Ocular Diseases?

[pharmstudent993]

Hey guys,

Do optometrists treat ocular diseases? Yes, I know that they can diagnose a variety of diseases, but are they directly involved in the treatment of the disease. What I mean is, do they prescribe the medication or do they just refer them to an ophthalmologist, and let him handle the disease? Thanks for any responses.

P.S. I don't mean vision problems.

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[IndianaOD]

Hey guys,

Do optometrists treat ocular diseases? Yes, I know that they can diagnose a variety of diseases, but are they directly involved in the treatment of the disease. What I mean is, do they prescribe the medication or do they just refer them to an ophthalmologist, and let him handle the disease? Thanks for any responses.

P.S. I don't mean vision problems.

Diagnose and treat everything short of surgery.
In most states ODs can prescribe any topical or oral medicine related to the eye and orbit.

About the only thing I ever refer is for catarct surgery, the rare lasik, the rare retinal detachment etc.

 

[rpames]

About the only thing I ever refer is for catarct surgery, the rare lasik, the rare retinal detachment etc.

I completely agree. The only time my patient sees an ophthalmologist is if they need to be cut. I have sent out a couple retinal issues I wanted a consult on, but they went right to the retinal specialist.

For example:
I had a 75 y/o male come to me at church and tell me he had trouble seeing just to the right of the center of his vision since yesterday. We skipped coffee hour and we went to my office. His retinal was fine so I ran a visual field. He had a field defect that told me he had had an ischemic event in his left temporal lobe of his brain. I had his PCP run a carotid doppler, echocardiogram, and MRI. Notice I said I had his PCP run those test, I personally did not run them or order them. Here is the fun part, that is exactly what an OMD would have done. I co-managed this patient with the doc who knows a little more about the systemic system than I.

The above example is what any OD would have done, if they know what is going on. Sure, some OD's farm things off, but they were trained how to handle that stuff.

ODs practice at all different levels. There are ODs in chains and private practice who send anything out the door that does not need a -2.50 lens in front of it. There are ODs in hospitals who directly order blood work and imaging scans. There are ODs who practice full scope medical optometry including oral medications, and in some states injectable.

You can pick what ever you want. Be a refrationist, or be a doctor. You get to choose.

 

[broadway]

Don't forget the patient also gets to choose. Sometimes they pick the guy w/ the md after their name. Don't get so caught up in ocular dz. 95% of pts. that visit od's visit for refractive care. I know it's a tough pill to swallow, but swallow it now so you won't be disappointed when you graduate.Also don't take it personally when a pt. that you have been treating leaves you to go see a specialist or a medical dr. It doesn't happen often but it happens.

 

[hello07]

IndiananOD and rpames, did you guys ever apply to Med school or take your MCAT's with the intention of becoming physicians? You both practice medical optometry and have much interest in it. Kudos to you by helping your patients utilizing your full scope knowledge.
Why didn't you guys become ophthalmologists? Fair question?

 

[362.04]

IndiananOD and rpames, did you guys ever apply to Med school or take your MCAT's with the intention of becoming physicians? You both practice medical optometry and have much interest in it. Kudos to you by helping your patients utilizing your full scope knowledge.
Why didn't you guys become ophthalmologists? Fair question?

hello07,

I'm guessing you've been practicing already for a few years but it begs the question of what you might have "missed" about ophthlamologists.

Although both optometrists and ophthalmologists may appear to overlap in medical optometry to some degree, that overlap isn't quite so pervasive.

Most often, optometrists aren't so focused on just the structure of the vision system like the surgeon does. That's the job of a surgeon. If it is there, cut it out.

Optometrists, however, also consider the function of the vision system and do provide a greater or broader viewpoint of the eye. Thus for many medical eye problems which impact function, there is that balance of when to pursue surgical intervention. It need not be done "just because it is there".

This is can be clearly seen in low vision where the retinal surgery is acclaimed to be a success, but unfortunately, the patient still cannot see or function. Most retinologists will say that their job is done. Enter the low vsiion rehabilitation specialist.

Back to the question of medical school vs optometry school. Granted the title of ophthalmologists MD provides an unlimited horizon than optometry will ever do, but that doesn't mean that much satisfaction can be attained by optometry schools if the expectations are correctly set.

Lastly, even though optometrists may be involved in medical eye care, even ophthalmologists will recognize that spectacle and contact lens sales can make a big difference in profitability and there aren' too many health care specialties that can generate revenue without the doctor ever touching the patient.

