    I applaud you and appreciate your willingness to inquire. It is very frustrating that most MDs have no idea what an optometrist is or how well they are trained. I get the feeling sometimes that MDs think ODs get a 2 year associates degree after high school. For example, even though I have extra education in pediatrics and have examined thousands of them, local pediatricians will automatically send their patients to an opthalmologist who sees very few kids. Nothing against the ophthalmologist at all, but when you spend 90% of your time dealing with cataracts and people over 60 ya might be rusty with a screaming kid. Most of the local MDs highly respect me now but it took some time to overcome some stigma. Saved a couple of them some lawsuits by diagnosing things they missed and that helped a lot:D . Some of stigma comes from less trained older ODs and I understand that, but this is a whole different profession than it was 30 years ago. Otherwise I would have gone to med-school ;) .
     
  18. mille125

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    thank you for your posts..I actually know the type of training that an optometrist must go through (I have a good friend who graduated from PCO). Most of my collegues are aware of your training requirements as well. I did not know what an optician was and how much training was required. I am disappointed in the MD's in Washington if they truly supported opticians in their ridiculous quests. The vast majority of MD's do care about patient safety and would not support these efforts. It would be viewed as practicing way out of their scope of practice. Most MD's (myself included) are vehemently opposed to the practice of eye surgery by an optometrist (again for patient safety). However, I strongly support practice in your scope as well as prevention of untrained individuals entering your "field".
     
  19. IndianaOD

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    I don't want to do surgery, but why is there an issue with patient safety? Do you think the same with dentists and podiatrists? Since Ophthalmologists get very little training in refraction, optics, and binocular vision are they endangering patients? I respect your opinion but I will never buy the patient safety thing (Its all about $$). Surgical ability comes entirely from residencies not medical school. If you're trained to do them you are as good as anyone else. An OD has more hands on training with a slit lamp and binocular indirect which are the main technical components of laser sugeries. I know, I know you've been brainwashed. ;)

    I have to maintain my belief that Ophthalmologists should be residency trained Optometrists...just as oral surgeons are residency trained dentists.
     
  20. KHE

    KHE Senior Member
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    What is the above statement based on? How much time have you spent participating in the training of ophthalmologists that allows you make such a comparision?
     
  21. IndianaOD

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    Worked with quite a few Ophth residents on my externship sites. Talked to even more of them, usually they are asking for tips since someone basically hands them the equipment and says "go"

    You can get an idea of someones training pretty fast by talking to them.

    Please don't start up the turf wars retoric. Optometry's abilities must be explained since most other professionals have no idea of what our training involves. You would think 4 years of undergrad plus 4 years of OD school plus a year of residency would allow me to at least have a clue about eyecare.
     
  22. mille125

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    you do have a clue about eyecare, no one is disputing that.....however if you want to put the training side by side optom equals 9 yrs post highschool and ophthalmologists equals 13 or 14 yrs post high school....no matter what you say the average optometrist does not have more NONsurgical training on the eye than the average ophthalmologist....there are good and bad doctors in both fields...you are gettting a skewed perspective because you are comparing ophthalmologists in training to yourself....compare apples to apples......again I will state that I have no problem with you practicing in your scope....eye surgery is not in your scope and there will be no shortage of doctors to testify against you should it come to that.......I will do what I can to prevent an expansion of opticians into your field....generally, i feel that people should expand their scope through education not legislation
     
  23. mille125

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    it is a matter of patient safety...if one is to do a procedure they must be able to handle the complications (which do occur if one does enough procedures)........there is a lot of data in the literature that suggests that the quality of cataract surgery improves as the surgeons experience improves.......so yes...this is a patient safety issue just like opticians doing refractions is a patient safety issue
     
  24. IndianaOD

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    It maybe 12 years of education, but only 3 with the eyes. If a cataract surgeon has a retinal problem they send them out, same as an OD would if a retinal problem arrised from an intraocular injection or YAG. Though I am not talking about invasive surgery. I totally agree if you want to do retina or cataracts at this time go to med school. YAG, PIs and Focal laser are point and shoot. LASIK is pretty much this way and becomes more that way all the time. Draining a cyst is less invasive than getting a tatoo. Its also not difficult to know where to shoot, we have fluoresceine angiography grand rounds, tons of ocular anatomy and all the good stuff. Personally I'd rather have a surgeon who spent 7-8 years on the eye than 3. (4 years OD school plus a 3 year optometric surgical residency). The is a big difference between wanting to do it and having the ability to train extra to do it. Like you said its all about experience. More years concentrating on the eye is better.

