Future of Ophthalmology?

[John_Doe]

Great to hear about the new VAH directive. This would not have happened without the support of the VAH patient support groups. Anyway just wanted to add that these turf battles continue and will persist; and they may not be lost unless support of both patients and doctors wane.

From AAO:
Academy prepared to do battle in four states targeted for OD surgery bills
As state legislatures convene for the 2005 session, optometrists have begun pushing their surgical agenda in Oklahoma, New Mexico, Mississippi and Puerto Rico. The Academy is working with the state ophthalmological societies to protect patient safety and stop these dangerous bills. You can help by making a contribution to the Surgical Scope Fund today.

---

Members don't see this ad.

 

[John_Doe]

Commentary: No aye for eye
New Mexico legislators must defeat a bill that would allow optometrists, who do not have medical degrees, to perform eye surgeries. There's too much risk.

By Kathleen Blake
February 3, 2005

There are times when taking a shortcut makes sense. Almost everyone knows a quick back-road route to his or her home to avoid extra traffic lights. Weeknight dinner shortcuts to get food on the table in a flash? I'm all in favor.

But when it comes to providing medical care, shortcuts can mean a dangerous outcome for patients.

Our legislators are debating whether to take a shortcut in eye care for New Mexico residents. At hand is a proposal, House Bill 199, that would allow optometrists to perform procedures on the eye. These procedures would include surgeries with lasers, scalpels and needles, plus prescribing any oral or injectable drug.

On the surface, it can be confusing to sort out the differences between optometrists and ophthalmologists. But, in reality, it's quite simple.

Ophthalmologists are medical or osteopathic doctors and have 12 years of undergraduate and medical or osteopathic education and residency. They complete 9,000 to 12,000 hours of education and surgical training before operating unsupervised.

Optometrists must have some undergraduate education and a four-year optometry degree. They do not have a medical or osteopathic degree and do not take part in surgical internships or residencies.

Despite these profound differences, our legislators are considering House Bill 199.

This issue is not new to the state. When Gov. Gary Johnson considered a similar proposal in 1997 from the optometric lobby, he rejected it.

House Bill 199 would set a dangerous precedent for patient care in New Mexico. It would allow optometrists to:

Conduct invasive diagnostic tests on the eye that pose risks, including heart attacks.

Use lasers for eye surgeries, including the popular laser vision correction, which, if not executed properly, could cause irreparable damage.

Wield a scalpel to remove lesions around the eye that might be the manifestation of a dangerous form of cancer.

Optometrists are not trained to diagnose, manage or treat events that can arise from these types of treatments and procedures, nor are they trained to handle the complications of major surgery.

So what do patients have to gain if our Legislature passes House Bill 199? Nothing.

The lobbyists for the optometrists will try to convince our legislators that an optometrist is just as capable of providing high-level eye care as an ophthalmologist. They have no evidence to show that.

They will say that expanding "scope of practice" for optometrists will help ensure access to eye care for patients. There is no access problem for patients who want or need to visit an ophthalmologist.

They will say it's nothing but a petty "turf war" between two disciplines. That ignores the very real medical needs of patients, who are looking for safe and effective care.

They will say they aim to drive down costs. In fact, there is no evidence that costs for a specific procedure carried out by an optometrist will differ from that of an ophthalmologist; however the price of potentially compromising patient safety is immeasurable.

New Mexico's Legislature should not travel down this path. Gambling with patient safety when there is no pressing need is irresponsible and only serves the interests of those who seek to improve their bottom line.

It is now up to the Legislature to reject the demands of this special interest and put patients at the top of the priority list.

Blake is president of the New Mexico Medical Society.
http://www1.abqtrib.com/albq/op_commentaries/article/0,2565,ALBQ_19866_3517831,00.html

 

[John_Doe]

Here is some of the print from the NM Bill:

AN ACT

RELATING TO THE PRACTICE OF OPTOMETRY; AMENDING AND ENACTING CERTAIN SECTIONS OF THE OPTOMETRY ACT.
.........
A. "practice of optometry" [(1)] means:...............................

(3) the use of surgical procedures and injections for the correction, relief, treatment or referral of visual defects or abnormal conditions of the human eye and its adnexa, including the use of an injection to treat anaphylactic reaction but excluding full thickness incision surgery, vitreo retinal surgery or intraocular injections or retro-bulbar injections in the treatment of eye disease;

(My question is what surgical procedures would this allow? Lasik, strabismus, blepharoplasty, etc)

The Bill goes on .......
Section 3. A new section of the Optometry Act is enacted to read:

"[NEW MATERIAL] CERTIFICATION FOR USE OF SURGICAL PROCEDURES AND INJECTIONS.--

A. Except as provided in Subsection D of this section, no person shall use surgical procedures and injections in the practice of optometry without first being certified for such use by the board pursuant to the provisions of this section.

B. The board shall issue certification for the use of surgical procedures and injections to licensed optometrists who:

(1) have been certified to prescribe and administer oral pharmaceutical agents pursuant to Section 61-2-10.2 NMSA 1978; and

(2) submit proof to the board of having successfully completed education from a school or college of optometry, approved and accredited by the board, demonstrating that the optometrist is competent in the use of those surgical procedures and injections included in the practice of optometry.

C. The certification authorized by this section shall be displayed in a conspicuous place in the optometrist's principal office or practice location.

D. Nothing in this section requires certification for a licensed optometrist to insert punctal plugs, treat the lacrimal gland and lacrimal drainage system, remove foreign bodies or epilate eyelashes."

Section 4. EFFECTIVE DATE.--The effective date of the provisions of this act is July 1, 2005.

http://legis.state.nm.us/Sessions/05 Regular/bills/house/HB0199.html

 

[John_Doe]

There are at least three measures which Ophthalmologists could promote regarding scope of practice issues and political advocacy.

1. All residents should become politically active or learn about the issues so that there will be a constant influx of new Ophthalmologists which will contribute to the future of patient eye care. This is currently underway.

2. Financially, there needs to be more support. States are where most of the political activity occurs. Ironically, there is very little state membership among Ophthalmologists. AAO and state societies should form an alliance where AAO dues would pay for both AAO and state membership. Dues for AAO would increase, but state membership and support would increase - and state fees would be reduced due to increased volume of members. A portion of these dues could focus on key states (it is only a key few states at any one time that really matters- and a few more state losses will undermine the whole process). There would also be much more money than there currently is available from AAO, state societies, and Surgical Scope fund combined, in my opinion.

3. State, federal, and VAH policies need to address a definition of surgery. They should work with other specialties to come up with this definition. I believe that PA is currently working on that - and may serve as a model.

Your thoughts are appreciated.

 

[John_Doe]

There are at least three measures which Ophthalmologists could promote regarding scope of practice issues and political advocacy.

1. All residents should become politically active or learn about the issues so that there will be a constant influx of new Ophthalmologists which will contribute to the future of patient eye care. This is currently underway.