 

[hello07]

I understand your point well. Valid statements. as long as you believe in what you are telling me , that's is all that counts. My question was did they ever want to become physicians or ever want to go to Med school?
Since they are so much involved into therapeutics, why not become MD's and treat everything under the sun?
Some, might argue they are practicing as MD wannabe. i don't mean to sound cruel but we are all optometrists and all want to help people best we can. Some, think too highly of themselves above and beyond what we really are.

 

[362.04]

I understand your point well. Valid statements. as long as you believe in what you are telling me , that's is all that counts. My question was did they ever want to become physicians or ever want to go to Med school?
Since they are so much involved into therapeutics, why not become MD's and treat everything under the sun?
Some, might argue they are practicing as MD wannabe. i don't mean to sound cruel but we are all optometrists and all want to help people best we can. Some, think too highly of themselves above and beyond what we really are.

I answer those questions by saying that I am doing what they 're doing (or about 80% of their things) with my current level of training and education.

You have to say that there isn't just enough eye surgery to go around and many general ophthalmologists are struggling. Many have decided to take up refractive surgery or selling glasses for their salvation.

 

[IndianaOD]

IndiananOD and rpames, did you guys ever apply to Med school or take your MCAT's with the intention of becoming physicians? You both practice medical optometry and have much interest in it. Kudos to you by helping your patients utilizing your full scope knowledge.
Why didn't you guys become ophthalmologists? Fair question?

hello,

I really considered MD school. However it didn't make sense to me. I could never grasp spending 4 years in med school, 98% of which would never be used again if I became an ophthalmologist. I also really wanted to actually talk and interact with my patients. In my experience OMDs do about 5 minute exams and then cut on a patient who is doped up.

I think surgery is pretty neat, but if you spend all your days doing the same procedures and exams its not much different than optometry. You just make more money.

I did not know all of optometry's problems going in, otherwise I might have reconsidered. Dermatology was on my radar screen as possibly neurology. I truly believe that almost all OD students could have gotten into an MD school if they really wanted to.

Not to toot my own horn, but I graduated #1 out of my undergrad pre-med class. At least 5 students quite a ways behind be got into medical schools. I scored at the top of the nation on the boards and was in the top 3 of my OD class. I could have done whatever basically but I usually like what I do now and have the training to truly understand the entire visual process, not just the organic structure and funtion necessary for surgery. Plus I think if you become an ophthalmologist the only smart thing to do is subspecialize.

 

[still_confused]

Not to toot my own horn, but I graduated #1 out of my undergrad pre-med class. At least 5 students quite a ways behind be got into medical schools. I scored at the top of the nation on the boards and was in the top 3 of my OD class.

nerd-alert

 

[rpames]

I also considered medical school. I did research at Des Moines Osteopathic Medical school for a couple years in undergrad and also took the MCAT. I worked for a "bone-breaker MD" for a summer and did a lot of research. I did not graduate number one in anything, but I was told by the people at DMU that I could have gotten in several schools.

After thinking long and hard about my goals in life, the OD made more sense. I knew I wanted to me an OD or OMD. OMD is actually one of the hardest residencies to get. So I knew there was a small chance of me getting it. My father is an OD so I wanted to take over his practice and if I went to medical school and did not get the OMD spot, I would be screwed...at least for that plan.

As far as being able to treat "anything under sun." I can! I treat EVERYTHING medical that comes in my door. If they need surgical intervention, I send it out the right sub-specialist. This way I get to treat retina to cornea. If I were a OMD, I would only really see one part of the eye and send out to other sub-specialist. If I were a cornea guy, I would send out retina stuff. They self limit, just as I do.

Got to go!

 

[WoodyJI]

...Since they are so much involved into therapeutics, why not become MD's and treat everything under the sun?
Some, might argue they are practicing as MD wannabe. i don't mean to sound cruel but we are all optometrists and all want to help people best we can. Some, think too highly of themselves above and beyond what we really are.

I think that it's good for us to think highly of ourselves. There's no reason to sit under a self-imposed inferiority complex simply b/c there are MDs out there who could theoretically do our job + surgery.