    I totally agree about opticians. It would not only endanger patients but cost a lot of ODs and ophthalmologists their jobs.
     
  25. mille125

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    so you are telling me that every single class and topic that you learn in optometry school directly relates to the eye...before you answer I have looked at the curriculum for several of your schools...looks a lot like medical school to me...2.5 yrs basic science...1.5 yrs clinics..dont overstate your training....


    you are also assuming that we get no training about the eye in medical school..i guess that they just ignore the eye to focus on other fascinating organs....i guess that i am totally ignorant about the eye even though i did a 2 month optho rotation in med school............


    the ophthalmologist has 13 yrs of training after high school not 12



    anyway you slice it the average ophthalmologist has more training and more knowledge about the eye than the average optometrists... you may be an exception and if so I applaud you for that...however do not insult the readers by saying that your training is the same..............


    i did colonscopies, vaginal deliveries and many other procedures in my internship... can I do these procedures know...absolutely......should i do them...absolutely not.....what we can and should do may be two different things.......................



    all and all optometrists, chiropractors, and podiatrists are very well trained and offer an important service to their patients. However, podiatists do not have training to operate on the upper leg, chiropractors do not have training to do EMG's and sports physicals, and optometrists do not have training to do eye surgeries.......again think about what we can do and what we should do..........................
     
  26. IndianaOD

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    We'll agree to disagree. I have worked with 3 OD, MDs (ophth) who have both degrees. They basically agree with me. Where are you getting 13 years? undergrad 4 + med-school 4 + transition surgical year 1 + 3 years for general ophth. Retinal fellows and others tack on more. Ophthalmologists know more about surgery by nature but that's where the extra stops. I wish MDs got to work with residency trained Optometrists and finial year Ophth. residents. I truly think your thoughts would change and you would probably see thier knowledge base AT LEAST equal. Yes a fellowship trained retinal surgeon would know more about retina, but I am comparing a generalist vs an optometrist.

    Reguardless both professions would be damaged by opticians. The problem comes from an optician not being able to distinguish refractive vision loss from pathological vision loss. I just got paged for an ocular emergercy (love those on saturday with an hour drive) so I'm done posting on this thread. You can have to last words if you want.
     
  27. orangezero

    orangezero Junior Member
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    Just to add some comments. I think generally a foe of a foe is your friend. Ophthalmologists are always going to side with opticians because it hurts optometrists financially, PAC money or otherwise. Thats a fact.

    General MDs have less of a problem with optometrists because they aren't a direct financial threat. Or we aren't even on the radar.

    And once again, I think the idea that current optometrists want to do cataract surgery is misguided and plain wrong. Students, if you want this, you need to rethink how you are spending your loan money. This push for some type of OD surgical residency seems to be mostly academically money driven. IE. the only ones profiting from this will be the schools. Wouldn't they love to put out 100s of new surgeons a year?

    The problem I have is when MDs claim optometrists should not be allowed to do any type of surgery, ie epilation, lasik, etc... There are invasive procedures, and there are invasive procedures... and their are the legal/medical definitions of such. We should perhaps be a bit clearer on what we are dealing with and discussing.
     
  28. IndianaOD

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    Attached Files:

  29. PBEA

    PBEA Senior Member
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    These cases are of course no surprise, as opticians receive no education except a high school or GED diploma. Their trade involves the manufacture or fabrication of spectacles, nothing more. There is no understanding beyond this hands on material knowledge. This is similiar to any other kind of tradesman or factory worker. They have no clinical training at all. The only reason for opticians to perform a "sight-test" is to make money.
     
  30. qwopty99

    qwopty99 Optometrist
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    its a joke that (in ontario at least) they can dispense contact lenses.

    i worked with some - and they didn't even know how to use a slitlamp.
     
  31. IndianaOD

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    Its been reported that Ophthalmologists commonly serve as off-site rubber stampers for opticians. Will this continue? Truly if ophthalmology supports stand alone or rubber stamping of opticians they DO NOT have patient's best interests at heart. Motivation would be only to make money or attack optometry.
     