2. Financially, there needs to be more support. States are where most of the political activity occurs. Ironically, there is very little state membership among Ophthalmologists. AAO and state societies should form an alliance where AAO dues would pay for both AAO and state membership. Dues for AAO would increase, but state membership and support would increase - and state fees would be reduced due to increased volume of members. A portion of these dues could focus on key states (it is only a key few states at any one time that really matters- and a few more state losses will undermine the whole process). There would also be much more money than there currently is available from AAO, state societies, and Surgical Scope fund combined, in my opinion.

3. State, federal, and VAH policies need to address a definition of surgery. They should work with other specialties to come up with this definition. I believe that PA is currently working on that - and may serve as a model.

Your thoughts are appreciated.

February 23, 2005
New Mexico Optometrists Lobby For Right to Perform Surgery With Lasers And Scalpels



Optometrists are pushing legislators in New Mexico to allow them to perform several laser procedures:

laser posterior capsulotomy
laser trabeculoplasty
laser irridotomy
photorefractive keratectomy
phototherapeutic keratectomy

Alarmingly, this is just the beginning. New Mexico optometrists also want legislators to give them the right to use a scalpel to excise potentially cancerous lesions around the eye. Though we have defeated similar legislation in New Mexico in the past, make no mistake about it, this legislation is on the march. Today, the bill passed the House by a vote of 60 to 8. It now moves to the Senate.

Please act NOW

It's critically important that every ophthalmologist become involved in this battle to protect our profession and our patients by making an immediate contribution to the Surgical Scope Fund.

It was ophthalmology's unprecedented unity coupled with your support for the Surgical Scope Fund that allowed us to win last year's all-out effort to safeguard our nation's veterans. We must do no less for New Mexico. We must do no less for our profession.

 

[PBEA]

It was ophthalmology's unprecedented unity.....

You do know this OD/OMD clash will never stop. You can pour money all day into this fire, and it will continue. It doesn't matter who wins this battle, really it doesn't, because it will continue. It will continue NOT because of qualifications, or prestige, or turf, or money, or even patient welfare. As long as the educational tracts for optometrists and ophthalmologists are separated then there will always be these battles. You can unify all you want but it won't change anything. This is the current system revolting, and hopefully leading to change for the better. My .02

 

[John_Doe]

Survey Shows New Mexicans Overwhelmingly Disapprove of House Bill 199
ALBUQUERQUE, N.M., Mar. 07 /PRNewswire/ --

ALBUQUERQUE, N.M., March 7 /PRNewswire/ -- The New Mexico Medical Society, the state's professional organization for medical and osteopathic doctors, today released the results of a statewide consumer survey regarding House Bill 199, which seeks to allow optometrists (who are non-medical doctors) to perform a multitude of laser and invasive eye surgeries. A public hearing and vote on HB 199 is expected to take place later today in the Senate Corporations and Transportation Committee.

The random telephone survey of 400 New Mexico residents was conducted March 3, 2005 by the survey research firm Strategy One, and has an error rate of +/- 4.9%.

"To summarize, this survey shows that New Mexicans are confused about which type of eye care professionals are actual medical doctors and they feel very strongly that non-MD's should not be operating on their eyes," said Kathleen Blake, MD, president of the New Mexico Medical Society. "The bottom line is that New Mexicans want clarity about who will operate on them."

Primary findings from the survey include: * 94 percent of those surveyed say it is "very important" that an eye care specialist performing surgery be a licensed medical doctor. Asked, "If you or your family member needed eye surgery, how important is it to you that the eye care specialist who would perform the surgery be a licensed medical doctor?", 94 percent of respondents answered "very important," and an additional 4 percent answered "somewhat important." * Large majorities believe that only licensed-MD eye specialists should perform surgical procedures and injections. 78 percent of those surveyed say that only ophthalmologists -- licensed MDs -- should perform "laser surgery to reshape the cornea," 76 percent for "laser surgery to treat eye disease," and 64 percent for "injections of drugs in and around the eyeball, including Botox." * However: Half of those surveyed are misinformed about which eye care specialists are, in fact, licensed medical doctors. Optometrists (often referred to in New Mexico as "optometric physicians") are not licensed medical doctors. Yet when asked to identify which among various types of eye care specialists " ... are licensed medical doctors, meaning they had to graduate from medical school and then spend additional years as an intern and in a residency program," one in two wrongly believe that optometrists and optometric physicians are licensed medical doctors. * 89 percent of those who required eye surgery in the past five years say they've experienced no problems finding a medical doctor in the state to perform the operation. Asked, "Did you experience any problems finding a medical doctor in New Mexico to perform the surgery?", 89% of those who have had such surgery responded no. (Because eye surgery by non-MDs is presently illegal in the state -- and assuming no illegal eye surgery was performed by non-MDs -- the overwhelming majority of respondents had no difficulty finding an ophthalmologist in New Mexico to perform the operation.) * More than seven out of ten New Mexicans oppose pending legislation allowing optometrists to perform certain types of eye surgery. Informed that ophthalmologists are trained MDs and that optometrists are not -- then told that, "There is proposed legislation in New Mexico that would allow optometrists to perform certain types of eye surgery" and asked whether they would support or oppose the measure, 73 percent say they would oppose the legislation (56 percent "strongly oppose," 17 percent "somewhat oppose.") Only 16 percent would support the measure (8 percent "strongly," 8 percent "somewhat").

"This legislative train is headed in the wrong direction," said Dr. Blake. "We hope these results serve as a wake-up call for legislators considering this bill -- New Mexicans want a swift and resolute defeat of House Bill 199."

The New Mexico Medical Society (NMMS) is New Mexico's professional organization for medical and osteopathic doctors. The NMMS was formed in 1882 to secure enactment and enforcement of just medical laws, to promote friendly relations among our members, to uphold the principles of medical ethics of the American Medical Association, to extend medical knowledge and the standard of medical education, to uphold the obligations each member assumed under the Hippocratic Oath, all the while being cognizant of our unique influence on society.

The New Mexico Medical Society

 

[PDT4CNV]

Dr. Doan,

Thanks for your post on this subject.

1. If a patient was a "suitable" canddiate for a surgical procedure with a unremarkable medical history and had an H&P just prior to surgery, what would be the chances of an unanticipated complication in external non-invasive laser eye surgery?

2. If a patient had an unremarkable and non-contributory medical history and H&P, what would be the chances of an unanticipated complication in an excision of a simple pterygium?

3. If the above two cases were done in a hospital setting (note: not in an office!) would there be sufficient back up if something happened. I'm asking because I worked for some time in various settings and when a code blue occured, the physician ophthalmologist immediately stepped back and let the code blue team work and immediately asked for 911. In the 20 cirucmstances I've seen, at no time did the outpatient-based ophthalmologist do more than call 911.

4. Your experience in residency prepares you for working on complicated cases, but if someone was "cherry-picking" easy non-complicated cases, would not such a circumstance be minimal or extremely rare?

