O.D med treatments

Discussion in 'Optometry' started by traveljunky, Jan 3, 2009.

  1. traveljunky

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    hey everyone,
    i recently visited an optometrist due to a freak accident where i had torn my cornea. When i went in the Doctor examined my eye and told me ihad a ripped cornea and gave me a numbing agent to ease the pain. However that is all he did- he then sent me to an oplathmologist who gave me prescription eye drops and inserted a lens in my eye to help prevent irritation of the eye when i blinked.

    My question is..... Why couldnt my optometrist have done the same thing? I thought OD's were only limited in prescribing oral Rx?!?!?!

    any imput is very much appreciated... I havent gotten a chance to ask my OD myself but i will post his answer as soon as i get a chance to as him.

    Thankx in advance!:)
     
  2. 362.04

    362.04 SDN Mentor
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    Many optometrists like any other medical practitioner have different levels of interest or comfort or experience in dealing with your problem. Most optometrists that you might see are able to and are interested in treating your particular problem.
     
  3. IndianaOD

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    Sounds like you saw an OD has not kept up with the times. Yes, an OD should have treated that easily.
     
  4. eyestrain

    eyestrain Member
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    That's what I thought too. Sounds like a basic corneal abrasion. ODs that refer that stuff out to an OMD are giving us all a bad name.
     
  5. 4Eyes

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    While I don't disagree with the previous replies, just to play the devil's advocate....

    If it was severe/large/central/deep/OD questioned whether pt would be 20/20 after healing...the OD may have referred as a means of covering his/her rear...not just a matter of whether or not the OD was comfortable with treating it.

    Not saying that was the best move in this particular situation, just thought I'd throw that into the discussion.


    Personal example (abridged version): kid playing sports, blunt trauma, macular scarring. I was 99.999% sure an OMD would just monitor the kid, but my colleague and I agreed better send to a retinal specialist so it doesn't come back to haunt us when the kid does not regain 20/20 vision in that eye. (The OMD did choose to monitor.)

    So at what point do you refer as a means to CYA?

    Again, seems unnecessary if it's a run of the mill K abrasion, but thought I'd throw that out there....
     
  6. 362.04

    362.04 SDN Mentor
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    1. The patient is a PIA and butthead and you just don't like them.
    2. Out of your element.
    3. Don't want to bother.
     
  7. eyestrain

    eyestrain Member
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    #3 is not a good reason. #1 probably isn't either, but I can still get behind it.
     
  8. chipmunk222

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    Just my 2 cents and personal life experience: I would prefer to be under the care of an OMD than an OD when it comes to ocular disease or injury. Over the years every OD I've been to (5+) has either missed or misdiagnosed my ocular disease and so either did not treat it while it was in its early stages or treated it wrongly and it progressed to the point that I am now under the care of a corneal specialist...but the damage has been done and irreversible and my life totally ruined.

    I applaud the OD that knew his/her limits and referred you to the OMD. I think it is important to know when one should refer to an expert.
     
  9. KHE

    KHE Senior Member
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    You would have to provide more details of your case for us to make an adequate statement on it. I can understand how you may not want to discuss your personal medical history but to come on here and say that 5 ODs "totally ruined your life" without an explanation is going to be difficult to take seriously.

    Also, the treatment of a superficial corneal abrasion is well within the capability of even the dimmest OD or physician out there.
     
  10. Tippytoe

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    Absolute B.S.

    You're a lier. I'm calling you out for proof. There is no corneal disease severe enough to ruin your life that could possibly be missed by 5 ODs. NONE.
     
  11. chipmunk222

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    THis message is to tippytoe: I don't understand why some in the allied health profession are so insecure that they constantly feel the need to validate themselves. All I meant by the post was that I applaud people who either know their limits, or are able to be cautious enough to know when to refer. I mean, to play devil's advocate, maybe it wasn't just a superficial corneal abrasion...or maybe the OD thought that something was a little off and decided to refer out. What's wrong with OD's referring out?!?!!?

    I do not want to go into detail about my health condition other than having rapidly progressing Sjogren's, along with other health conditions, with symptoms only manifesting in the eye. I kept being dismissed as nothing, or simple dry eye syndrome, and sent away with PF drops and steroids or allergy drops and plugs. All I can say is thank god I paid out of pocket for a corneal specialist (OD's didn't feel like they needed to refer) who immediately ran the appropriate tests, put me under the right care, and sent me to Boston Foundation of Sight. While I can see with my sclerals, I am in constant pain and agony (cant use computer no more than 2-3 minutes at a time), and had to quit my job and dreams of going to med school, and no more social life. I am now forced to sit at home all day. DO NOT tell me that my life is not ruined and that I am a liar. I can't believe you would lash out at any criticism like that.
     
  12. chipmunk222

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    I apologize if I sounded bitter. I did not intend to bash the profession. I have met some amazing optometrists specialized in using and designing therapeutic contact lenses. Why aren't there more of these optometrists around?

