Not enough eye exams

[Ryan_eyeball]

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I get upset when a 50 year old comes in for their first eye exam. You might be a student reading these forums contemplating a career in this profession. It is a good profession, you won't starve, and be able to have provide good patient care.

There are very upsetting trends that I see with this profession, some lasting over 50+years.

1) No mandatory eye exam law before a child starts school in 47 out of 50 states. But at least the child has had the mandatory dental exam. Our society again fails us because we are based on cosmetic appearance and not overall health, and learning. Teeth are important, but ask any OD that has seen a 13 year old as a +4.00 OD, and plano OS failing and having problems reading.

2) School Nurses are allowed to give Vision Screenings at school. Mom states, "Johnny doesn't need to see the doctor because he already had his eye exam at school, and I'm not paying your fees." Eight years of higher education to provide your care, being undercut by a school nurse. Without liability for malpractice for missing undiagnosed binocular vision problems or diseases of the eye. Heck sometimes I can't even convince the mom with a zero eye copay to have their child examined by me.

3) The DMV. Not quite as bad as the other two, but I believe every person should have to be evaluated before their drivers license renewed. Too many times I see 20/60 OU being acceptable as passing. A few patients feel inclined to come in for an eye exam, because they were borderline but many do not. Also undiagnosed problems are detected earlier such as diabetes, and glaucoma.

4) Over the Counter readers. I do believe these work well for many people, but should not be sold without a prescription. It allows too many people to bypass eye exams because they can get by with OTC readers. Again undiagnosed problems can persist for years.

5) My last eye exam was........... Too many times I hear from a new patient it was 5 years ago. Our AOA fails to encourage annual examinations. Some OD's will they advocate every two years is more than adequate, but I would rather stay busier and get to know patients better than every few years. Not to mention a better detection of earlier pathology. Dentists do a great job of encouraging q six months exams. No I do not regret being a dentist, there a lot of nasty mouths out there.

6) OMD's doing routine eye exams. Most patients that need q 6 months exams are taken up by OMD's. Some will stay with your for their care, but patients are stolen from you.

7) OD's increasing each year by the number graduating, OD's working longer and not retiring earlier. Three new schools opening up soon.

Sigh if only there was plaque buildup like there is on teeth to removed by a cosmetic technique (and if we were allowed to do something like this). I'd never have to work weekends again.

I love what I do, but you are 90% dependent on getting people in your chair based off a product...glasses or contact lenses. I do well financially but you have to be a great people person, and really encourage exams.

 

[zyg0te]

[/quote]

1) No mandatory eye exam law before a child starts school in 47 out of 50 states. But at least the child has had the mandatory dental exam. Our society again fails us because we are based on cosmetic appearance and not overall health, and learning. Teeth are important, but ask any OD that has seen a 13 year old as a +4.00 OD, and plano OS failing and having problems reading.

Oral health goes much further than cosmetics.

5) My last eye exam was........... Too many times I hear from a new patient it was 5 years ago. Our AOA fails to encourage annual examinations. Some OD's will they advocate every two years is more than adequate, but I would rather stay busier and get to know patients better than every few years. Not to mention a better detection of earlier pathology. Dentists do a great job of encouraging q six months exams. No I do not regret being a dentist, there a lot of nasty mouths out there.

Are you a member of the AOA?

Besides educating your own patients, what are YOU doing to educate your community on the importance of seeing an OD for their annual eye exams.

Also, how well do you really get to know your patients? I'd assume seeing them once a year for 45 minutes, you don't really get to know them much at all.

 

[KHE]

Ryan,

Can you refresh us all on when you graduated and what your current practice modality is?

I get upset when a 50 year old comes in for their first eye exam. You might be a student reading these forums contemplating a career in this profession. It is a good profession, you won't starve, and be able to have provide good patient care.