5. Again, I am not advocating surgical privileges for optometrists. I'm just asking some explanation of the assumptions that some people have on this subject.

Regards,
Richard Hom, OD,FAAO
San Mateo, CA

Just to give two examples, at our eye hospital, we are a separate facility from the university hospital. At night, there is one ophthalmology resident in the hospital to staff the ER and manage the inpatients.

1. We recently had a lady code after an FA. It was the ophthalmology residents who stabilized her for 20 minutes before the medics arrived.

2. Recently one of the inpatients who was s/p PPV/RD repair had a large ST elevation MI. This was diagnosed and the patient was stabilized and treated by the ophthalmology resident on call prior to the arrival of the medics after which he was transferred to university hospital and immediately taken to the cath lab where 4 stents were placed.

3. How can one cherry pick cases? Ophthalmologists have no choice but to take care of elderly patients with multiple medical problems. This is the patient population who have many eye problems. Complications cannot be predicted, one has to be prepared and trained to handle them because they happen.

4. The type of "surgeon" who is only operating on these perfect patients with no risk factors with no possibility of complications should not be a surgeon.

 

[PDT4CNV]

Dr. Doan,

1. Do you your own H&P? or would a general internist or family practice do it. By protocol at our hospital, the H&P is done prior to ophthalmic surgery in all cases.

2. In many underserved areas, ophthalmologists are unwilling to see patients under the schema of limited or no reimbursement. (under served could mean urban or suburban). I have no arguement referring complicated medical patients or complicated eye problems to ophthalmologists. I might have trouble trying to get an ophthalmologist to see one of my patients if it is not 'complicated'. Should this patient be rationed all eye care until an ophthalmologist is "ready to see them"?

3. In limited circumstances, I believe that certain well-defined procedures and in certain environments can can be done by optometrists safely and cost effectively.

4. This is the type of "cherry picking" I'm talking about. Cases not severe enough to get the ophthalmologists to see but sufficient serious enough that the quality of life for the patient is affected.

Thanks again for your rationale response to my query.

Richard

ALL H/P are completed at our eye hospital by an ophthalmologist. Patients are also always cleared by the anesthesiologist. Those with very complicated medical histories are cleared by their internist in addition to this. Some we refuse surgery because risk doesnt outweigh benefit.

Next, the idea that some eye diseases are not "serious enough" for an ophthalmologists is ridiculous. Ophthalmologists are trained to care for the entire spectrum of eye diseases. With the ability to handle "serious" cases is also the ability to recognize what is a more complicated case. My first pair of glasses was acutally prescribed by one of the local vitreoretinal surgeons while I was in high school.

I think this issue of access to care is ridiculous. There are more than enough ophthalmologists to handle the surgical volume. What about other specialties?? Should midwifes be performing C-sections because there is no Ob/GYN locally. Should nurse practicioners be performing cardiac catheterizations and stenting because there is no cardiologist in some rural town to do it? NO...these patients are taken to hospitals where the appropriate physicians are available to care for these patients.

To beat a dead horse...Soon psychologists will be wishing to do neurosurgery-there are far more psychologists than neurosurgeons, they have a knowledge of neuroanatomy. The fact they are not physicians and have no surgical training shouldn't matter.

If the neurosurgeon won't see the patient because of reimbursement issues, then its ok for the psychologists to do the craniotomy and tumor resection.

The fact is, for patients who require any type of specialized surgery, if there is nobody locally, patients travel to the nearest surgeon. This is true for head and neck surgery, cardiothoracic surgery, vascular surgery, neurosurgery, orthopedic surgery, AND ocular and orbital surgery.

It is just stupid to allow somebody who is not a surgically trained physician to do surgery for the sake of convenience. This is not the type of surgeon I would want operating on my mom...I don't care how "straightforward" of a surgery it supposedly is.

 

[John_Doe]

http://www.txeyenet.org/capitol/2005-03-08_CallToAction.pdf

 

[thiaeyemd]

I trained in residency at an academic hospital, didn't have too much exposure to ODs. Now in fellowship I have a lot more experience as we get a lot of referrals. I never realized how much mismanagement occurs in the optometric world of eye disease. Patients that we get referred commonly (I don't mean once a year or once a month, I mean atleast once a week).

1. Patients with end stage advanced glaucoma that have been "watched" by the OD for years and now have .00001 of their rim left and finally loss of central vision.

2. Patients with nerve palsies secondary to tumors that have been prescribed glasses

3. Patient's with simple retinal disease (macular hole, diabetic retinopathy) that are sent as rule out optic neuritis, GCA...

4. Obvious Optic Disc Drusen sent as "silent" optic neuritis.

These examples are just the horses, not the zebras. Most OMDs take the referrals and say nothing to the OD about the gross mismanagement. I think they are just happy the patient finally got referred or don't want the referral to go elsewhere. After this year, I can truly understand why OMDs think OD's operating are a joke. Any mitigating feelings I had before about ODs using drops or other "medical" intervention has been completely wiped out. Operate??? Lean how to examine the eye and interpret a visual field first. Some people have no shame.

 

[SamuelAdams]

As long as the educational tracts for optometrists and ophthalmologists are separated then there will always be these battles.

You are absolutely right. But why does this battle exist in the first place? If someone wants to be a surgeon they should go to medical school.

It's VERY simple--go to medical school to become a surgeon.

I must be taking crazy pills, because that this is even a point that is debated completely mystifies me.

 

[VA Hopeful Dr]

You are absolutely right. But why does this battle exist in the first place? If someone wants to be a surgeon they should go to medical school.

It's VERY simple--go to medical school to become a surgeon.

I must be taking crazy pills, because that this is even a point that is debated completely mystifies me.

Because of course no one who didn't go to medical school ever does surgery. Hell, last year as an M1 I worked with a NP to excise 10-15 lipomas from a patient.

 

[SamuelAdams]

Because of course no one who didn't go to medical school ever does surgery. Hell, last year as an M1 I worked with a NP to excise 10-15 lipomas from a patient.

During my surgical training NP's or PA's would occassionaly assist in surgery and help close at the end of the case. These people had extra training in surgery after the completion of their NP/PA training. And they ALWAYS worked under a surgeon/hospital.

I'm going to assume the "10-15 lipomas" that you removed were on someone's back or trunk/legs, and not on their face, etc. And I'm sure that the surgeon or at least some other physician (I suppose this could be done at a family practice clinic, although I think that would be highly unusual) was within shouting distance in case the s**t hit the fan.

Regardless, an NP/PA can not open their own clinic and cut in to people completely independently, which is what ODs are aiming for.

I doubt anyone would approve of a microdiskectomy being performed by a chiropractor, which is the equivalent of eye surgery being performed by an optometrist.

 

[VA Hopeful Dr]

During my surgical training NP's or PA's would occassionaly assist in surgery and help close at the end of the case. These people had extra training in surgery after the completion of their NP/PA training. And they ALWAYS worked under a surgeon/hospital.