  32. KHE

    KHE Senior Member
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    I strongly disagree with that. I teach at an opticianry program part time and I can assure you in our state (where opticians are licensed) their training is FAR beyond a high school diploma or a GED. I wouldn't go so far as to say they should be refracting independetly but to say there is "no understanding beyond hands on material knowledge" is patently false.
     
  33. orangezero

    orangezero Junior Member
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    I've posted this before, but here goes. There is a vast difference between the newest "optician" in an unlicensed state and an educated optician with vast amounts of knowledge (of which there are many.) To say that they are all uneducated is just not true, and there are many states and provinces where it is perfectly legal for them to take a prescription and fit contacts, many times without any form of direct supervision.

    I don't see how given their current view on eyecare, ophthalmology would have any legal or ethical problem with this.

    Its my understanding that an MD signature is needed by the optician up in parts of Canada, not an ophthalmologist or optometrist signature. Who knows how the financial arrangement is made, but if it is really an MD co-signing the glasses prescriptions based of the eyelogic machine, why would the MD be against any of this? Its not really his/her business anyway. Just extra cash. I could be mistaken on this point, though.
     
  34. IndianaOD

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    Then the optician and MD cosigner should be sued into bankruptcy and loss of licensure. Singing off on a patient when you aren't even in the same building is unethical. Though I guess when it comes to making money ethics get swept under the table. Interesting that an MD with no refractive training can legalize a presciption. Never thought I'd say it, but thank goodness the litigeous nature of the US will limit this patient endangering scenario.
     
  35. Olddog1

    Olddog1 Junior Member
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    Could you post this link? I did a pretty exhaustive google search and could not come up with a single quote to support your statement that Ophthalmologist are off-site rubber stampers for opticians.

    Also, wouldn't this practice keep patients out of Ophthalmologist offices as well? This would prevent them from billing an office visit hence negating your last point about making money.
     
  36. luckyfool

    luckyfool SUNY Opt
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    A friend of mine who works for an established MD/OD practice in new york city (100+ patients per day) as an ophthalmic tech, told me that the MDs made her and the rest of the 8+ techs in the office refract, patient workup, write notes in the chart, and even forge the MD's signature so he doesn't even have to do that because the practice is so busy. most of the time he doesn't even see the patients himself. of course this doesn't happen everywhere. just so that people know that some MDs would go at great lengths to make that extra money.
     
  37. jefguth

    jefguth Senior Member
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    This is a fairly common practice among independent opticians in Canada that have purchased the "eyelogics" system, a glorified computerized/auto phoropter and chart, to generate spectacle perscriptions that are then signed by an off-site MD. They like to call it "Sight-testing." In most cases, the signing MD is not an ophthalmologist, but rather a physician specializing in some other area of medicine and supplementing his/her income by participating in this.

    The link provided by IndianaOD is to a list of patients in British Columbia that were harmed and misled by sight-testing opticians that pay MD's to sign their spectacle prescriptions.
     
  38. jefguth

    jefguth Senior Member
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    It's probably only a matter of time, even in Canada, before some of those involved in sight-testing face some professional discipline and malpractice suits. There is currenlty, in Ontario, pending proceedings against an MD that does not have ophthamlic training for failing to meet the standards of the profession in the case of 28 eye exams.
     
  39. PBEA

    PBEA Senior Member
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    Only about half of the states even require any licensure whatsoever with regard to opticianry. If that doesnt sum up their educational backround I dont know what does. You are obviously biased because you teach at an optician "program". Sounds like your overselling a "degree" to me. Ever tell your students that they dont actually legally need to be there, that they can train on the job and become certified without wasting money and time in some hackneyed "optician" program. Ive worked with well over a hundred opticians in my career and none had gone to school for opticianry, all had trained on the job, and were very good at making glasses.
     
  40. Daurang

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    You're correct. My cousin, who owns a couple optical shops in Dallas, said she hired high school kids to cut and fit lenses without any problem.
     
  41. KHE

    KHE Senior Member
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    The fact that half of the states don't require licensure means that half do and those that do require education and training beyond a GED, which is the assertion you incorrectly made. Where I live, to be eligible to sit for the licensure exam for opticianry you can either enroll in the program I teach at, or you can apprentice for 4 years. Most licenses chose the educational route because its much more economically viable.

    None of this means that I think they should refract independently but to make the assertion that all opticians are on the job trained GED holders is irresponsible. That type of attitude is very similar to what the ophthalmologists had all those years ago when optometry started its pursuit of DPA and TPA medication rights.