    I was just simply upset that someone would claim that there is no ocular disease that could ruin someone's life than an OD would miss. I'm so sorry that I've hurt your fragile ego. You know what, I'm not the only one. I have been referred to pain clinics where I have met a number of people who have gone through the b.s. that I have simply because an OD felt that he/she was just as good as an OMD when it came to medical treatment.

    By the way, a friend is typing this for me right now because I am unable to do so.
     
  13. Carly Ess

    Carly Ess Bananas=Guilty Pleasure!
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    Just curious, from a learning stand point, what did the corneal specialist do differently in treatment that was not done by original optometrists?
     
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  14. KHE

    KHE Senior Member
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    Ok, but to be fair here....

    Sjogrens syndrome does not normally progress rapidly. It is normally diagnosed in people over 40. (I have no idea how old you are.) It normally comes with a whole host of other symptoms. The treatments for it are normally PF drops, anti-inflammatories or plugs, which are the treatments you had. You can't just indict an entire profession because the first few docs you saw didn't nail down a disease which has an average time of diagnosis of 6 years from the onset of symptoms.

    In other words, it's highly unlikely that Sjogrens would have been on their radar. The fact that you saw an ophthalmologist who got it on the first try is also not an indication of anything significant because that person had the benefit of knowing all of the other treatments that you had tried that failed. That gave them the benefit of knowing to look for zebras instead of horses.

    That happens to every doctor. Sometimes we're the hero because we fix something that 4 other doctors couldn't but we had the benefit of knowing what had already been tried and failed. Sometimes we're the goat because we try something that doesn't work and the patient sees someone else and the other doctor gets to be the hero.
     
  15. IndianaOD

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    Excellent post Ken. I agree completely. IMO ODs are much more likely to spend the time to properly manage severe dry eye than an OMD. In fact some of the most respected dry eye specialists are ODs ala Paul Karpeki.

    Please don't come on here making blanket statements. Any OD can tell you numerous stories of OMD screw ups just as OMDs can the reverse.
     
  16. chipmunk222

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    This is the last time I am going to post in this thread because no way did I intend to start some kind of flame war and point fingers and degrade a profession. I just wanted to offer some kind of personal experience and reason as to why I applaud an OD who does not have the attitude show here of "i can treat any disease that an MD can treat...the only difference between me and a MD is surgery."

    First of all, I did not make a blanket statement about the optometry profession. I said that in my personal experience as a patient, I prefer to be treated by an OMD than an OD when it came to managing ocular disease. Likewise, for contact lens expertise, I would go an OD over an OMD. I believe you're the one making a blanket statement saying that ODs would be more likely to spend the time to manage severe dry eye. Some people on this forum are just so sensitive and defensive about their chosen profession that they feel the need to constantly validate themselves. This is starting to look like one of the DO forums. There is more difference between an OD and an OMD other than just surgical knowledge, so get over it! The disease management training is not the same.

    The reason I came across this thread to begin with is because my fiance, who is typing this for me, is a materials engineer PhD student, who after traveling with me to a couple optometrists specialized in designing and fitting therapeutic contact lenses, has become very interested in the potential for the field therapeutic contact lenses and will be applying to optometry school soon. So I have nothing against the profession, except that some ODs have a stick up their ***** and think they are physicians, instead of focusing on optometry, like developing their contact lens knowledge and experience.

    I agree that anyone can screw up, no matter what your profession is.
    And you know, I could have been unlucky and saw the world's worst 5 ODs and then got super lucky and am seeing the world's best corneal specialist. Geezus, I completely understand that. KHE, you are completely right that I am not a textbook example (I'm in my early 20's...but I did meet a bunch of people in the Sjogren's support group who only had eye symptoms, so I don't think its that uncommon, but I could be wrong), which can make it difficult for anyone and I could have gotten super lucky with my OMD who did everything right. But my OMD did have the same info as OD's number 3,4, and 5 who did absolutely nothing except to tell me to continue what I'm doing and sent me on my way and therefore did not catch on like my corneal specialist. Perhaps if I had went to one of you hot-shot ODs, you would have done everything my OMD has done.

    So that's it...I apologize for pissing anyone off or making it seem I thought optometry was crap. I did not mean to. The rest of my post is to answer Carly Ess's question, of which I will just explain in chronological order:

    OD #1: Did not understand why I was in pain; concluded that since my eyes were not red, they could not possibly be that dry, so just presribed PF drops 4x a day. Did not perform a schirmers or tbut. PF drops did nothing, came back for a return appt, and doc shooed me away.

    OD #2: Did a schirmers, and TBUT. I had a low TBUT, but doc assured me that my MGs were fine (turned out he was wrong). Gave me allergy drops. Later at F/UP appts, was given steroids, restasis, and plugs. I had no improvement, felt worse, but doc told me that is pretty much all that can be done and an OMD would just do the same so I just have to deal with it.