I'm going to assume the "10-15 lipomas" that you removed were on someone's back or trunk/legs, and not on their face, etc. And I'm sure that the surgeon or at least some other physician (I suppose this could be done at a family practice clinic, although I think that would be highly unusual) was within shouting distance in case the s**t hit the fan.

Regardless, an NP/PA can not open their own clinic and cut in to people completely independently, which is what ODs are aiming for.

I doubt anyone would approve of a microdiskectomy being performed by a chiropractor, which is the equivalent of eye surgery being performed by an optometrist.

All true, but I there's a huge difference between a microdiskectomy and, say, punctal plugs. I completely agree that ODs have no place doing 99% of what is, by medicare, considered surgery. But there are a handful of things that they are trained to do while in school, so why not let the ODs do them?

Unrelated, but I did this at a rural family practice office. The MD there did lots of things that you don't typically think of FPs as doing since he was so far in the boonies.

 

[SamuelAdams]

All true, but I there's a huge difference between a microdiskectomy and, say, punctal plugs. I completely agree that QUOTE]

Agreed; but I don't think there is much difference between cataract extraction and microdiskectomy. I fear that allowing non-physicians to perform more procedures is a slippery slope that is best avoided.

 

[IndianaOD]

Don't ophthalmology residents have more to do than complain about ODs? I stop by these forums once a week or so for a good laugh. As one Ophthalomolgist told me before, its all about $$$ and nothing else. Most of you have no idea how an OD is trained. Ever look through the curriculum? Last time I started stating the actual satistics of how good optometric care was with expanded scope, the thread got shut down. Basically, the ODs are doing a great job. I'll avoid this, but recommend you look at the facts. If half of you are so afraid of ODs why not choose another med specialty?

Spend your time becoming a good surgeon so I have someone decent to refer to. Believe me there are as many terrible Ophthalmolgists as Optometrists. I work in a referall center and see the bad in both.

 

[NDESTRUKT]

All true, but I there's a huge difference between a microdiskectomy and, say, punctal plugs. I completely agree that ODs have no place doing 99% of what is, by medicare, considered surgery. But there are a handful of things that they are trained to do while in school, so why not let the ODs do them?

Unrelated, but I did this at a rural family practice office. The MD there did lots of things that you don't typically think of FPs as doing since he was so far in the boonies.

FP's in rural areas do things like appendectomies even. The thing is, they've been trained to do it during residency (many FP residencies have multiple surgical rotations to train rural practioners to do simple surgeries). Also the FP has a license to perform medicine and surgery (as all MD licenses state).

So FP doing simple surgeries is not analogous to OD's doing eye surgeries. You don't see a cardiologist doing cardiac surgery or a GI doctor doing colon resections do you?

 

[VA Hopeful Dr]

FP's in rural areas do things like appendectomies even. The thing is, they've been trained to do it during residency (many FP residencies have multiple surgical rotations to train rural practioners to do simple surgeries). Also the FP has a license to perform medicine and surgery (as all MD licenses state).

So FP doing simple surgeries is not analogous to OD's doing eye surgeries. You don't see a cardiologist doing cardiac surgery or a GI doctor doing colon resections do you?

I never said I had a problem with FPs doing surgery. I was pointing out that a NP and I were doing some at a rural FP clinic. That's all.

There's a neat chapter in that book Complications that talks about a hernia surgical clinic that employs only FPs who do nothing but hernia repair day in and day out. They apparently get great results.

Agreed; but I don't think there is much difference between cataract extraction and microdiskectomy. I fear that allowing non-physicians to perform more procedures is a slippery slope that is best avoided.

I won't argue that either. I've yet to meet an OD (and I know quite a few) who thinks that optometry ever has a place doing cat sx. Honest truth, most ODs are more concerned with a) getting on medical insurance b) getting up to snuff with pharmacology scope of practice and c) wal mart. Keep in mind, for every oklahoma and new mexico, there are 48 other states with (to my knowledge) no surgical scope expansion planned. Hell, here in SC ODs just spent alot of money on a bill that requires all ODs to be TPA certified by a certain date or lose their licences. Plus a recent bill that outlaws non-eye care providers to give out plano lenses. Myrtle Beach retailers were furious about that one.

 

[eyerish]

I admit I am fairly new to reading posts on these boards, but thought it was an important thing to do. After lurking for awhile, I can't help but say something on this beaten topic.

I have to agree with SamuelAdams that I don't understand why this issue is even being argued in the first place.

I keep reading similar arguments that OD's "don't want to do more". Then what's going on? Don't leave it to us, you write that legislature in clear language and then we will get "off your back".

JennyW is fond of mocking the roadblocks to using tropicamide drops, but saying such a thing is extraordinarily short-sighted. It is not difficult to see the "slippery slope" argument as it applies here. It is not so much the use of the particular drug in question, it is the fact that once you are administering drugs, it is a shorter step to administering more drugs / systemic drugs / small procedures / large procedures.

I saw a question "when was the last time an ophthalmologist was managing an inpatient" and I would answer, I was just doing this today. I have admitted people when I need to, and I work in a busy urban-hospital setting. When I need to, I can obtain a medical consultation, but for the most part, I am comfortable managing a number of more broad medical issues; BP, DM, CHF, renal failure, and the consideration of these issues when deciding about using acetazolamide, or other systemic medications. Ultimately, if an optometrist is going to be pushing for surgery, they may have to admit a patient, which means managing their systemic issues as well: NOT JUST eyes. Simply saying "hey, I can handle the surgical procedure" is not enough; you cannot dump your patient in the hospital and hope someone else takes care of it.

Additionally, it is not the point that there are "multiple paths to enlightenment";your path does not achieve the same endpoint. It is ridiculous to establish a secondary pathway that, in the end, must provide the same end-product which so far, we have yet to find another way to produce. If you want to obtain equal training, then you will end up doing the same training anyways. Primarily ocular training in no way prepares you to be a surgeon.

ODs and MDs are NOT equals. I will never agree with that statement. We are medical doctors, with a specializing interest in a specific organ.

For injection privileges (such a fluorescein) when was the last time an Optometrist ran a code? With medical training, I am in a far more appropriate position to deal with this reality of patient care, particularly in an elderly patient population who receive a large portion of health care.
Arguments regarding FB removal and other such things are also mildly ridiculous: any MD can remove a FB, any ER doc worth his salt can certainly handle this, as well as primary care physicians. So in all honesty, no, we don't "need" optoms to be able to perform even this.

I believe part of the problem is that many OD's simply do not even know what it is they don't know. (I'd cite talking about Keflex in some old post on here) Part of the systemic training argument is to at least make some attempt to safeguard the state of antibiotics and other medications from a public health standpoint. Otherwise, why not let people buy antibiotics OTC?

I believe this is not something that should be argued. If it becomes a mildly "ugly" argument between these two groups, then so be it. I will not compromise my patients care and well being.