There is no point in being upset about this. To draw an analogy, millions of physicians every year and billions of dollars a year in education campaigns try to get the public to lose weight, not smoke, exercise, don't speed, don't drink and drive, wear your seat belt, don't talk on your cell phone while driving and yet millions of people every year still do some or all of those things.

1) No mandatory eye exam law before a child starts school in 47 out of 50 states. But at least the child has had the mandatory dental exam. Our society again fails us because we are based on cosmetic appearance and not overall health, and learning. Teeth are important, but ask any OD that has seen a 13 year old as a +4.00 OD, and plano OS failing and having problems reading.

A couple of points about this and some of what I say is going to be controversial. Firstly, I do not agree with mandatory eye exams. To be fair, I also don't agree with mandatory dental exams either. But that's more of a political philosophy. But after having spent some years in education and dealing with a fair amount of special education students, I think ODs as a group have to realize that while yes, there are some students out there who are performing poorly as the result of some uncorrected or undiagnosed vision issue, the vast majority of special ed or struggling students are NOT struggling because of vision issues and in fact, many many more students HAVE these same vision issues yet are still straight A students. In summary, very very VERY rarely is an undiagnosed vision problem the proximal cause of poor academic performance.

2) School Nurses are allowed to give Vision Screenings at school. Mom states, "Johnny doesn't need to see the doctor because he already had his eye exam at school, and I'm not paying your fees." Eight years of higher education to provide your care, being undercut by a school nurse. Without liability for malpractice for missing undiagnosed binocular vision problems or diseases of the eye. Heck sometimes I can't even convince the mom with a zero eye copay to have their child examined by me.

Screenings of ALL types will by their very nature miss some of the diseases they are designed to pick up. The only way to ensure zero false negatives is to have every person undergo a comprehensive evaluation which to me is far too costly and unneeded. Current school screenings in many districts may not be completely ideal, but they are more than adequate in most cases.

3) The DMV. Not quite as bad as the other two, but I believe every person should have to be evaluated before their drivers license renewed. Too many times I see 20/60 OU being acceptable as passing. A few patients feel inclined to come in for an eye exam, because they were borderline but many do not. Also undiagnosed problems are detected earlier such as diabetes, and glaucoma.

This I will generally agree with.

4) Over the Counter readers. I do believe these work well for many people, but should not be sold without a prescription. It allows too many people to bypass eye exams because they can get by with OTC readers. Again undiagnosed problems can persist for years.

Yet millions of people have them and there is not an epidemic of blindness. Cost/benefit analysis has to come into play again here.

5) My last eye exam was........... Too many times I hear from a new patient it was 5 years ago. Our AOA fails to encourage annual examinations. Some OD's will they advocate every two years is more than adequate, but I would rather stay busier and get to know patients better than every few years. Not to mention a better detection of earlier pathology. Dentists do a great job of encouraging q six months exams. No I do not regret being a dentist, there a lot of nasty mouths out there.

Exam frequency recommendations shouldn't be made on the notion of keeping a doctor busy.

6) OMD's doing routine eye exams. Most patients that need q 6 months exams are taken up by OMD's. Some will stay with your for their care, but patients are stolen from you.

Hey, many OMDs are struggling just as much as we are and many of them are just trying to scrounge around for cataract patients.

7) OD's increasing each year by the number graduating, OD's working longer and not retiring earlier. Three new schools opening up soon.

Yep....sucks.

I love what I do, but you are 90% dependent on getting people in your chair based off a product...glasses or contact lenses. I do well financially but you have to be a great people person, and really encourage exams.

That's the way it is in this business. It's best that students and prospective students understand that sooner rather than later. If you think you're going to spending your days evaluating and treating cool and exciting ocular pathology, well....you're not. My practice is about as "medically oriented" as an optometric practice can be. We have just about every fancy gadget and toy out there and yet 80-90% of our patients present for vision related issues. That's just the way it is. Make peace with it, enjoy it, and get paid well to do it.