    OD #3,4,5: Agreed with OD#2. Only difference was increased dosage of Restasis.

    What Corneal Specialist did differently in terms of treatment:
    1. Looked at dry eye differently. He told me that he never simply treats symptoms by "plugging and dropping" and using steroids. He always looks for the CAUSE of problem...even if the problem seemed mild. I think this is key.
    2. Removed my plugs - very upset that someone would even think about putting plugs in such an imflamed eye. Called up previous OD and had an argument with him right in front of me. If I wasn't so upset from the pain, I would have thought it was funny.
    3. Realized that the preservatives in the steroids I was prescribed was causing further irritation and pain and called a compounding pharmacy to specially make me PF steroids, as well as compound Restasis in a different vehicle so it would not irritate me. I feel like this is something ODs could have done, but didn't.
    4. Told me I had severe ocular rosacea despite no facial rosacea - by this point, 75% of my MGs had atrophied. I think that this is something ODs should have caught...I had even asked them. So put on tetracyclines and off-label use of Metrogel and Azasite. Was told by the OMD that if the ODs had caught this early on like they should have, my MGs would be not be atrophied, and I would be in less pain.
    5. Ran blood tests for Sjogren's and some other diseases.
    6. Referred me to a trusted OD in the same clinic for bandage lenses to help with my corneal erosions.
    7. Put me on blood serum drops and lacriserts
    8. Referred me to an OD to try out specially designed contact lenses...had to travel out of state for this...surprised how few ODs have this expertise.
    9. Referred me to Boston Foundation for Sight for sclerals
    10. Took me off allergy drops
    11. Referred me to the allergist - turned out I had multiple food allergies contributing to eye inflammation.
    12. Has told me he has more in his bag of tricks for subsequent f/ups...and that he has not run out of options unlike what previous ODs have told me.
    13. Oh, he also cultured my eye, and took an eyelash to look for mites, which came up with nothing. But those were cool tricks, nonetheless.

    The corneal specialist had enough medical training to realize to look further than just eye...he looked at the lids, at other diseases that could manifest as dry eye, and even looked at food allergies! This is the reason I think that ocular disease may be better managed by OMDs...of course, keeping in mind there are crappy OMDs out there, as well as superb ODs.
    I mean, are blood serum drops, getting eye cultures, and allergy testing things that ODs tend to do to manage dry eye? I doubt it.
    I hope that answers your question, Carly Ess.
    Geez this was a long post.
     
  17. Carly Ess

    Carly Ess Bananas=Guilty Pleasure!
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    Thank you for posting the reply. I know you probably took you a long time to type out.

    As for the 5 OD's. Were they all in commercial establishments like Walmart or Visionworks? If so, I think it stems down to the OD's in those shops who are rushed by their managers to rush people in and out. I think the public should be told to never visit commercial places unless they want in-and-out service that is rushed and forced upon the OD.
     
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  18. KHE

    KHE Senior Member
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    Even though this poster has indicated that they no longer wish to participate in this thread, I wanted to make a couple of points here for the benefit of optometry and pre-optometry students.

    One of the things that I would be interested in knowing is the time frame from the first visit to an OD to the last visit. The biggest mistake that the later ODs made was in doing nothing different. Even if they had no clue what was happening, they should have made a referal to someone, particularly when none of the standard treatments worked.

    That's also an important point. All of the treatments that this person received are the standard treatments for their complaints. They are also the standard treatments for most Sjogrens syndrome cases.

    Phoning up another provider and bawling them out in front of a patient is the HEIGHT of unprofessionalism. This occurs rarely, but when it does it is almost exclusively because the unhappy doctor is virulently anti-optometry and is thrilled to have the opportunity to put on their little dog and pony show in front of a patient. His "outrage" at putting plugs in an inflammed eye is also likely just another opportunity to do the dog and pony show. Most eyes that are inflammed do show some amount of redness. For an eye and/or eyelid to be SO INFLAMMED that it's actually causing Meibomian gland atrophy would almost certainly show some level of redness and in most cases significant redness. By this patient's own admission, that wasn't present. This makes the option of punctal occlusion a reasonable attempt. The fact that this doctor ended up helping this patient on the first attempt (in large part by having the benefit of knowing what had been tried previously and had failed) he gets to look for the zebras (Sjogrens) and be the hero in the eyes of the patient. That's understandable, but he also seized the opportunity to run optometry into the ground.

    The moral of this story is not that "disease" should be seen by an ophthalmologist. I would bet $500 that 98% of ophthalmolgists (and optometrists) out there would have done the same things initially that the first two ODs did in this case. The remaining ones really dropped the ball by not making a referal in a case where a patient was not improving and remaining highly symptomatic despite all the standard treatments. Once that happens, that becomes outside the realm of "primary eye care." (again, whatever that is)
     
  19. IndianaOD

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    A corneal OMD is also not the same as a general OMD etc.
     
  20. fonziefonz

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    Different states/provinces give differing Rx rights to ODs.
     

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