 

[rubensan]

Welcome to this forum. I could not have said any of this better myself.

I admit I am fairly new to reading posts on these boards, but thought it was an important thing to do. After lurking for awhile, I can't help but say something on this beaten topic.

I have to agree with SamuelAdams that I don't understand why this issue is even being argued in the first place.

I keep reading similar arguments that OD's "don't want to do more". Then what's going on? Don't leave it to us, you write that legislature in clear language and then we will get "off your back".

JennyW is fond of mocking the roadblocks to using tropicamide drops, but saying such a thing is extraordinarily short-sighted. It is not difficult to see the "slippery slope" argument as it applies here. It is not so much the use of the particular drug in question, it is the fact that once you are administering drugs, it is a shorter step to administering more drugs / systemic drugs / small procedures / large procedures.

I saw a question "when was the last time an ophthalmologist was managing an inpatient" and I would answer, I was just doing this today. I have admitted people when I need to, and I work in a busy urban-hospital setting. When I need to, I can obtain a medical consultation, but for the most part, I am comfortable managing a number of more broad medical issues; BP, DM, CHF, renal failure, and the consideration of these issues when deciding about using acetazolamide, or other systemic medications. Ultimately, if an optometrist is going to be pushing for surgery, they may have to admit a patient, which means managing their systemic issues as well: NOT JUST eyes. Simply saying "hey, I can handle the surgical procedure" is not enough; you cannot dump your patient in the hospital and hope someone else takes care of it.

Additionally, it is not the point that there are "multiple paths to enlightenment";your path does not achieve the same endpoint. It is ridiculous to establish a secondary pathway that, in the end, must provide the same end-product which so far, we have yet to find another way to produce. If you want to obtain equal training, then you will end up doing the same training anyways. Primarily ocular training in no way prepares you to be a surgeon.

ODs and MDs are NOT equals. I will never agree with that statement. We are medical doctors, with a specializing interest in a specific organ.

For injection privileges (such a fluorescein) when was the last time an Optometrist ran a code? With medical training, I am in a far more appropriate position to deal with this reality of patient care, particularly in an elderly patient population who receive a large portion of health care.
Arguments regarding FB removal and other such things are also mildly ridiculous: any MD can remove a FB, any ER doc worth his salt can certainly handle this, as well as primary care physicians. So in all honesty, no, we don't "need" optoms to be able to perform even this.

I believe part of the problem is that many OD's simply do not even know what it is they don't know. (I'd cite talking about Keflex in some old post on here) Part of the systemic training argument is to at least make some attempt to safeguard the state of antibiotics and other medications from a public health standpoint. Otherwise, why not let people buy antibiotics OTC?

I believe this is not something that should be argued. If it becomes a mildly "ugly" argument between these two groups, then so be it. I will not compromise my patients care and well being.

 

[qwopty99]

Arguments regarding FB removal and other such things are also mildly ridiculous: any MD can remove a FB, any ER doc worth his salt can certainly handle this, as well as primary care physicians. So in all honesty, no, we don't "need" optoms to be able to perform even this.

i don't really want to get into this - i really don't want to be part of some OD/MD fight.

but what u say about foreign bodies... would u prefer a family doc remove one from your eye, or an OD with a slit lamp remove it from your eye? i mean, at the very least, the OD has a slit lamp at his disposal - that has to count for something.

further - u say virtually any MD "worth his salt" can do it. can't the same be said for ODs? if u say how easy a procedure it is for someone not trained in the eyes to do it, then that is equally an argument for ODs to do that specific procedure, since it is so trivial to begin with. the argument goes both ways.

 

[eyerish]

i don't really want to get into this - i really don't want to be part of some OD/MD fight.

Too late. I don't consider this "some fight". It is a valid discussion regarding maintaining the overall quality of patient care in the US.

but what u say about foreign bodies... would u prefer a family doc remove one from your eye, or an OD with a slit lamp remove it from your eye? i mean, at the very least, the OD has a slit lamp at his disposal - that has to count for something.

Most ER's also have a slit lamp.

further - u say virtually any MD "worth his salt" can do it. can't the same be said for ODs?

Can't the same be said for opticians refracting? I bet you have some feelings regarding this issue. And no, I do not believe the same can be said for ODs. I think this point has been established in prior posts including mine.

if u say how easy a procedure it is for someone not trained in the eyes to do it,

I don't recall making this statement.

then that is equally an argument for ODs to do that specific procedure, since it is so trivial to begin with. the argument goes both ways.

I disagree, the argument does not go both ways. Physicians are "trained in the eyes". I also did not say that FB removal was trivial. If all it takes is a slit lamp for "people with minimal access to ophthalmological care" to have appropriate FB removal as you suggest, then the point I make is simply that the oft quoted reason for expanding optom procedures is easily remedied (in fact, already remedied), and again at the very heart of the issue, NOT a necessary part of the scope of your practice - if people are going to continue to push further with each small ability, I am willing to begin suggesting that these be declined in the future.

 

[qwopty99]

wow. bitter guy.


btw - i had a 1.9 undergraduate GPA, got 2-2-3-K on the MCAT (i studied hard too, dang!), failed out of 2 community colleges, took 7 years to finish optometry school, took the three national boards 3 times (each!), and don't know the difference between the cornea and the retina.


but... I finally got my OD, after all that hard work and a few beers.



anyhoos... i'll just go back to my slit lamp and remove some foreign bodies from patients.



ciao!

 

[VA Hopeful Dr]

For injection privileges (such a fluorescein) when was the last time an Optometrist ran a code? With medical training, I am in a far more appropriate position to deal with this reality of patient care, particularly in an elderly patient population who receive a large portion of health care.
Arguments regarding FB removal and other such things are also mildly ridiculous: any MD can remove a FB, any ER doc worth his salt can certainly handle this, as well as primary care physicians. So in all honesty, no, we don't "need" optoms to be able to perform even this.

I've yet to see an ophthalmologist's office that had a crash cart ready to run a code if the patient had a bad reaction to the fluorescein. Their procedure is to call 911 and do CPR until the paramedics got there. I'm not saying this to advocate ODs doing any of that (I've rarely seen an OD office that would do more than 1-2 injections a month, if that.... not worth fighting for that in my mind), just pointing out.

As for FBs.... ODs are trained in school to deal with the superficial ones, so why not let them? You're right in that we don't "need" them to do it, but they can so why not?

 

[PBEA]

You are absolutely right. But why does this battle exist in the first place? If someone wants to be a surgeon they should go to medical school.

It's VERY simple--go to medical school to become a surgeon.

I must be taking crazy pills, because that this is even a point that is debated completely mystifies me.

You agree with my post and yet you are mysified that this battle takes place??

I understand you see ODs as being so far removed from eye surgery, but again my post helps explain one very big reason for the contant battle.

 

[PBEA]

I keep reading similar arguments that OD's "don't want to do more". Then what's going on? Don't leave it to us, you write that legislature in clear language and then we will get "off your back".