    Optometry....that's a 2 year associates program right? They can't use eyedrops!"
     
  42. PBEA

    PBEA Senior Member
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    You are missing the point. My post with regard to optician training is in reference to the case studies posted by indianaod. In these examples it is clear that an optician or technician is totally and thoroughly unable to perform independent assessment of any eye under ANY circumstance. Why? Because they receive ZERO clinical training. Also I disagree that this is a parallel between OD scope expansion. The fact is that an ODs education has/had evolved to include the full range of medical/optical/and yes even some minor surgical modalities. Some on this forum often claim that we have achieved so much solely through legislation, but thats only part true, first we had to demonstrate beyond a reasonable doubt that were indeed being trained adequately. This is not the case with opticianry.
     
  43. orangezero

    orangezero Junior Member
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    Opticianry is a hodge-podge of differing regulations, laws, and wild-west.

    I think a good deal of opticians feel (rightly or wrongly) that optometry has done as much as it could have legislatively to keep opticians nonlicensed. On a one to one basis, I'm sure this is much less apparent as I think most ODs prefer to have highly educated opticians surrounding them. But, statewide, legislatively, I think there could be some truth to this.
     
  44. KHE

    KHE Senior Member
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    Whether you were referring to a particluar case or not is immaterial. I think it is arrogant (and dangerous) to underestimate the width and breadth of knowledge of opticians who are licensed in the states in which licensure is required.

    I disagree with your assertion that there is no parallel with OD scope expansion. Just as we expanded our scope through training then legislation, opticians (in those states where licensure and examination are required) are likely to do the same thing.
     
  45. KHE

    KHE Senior Member
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    But for a long time, optometry was the same way and in many respects it still is. There are DPA/TPA non DPA, glaucoma certified, laser certified oral use, no oral use, steroid use, no steroid use etc. etc. throughout the 50 states. While unlike opticianry, licensure is required for optometry in all states but for many many years there was tremendous difference in licensure requirements and scope of practice amongst the states.
     
  46. PBEA

    PBEA Senior Member
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    Well since the OP is in regard to opticians performing independently then it is material to this discussion. Im not underestimating an opticians ability, Im more then comfortable with the fact that they clearly cannot perform independent evaluation of ANY eye under ANY circumstance. If we can agree on this sole fact, then the rest of this discussion is immaterial.
     
  47. orangezero

    orangezero Junior Member
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    Right, but what you didn't have was an guy being pulled from the garden department to perform eye exams. I think as varied as the OD license is, an OD in one state can legally do almost the same things and (perhaps more importantly) SHOULD have almost the same knowledge base.

    But, with opticians, one could put almost any OD and OMD to shame in their knowledge of RGP materials and design, while another "optician" can't even take a PD properly. I'm not convinced the battle cry of some opticians taking the over routine eye exams (or sight tests or whatever they want to call them) is realistically comparable to optometrists looking to increase their scope of practice. Not that I don't think it could happen eventually, but I think the comparison falls apart on a lot of levels.
     
  48. KHE

    KHE Senior Member
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    You may think that, and I may think that but in the in the end, it isn't going to make a lick of difference what you or I think. It will be up to state legislators to grant opticians the power to "sight-test" or whatever you want to call it and for us to bury our heads in the sand and think "couldn't happen" is not wise.

    It is fair to say that ophthalmology underestimated optometry all those years ago. Will we ultimately end up making the same mistake?

    We'll see. I sure hope not.
     
  49. qwopty99

    qwopty99 Optometrist
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    just spoke with an OD friend in alberta.

    he tells me the WM/eyelogic thing is actually on the shelf, and has been for a while now.

    (according to him and what he read) it was determined that the eyelogic thing was deemed a medical device. so a regularly-licensed optician wasn't licensed to operate it.

    he couldn't remember the prognosis of the situation - whether an optician could rack up credentials in order to use it, or whether it would be out of their scope entirely.
     
  50. jefguth

    jefguth Senior Member
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    I think I did read recently that the eyelogic device was recenlty listed by Health Canada as a class II (?) medical device. Now, I don't think that prevents registered opticians from acquiring one, since so many independents (esp in AB and BC) already have them, but perhaps as a lay corporation Walmart is not permitted to purchase the system?
     

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