Why should we?!? Ophthalmology has a LONG history of self-preserving nonsense that has little to do with pt care and lots to do with your bottomline. You have been "on our backs" for FAR longer then this latest "surgery" debacle. I dont anticipate you ever getting off it either

JennyW is fond of mocking the roadblocks to using tropicamide drops, but saying such a thing is extraordinarily short-sighted. It is not difficult to see the "slippery slope" argument as it applies here. It is not so much the use of the particular drug in question, it is the fact that once you are administering drugs, it is a shorter step to administering more drugs / systemic drugs / small procedures / large procedures.

It sounds like your saying that just because using tropicamide doesnt amount to much harm, is not a good enough reason for ODs to use it?? Or is it ODs should not use tropicamide because we might justify our use of other tx?? And by extension any tx or procedure should be off limits because they have extremely low rates of harm and ODs just should not be able to use it?!? Please correct me here because this is a load of baloney.

I saw a question "when was the last time an ophthalmologist was managing an inpatient" and I would answer, I was just doing this today. I have admitted people when I need to, and I work in a busy urban-hospital setting. When I need to, I can obtain a medical consultation, but for the most part, I am comfortable managing a number of more broad medical issues; BP, DM, CHF, renal failure, and the consideration of these issues when deciding about using acetazolamide, or other systemic medications. Ultimately, if an optometrist is going to be pushing for surgery, they may have to admit a patient, which means managing their systemic issues as well: NOT JUST eyes. Simply saying "hey, I can handle the surgical procedure" is not enough; you cannot dump your patient in the hospital and hope someone else takes care of it.

I guess all those dentists out there who broadly use anesthesia, are comfortable managing CHF, and renal failure. Interesting a dentist recently killed a teenager in my area after repeated "doses" of various anethesia and there certainly was no outcry from the medical community. But if an OD uses topical or even local anesthesia then this is a whole different ballgame. Also every ophthalmologist Ive ever worked with did JUST EYES, good thing too as every single one of them would admit to being thoroughly uncomfortable (bordering on malpractice) should they attempt manage ANY of the conditions you listed.


Additionally, it is not the point that there are "multiple paths to enlightenment";your path does not achieve the same endpoint. It is ridiculous to establish a secondary pathway that, in the end, must provide the same end-product which so far, we have yet to find another way to produce. If you want to obtain equal training, then you will end up doing the same training anyways. Primarily ocular training in no way prepares you to be a surgeon.

I agree with this statement. Taking it even further, there are already too many ophthalmologists in the US. I see some OMDs in my area who are surgeons first and foremost and others who have shop on main street doing low level often routine care. (My bread and butter) Yeah, too many OMDs. (Please dont quote some baby boomer stat)

ODs and MDs are NOT equals. I will never agree with that statement. We are medical doctors, with a specializing interest in a specific organ.

For injection privileges (such a fluorescein) when was the last time an Optometrist ran a code? With medical training, I am in a far more appropriate position to deal with this reality of patient care, particularly in an elderly patient population who receive a large portion of health care.

Again all true, if you code in front of me no matter what I did to you, you may very likely die. Aside from basic CPR, the EMT better get here pronto. I guess that isnt too different from almost every ophthalmologists Ive ever worked with. You must have magic powers.

Arguments regarding FB removal and other such things are also mildly ridiculous: any MD can remove a FB, any ER doc worth his salt can certainly handle this, as well as primary care physicians. So in all honesty, no, we don't "need" optoms to be able to perform even this.

Whoa, cowboy dont get outta hand. If an ER doc wants to do anything then I dont have much to complain about, but dont give me this "any MD" crap. These are the kind of two-faced comments that make me write a big check to my optometry PAC. You can go ahead and retract that part. Thank you

I believe part of the problem is that many OD's simply do not even know what it is they don't know. (I'd cite talking about Keflex in some old post on here) Part of the systemic training argument is to at least make some attempt to safeguard the state of antibiotics and other medications from a public health standpoint. Otherwise, why not let people buy antibiotics OTC?

Holy cow, you might want to point that finger at your own. Indicriminate use of abx is found in 100% of the 2nd opinion red eyes that I see. Number one offender: PCPs. I actually had a similiar discussion with a number of your ilk on this forum. Virtually all of them tried to convince me that abx resistance is NOT something that occurs with overuse of abx.

I believe this is not something that should be argued. If it becomes a mildly "ugly" argument between these two groups, then so be it. I will not compromise my patients care and well being.

Oh its ugly pal, been that way for a LONG time, and it is largely the fault of ophthalmologists like yourself who think I should be relegated to refracting only and referring every diabetic, glaucoma, and macular degeneration pt to you. I too will not compromise my pt care and well being

 

[7ontheline]

I've yet to see an ophthalmologist's office that had a crash cart ready to run a code if the patient had a bad reaction to the fluorescein.

Maybe you haven't been looking for the crash cart then. Not that we have to use it much but we have one, and know how to use it. Of course we call 911 also, to do otherwise would be stupid. What kind of argument is that?

 

[VA Hopeful Dr]

Maybe you haven't been looking for the crash cart then. Not that we have to use it much but we have one, and know how to use it. Of course we call 911 also, to do otherwise would be stupid. What kind of argument is that?

I was merely pointing out my experience, and I also never said that an MD with a cart wouldn't call 911. All I was saying is that the MDs I've seen would do the exact same thing an OD would (since they didn't have crash carts in their offices).

 

[eyerish]

Why should we?!?

Because you feel that we are writing unfair rules, yet you continually claim that you are not "expanding scope". Prove that the medical community can trust that you do not wish to make slow inroads into medical practice.

I dont anticipate you ever getting off it either

You are correct.

It sounds like your saying that just because using tropicamide doesnt amount to much harm, is not a good enough reason for ODs to use it??

No, that doesn't sound like what I'm saying.

Or is it ODs should not use tropicamide because we might justify our use of other tx??

Yes.

And by extension any tx or procedure should be off limits because they have extremely low rates of harm

No.

and ODs just should not be able to use it?!? Please correct me here because this is a load of baloney.

Because you have proven that you cannot be trusted not to attempt to continually push for additional treatments, including those for which you are not trained and are surgical in nature.

I guess all those dentists out there who broadly use anesthesia, are comfortable managing CHF, and renal failure.

I do not recall having a focus of anesthesia within my arguement, so I do not understand what point you are making with this statement. Unless you think acetazolamide is an anesthetic agent?

Interesting a dentist recently killed a teenager in my area after repeated "doses" of various anethesia and there certainly was no outcry from the medical community. But if an OD uses topical or even local anesthesia then this is a whole different ballgame.

What would *you* need to be using local anesthesia for?

Also every ophthalmologist Ive ever worked with did JUST EYES,

Perhaps from your perspective, that would seem true. I do not see it that way, and if you asked them, I feel they would have a different response. Regardless, I do not work with "just eyes", and in fact, I am rarely ever working with "just eyes".

good thing too as every single one of them would admit to being thoroughly uncomfortable (bordering on malpractice) should they attempt manage ANY of the conditions you listed.

Define manage? As an inpatient admitted to their service for another procedure, or manage as an outpatient? In one instance, I would agree. In the other, I would not.

I agree with this statement. Taking it even further, there are already too many ophthalmologists in the US.

In what way does this "take the argument further"? I do not see this as an extension of my above argument in any way.

I see some OMDs in my area who are surgeons first and foremost and others who have shop on main street doing low level often routine care. (My bread and butter)

So, one might say you are worried about *your* bottom line?

Again all true, if you code in front of me no matter what I did to you, you may very likely die. Aside from basic CPR, the EMT better get here pronto. I guess that isnt too different from almost every ophthalmologists Ive ever worked with. You must have magic powers.

Your unending sarcasm aside, I do not have magic powers. Every office performing FA's I have been in has a crash cart. I also know what is in it and how to use it. Do you?

Whoa, cowboy dont get outta hand. If an ER doc wants to do anything then I dont have much to complain about, but dont give me this "any MD" crap.

If there is an "underserved" area requiring this procedure frequently, "any MD" can successfully perform this function. If it is too deep or concerning, the patient can be referred to an ophthalmologist.

These are the kind of two-faced comments that make me write a big check to my optometry PAC. You can go ahead and retract that part. Thank you

How is this a "two-faced" comment? I will not retract my above statement.

Holy cow, you might want to point that finger at your own.

I did not claim that medicine is successful and correct about the best and most appropriate use of antibiotics. I am stating that allowing more and more people to prescribe/dispense/freely use is moving in the wrong direction.

Indicriminate use of abx is found in 100% of the 2nd opinion red eyes that I see.

That would be an excellent statistic to publish. Please provide this data, especially with powerful numbers such as "100%". Would you say your area is applicable to every area in which MD's practice in the US?

Number one offender: PCPs. I actually had a similiar discussion with a number of your ilk on this forum. Virtually all of them tried to convince me that abx resistance is NOT something that occurs with overuse of abx.

I would like to read this. Please provide the link.

Oh its ugly pal, been that way for a LONG time, and it is largely the fault of ophthalmologists like yourself who think I should be relegated to refracting only and referring every diabetic, glaucoma, and macular degeneration pt to you.

We are not pals. What I would like is a thoughtfully written explanation regarding why it is you feel you need to perform many of these procedures? Why are you unhappy with the current system? What is your interest in expanding the scope of your practice? Is it notoriety, societal praise, financial interest, challenge, excitement, or purely the altruistic service of humankind? If you feel so strongly and passionately, why didn't you apply to / attend medical school and live your dream of becoming a surgeon, performing procedures, and managing patients? A discussion regarding these points could be educational to me, rather then falling in line with continued sarcasm.

I too will not compromise my pt care and well being

You and your "ilk" already are.

 

[qwopty99]

all this reading is making my eyes and brain tired.



i say we ODs just forget about the squabbling here and take our interests to the legislators. no eye MDs here are going to listen to our arguments anyways.



i mean, if we tell the legislators we want surgery (cataract, cornea, retina, oculo-plastics) loud enough, and enough times, they'll eventually give it to us. afterall, lobbying is a function of money, and we're willing to give more of it than 'em other folks. us ODs may not be the smartest of the bunch, but we sure don't just sit on the sidelines and whine, while padding our bank accounts full of well-earned LASIK income (oh - and don't forget those keratectasia RGP re-fits - oops - gotta hire an OD to fix THOSE mistakes...).



anyhoos - just remember: IQ ain't nothin. i'll be able to tell my friends that with a lower GPA, no MD, and no residency, i got to become a real eye_doctor. heck - with surgery - forget doctor, i'll be telling my patients i'm a real eye-physician! and all this - with never being competitive for med school, ever. who da smart one now?



the truth is, being too smart really doesn't pay off that well. 'em smart people always come off all bitter and cranky. sux to be them i guess.

 

[qwopty99]

If all it takes is a slit lamp to have appropriate FB removal as you suggest,

No. It also takes a Harry Potter Magic Wand.

 

[boldwater]

...I really think this guy is smoking crack. Apparently too much Harry Potter is terrible for your health. Were all of your friends too busy to play dungeons and dragons, forcing you to resort to posting how stupid you are on a forum of your future colleauges? Grow up...

 

[DiveMD]

i mean, if we tell the legislators we want surgery (cataract, cornea, retina, oculo-plastics) loud enough, and enough times, they'll eventually give it to us. afterall, lobbying is a function of money, and we're willing to give more of it than 'em other folks. us ODs may not be the smartest of the bunch, but we sure don't just sit on the sidelines and whine, while padding our bank accounts full of well-earned LASIK income (oh - and don't forget those keratectasia RGP re-fits - oops - gotta hire an OD to fix THOSE mistakes...).

Do you really want other health professionals to respect you? With this type of comments? For you it’s all about money and lobbying, not patient welfare. This post should be a wake up call for every single REAL physician in this forum…

 

[PBEA]

Because you feel that we are writing unfair rules, yet you continually claim that you are not "expanding scope".

Since we are a limited license profession anytime some new tx becomes available (including non-invasive) we have to "expand our scope" to include them. Although clearly you feel that optometry should not grow to incorporate new technology and methods. I disagree with this, although I do agree that more surgeons are NOT needed

Prove that the medical community can trust that you do not wish to make slow inroads into medical practice.

This is semantics, optometry is "medical practice", dentistry is "medical practice", podiatry is "medical practice".

Because you have proven that you cannot be trusted not to attempt to continually push for additional treatments, including those for which you are not trained and are surgical in nature.

And you have proven that you cannot be trusted not to attempt to continually push to remove and limit txs from ODs, including those for which we ARE trained and are NOT surgical in nature. The "surgery" warcry of the AAO is just the latest round of fearmongering the has been repeated over and over during the last few decades. Oh my gosh OD can now do enucleations!! and open globe, run for your lives!! Of course none of that could be further from the truth, but serves as a convenient soundbyte for your AAO to rally the troops.

I do not recall having a focus of anesthesia within my arguement, so I do not understand what point you are making with this statement. Unless you think acetazolamide is an anesthetic agent? What would *you* need to be using local anesthesia for?

The point was that non-MDs can and do safely administer drugs, despite their not being able to manage the entire systemic condition. I dont need local anesthetic for anything (I couldnt cut my way out of a paper bag), nor would I want to.

Perhaps from your perspective, that would seem true. I do not see it that way, and if you asked them, I feel they would have a different response. Regardless, I do not work with "just eyes", and in fact, I am rarely ever working with "just eyes".

If you say so, but I have asked some, in fact a family member is a prominent ophthalmologist, and it seems pretty clear that you should limit your practice to JUST EYES.

Define manage? As an inpatient admitted to their service for another procedure, or manage as an outpatient? In one instance, I would agree. In the other, I would not.

OK, I see the distinction you are making and agree with you. Inpatient you manage fine, outpatient you dont.

In what way does this "take the argument further"? I do not see this as an extension of my above argument in any way.

You said we dont need any more kinds of eye surgeons. I agree and I also feel that there are probably too many of you already. Get it?

So, one might say you are worried about *your* bottom line?

Not unless they were to paraphrase and take my comments out of context

Your unending sarcasm aside, I do not have magic powers. Every office performing FA's I have been in has a crash cart. I also know what is in it and how to use it. Do you?

No, but I dont perform FAs, I happily send those to retina.

If there is an "underserved" area requiring this procedure frequently, "any MD" can successfully perform this function. If it is too deep or concerning, the patient can be referred to an ophthalmologist.
How is this a "two-faced" comment? I will not retract my above statement.

So an OD is not capable or trained adequately to perform FB removal, but a PCP is? No bigger pile of poo exists in the entire universe then that. Everytime I hear an ophthalmologist say that an OD really should not be doing these txs or procedures, and then follow that up with "any MD" can, I write a check to my PAC. If you cant see the double standard you should get your vision checked. Go ahead keeping making those kinds of comments, my PAC will love you.

I did not claim that medicine is successful and correct about the best and most appropriate use of antibiotics. I am stating that allowing more and more people to prescribe/dispense/freely use is moving in the wrong direction.

Oh, so thats why ODs should not rx abx. I see, you are trying to limit abx resistance, how noble of you. Somehow though I dont believe that is why you think ODs should not rx abx...hmmmmm

That would be an excellent statistic to publish. Please provide this data, especially with powerful numbers such as "100%". Would you say your area is applicable to every area in which MD's practice in the US?

HA, HA hilarious, while just my humble anecdote, Im surprised you dont see the same thing. Or do you just have a hard time admitting the truth?

We are not pals. What I would like is a thoughtfully written explanation regarding why it is you feel you need to perform many of these procedures? Why are you unhappy with the current system? What is your interest in expanding the scope of your practice? Is it notoriety, societal praise, financial interest, challenge, excitement, or purely the altruistic service of humankind? If you feel so strongly and passionately, why didn't you apply to / attend medical school and live your dream of becoming a surgeon, performing procedures, and managing patients? A discussion regarding these points could be educational to me, rather then falling in line with continued sarcasm.

I have no aspirations of becoming a surgeon. However, I would like to practice up to the level that I was trained. Sadly this is not to be, I havent rxd an oral medication since school (7 yrs) and my knowledge is lacking at this point because I practice in a state that does not permit oral usage. Combine this with repeated attempts by ophthalmology to remove punctal plugs, and Xalatan (of all things) from optometry or the fact that ophthalmology thinks "any MD" can adequately perform primary eyecare and I start to see the sad reality of all this. Ophthalmology is hell bent on discrediting optometry in every way, shape and form, and any cost. Why? Is it notoriety, societal praise, financial interest, challenge, excitement, or purely the altruistic service of humankind? I dont care anymore about the why part. Ive heard lies, drooling arrogance and two-faced comments long enough. I fully support my PAC and will continue to do so. They say you reap what you sow. Is ophthalmology prepared to face a future where breeding disrespect is the only way you can limit optometrists?


You and your "ilk" already are.

Thanks for that last part, Im sure the occult cnvm I sent to retina, or the psuedotumour pt who just went through repeated lumbar taps (her OB/PCP had never even heard of it before, so much for your "any MD" crap), or even the simple slab off prism pt would likely disagree with you, all seen in the last hour.

 

[PBEA]

Hey eyerish, heres the link you requested
http://forums.studentdoctor.net/showthread.php?t=337402

 

[qwopty99]

Physicians are "trained in the eyes".

so are optometrists.



let's play a game. Guess who am I?


i don't know how to spell astigmatism.

i have never removed a contact lens from an eye.

i don't know where the "ON" button is on a slit lamp.

i have never heard of the word "emmetropia".

i could probably remove a foreign body from an eye, but i do not know how to independently DIAGNOSE a foreign body.

i do not "do eyes" - i refer all eye-stuff out to ophthalmology.


i am your typical ER doc.


maybe u don't get it yet. this isn't about bashing ER docs or whatever. but if u can't concede that an optometrist can remove a foreign body, then u'll get what smart replies u deserve.

 

[eyerish]

Thanks for that last part, Im sure the occult cnvm I sent to retina, or the psuedotumour pt who just went through repeated lumbar taps (her OB/PCP had never even heard of it before, so much for your "any MD" crap)

I am dumbfounded that an OB/GYN MD has never heard of pseudotumor cerebri, almost to the point that I don't believe you. Was this a midwife? A P.A.? Where do you practice? I never said they could do any and everything. I was just saying that if the big complaint is FB removal in "the middle of nowhere, Oklahoma" then that doesn't seem like a very solid reason to me. I also never stated that an optometrist was not capable of removing a FB, but rather that FB removal is not a strong argument to use to expand surgical scope.

I still have not had a thoughtful reply to my above question. Perhaps instead of joining in the endless tirade, which seems to be a popular method of responding to posts by the two of you, (yes, you too 14_of_spades) why not answer the question regarding why? Just tell me why this group (or these groups) are pushing to do more? I won't mock, I won't flame. I will listen and attempt to gain understanding. Promise.

Discussions are much more interesting than flame wars, I'm sick of reading them.

 

[NR117]

Thanks for that last part, Im sure the occult cnvm I sent to retina, or the psuedotumour pt who just went through repeated lumbar taps (her OB/PCP had never even heard of it before, so much for your "any MD" crap), or even the simple slab off prism pt would likely disagree with you, all seen in the last hour.

Patients with pseudotumor cerebri are NOT treated with repeated lumbar punctures. Maybe several decades ago they were, but this is certainly a thing of the past. I don't know where you got that info - an outdated textbook?

 

[DiveMD]

Patients with pseudotumor cerebri are NOT treated with repeated lumbar punctures. Maybe several decades ago they were, but this is certainly a thing of the past. I don't know where you got that info - an outdated textbook?

 

[qwopty99]

optomologist (sp?)

 

[GuP]

optomologist (sp?)

Does changing the spelling make you feel more like an ophthalmologist with a MD? Feeling empty inside? Have you considered going to medical school?

 

[JR]

Looks like another thread I am going to have to close very soon...

 

[rubensan]

i usually have a much higher threshold for closing threads than JR, but this thread, like many others has degenerated into such nonsense with much contribution from 14 of spades and PBEA. i always wondered what Andrew Doan meant by "beware of a wolf in sheeps clothing!" i now know. all of the ophthalmologists on this forum know where both of you stand on these issues. thank-you for your enlightened contributions. best of luck to both of you in pursuing surgical rights. i am traveling to washington, d.c. soon to deal with this very issue. be prepared for a fight!

"Surgery by surgeons!"