Like most people have said, ophthalmology residency is one of the most selective and difficult positions to obtain. I don't know much, but I'm sure that being a surgeon of any kind requires such a breath of underlying knowledge (for the purpose of unexpected complications) that not very many students would ultimately be willing, even if capable, to put in the work required to perform that service. I would guess that most med students don't go in with an interest in opthalmology, or even one specific residency to begin with. Residency selection requires time--rotations, gauge of your academic standing and abilities/options, etc. Even if someone enters med school knowing that they want to be a surgeon, that still doesn't mean they'll pick eye surgery. It's not as simple as, "Oh, you want to treat eyes? Don't do optometry b/c only an MD can do everything under the sun, including surgery..."

The truth is, no doctor, no matter how prestigious, will treat "everything under the sun." We're all limited in our scope of practice, that is, if we want to keep our licenses. I'm sure you know that legally an MD has the freedom to treat whatever they want, and sure, that makes it sound like their options are so much greater, but they're really not. The medical field is becoming increasingly specialized, even within different professional sets. I would consider a dentist or an optometrist a med school candidate who has already made up their mind on a specialty. They've matched themselves and their abilities to the program's mode of practice, and I think you'll find that their options are still substantially wide. Just consider all the different styles of practicing optometry that we have to choose from--excluding a specific subset of surgery (i.e., eye surgery as opposed to heart surgery) from the list doesn't really diminish the content substantially. In addition, optometrists have the opportunity, through their specialized training, to gain proficiency at things which ophthalmologists don't get the same degree of training on. I won't go into details there, as this thread could spin out of control, but it's a simple concept. If eye doctors do more refractions than eye surgeons do in a week, and they're both smart people, who's going to have sharper skills when the patient with blurry vision walks in the door on Monday?

 

[IndianaOD]

nerd-alert

Heh, proud of it.

I also want to address this notion that an OMD residency is impossible to get into. Its just not true. If I recall correctly there is nearly a 90% match ratio.

The matches don't have higher GPAs because they are technically more difficult, but because more MD students want to do it. That's why more 9-5 jobs like dermatology, plastics, and ophthalmology are way at the top. Doesn't hurt that the salaries are very high.

Personally I think psychiatry should be near the top, but nobody wants to do it, so its at the bottom.

 

[VA Hopeful Dr]

Heh, proud of it.

I also want to address this notion that an OMD residency is impossible to get into. Its just not true. If I recall correctly there is nearly a 90% match ratio.

The matches don't have higher GPAs because they are technically more difficult, but because more MD students want to do it. That's why more 9-5 jobs like dermatology, plastics, and ophthalmology are way at the top. Doesn't hurt that the salaries are very high.

Personally I think psychiatry should be near the top, but nobody wants to do it, so its at the bottom.

The reason there is a 90% match rate is because residencies tend to be fairly self-selected. For example - my med school gpa is not that great. Since this is the case, I won't even bother applying for derm/ophtho/rads.

 

[IndianaOD]

I'm not intending to head down this road again but I personally worked with 3 OD, MDs. None of them were at the top of their OD classes (not at the bottom either). Since I am curious I asked them all about their experiences and they stated it wasn't as difficult to match as everyone made it out to be.

This was just their take though, and they are all excellent docs.

 

[VA Hopeful Dr]

I'm not intending to head down this road again but I personally worked with 3 OD, MDs. None of them were at the top of their OD classes (not at the bottom either). Since I am curious I asked them all about their experiences and they stated it wasn't as difficult to match as everyone made it out to be.

This was just their take though, and they are all excellent docs.

That is one of the things I've noticed in my admittedly small sample size. The non-traditional students seem to have their stuff together more than those of us straight out of college. They always seem less stressed and have a better handle on everything.

 

[hello07]

Kudos to both of you IndianaOD and rpames on your hard work and accomplishments. Both of your statements are impressive and pretty valid on how you feel and believe.

all the Best to both you!

 

[MacGyver]

Sure optometrists claim to treat everything, but bear in mind they wont get the volumes of pathology that MDs get.

Take for example glaucoma, I bet the average MD sees at least double or triple the amount of glaucoma pathology that an OD sees, and thats for regular opthos too. The glaucoma specialist MDs see at least 40 glaucoma patients every day in clinic.

 

[prettygreeneyes]

Sure optometrists claim to treat everything, but bear in mind they wont get the volumes of pathology that MDs get.

Take for example glaucoma, I bet the average MD sees at least double or triple the amount of glaucoma pathology that an OD sees, and thats for regular opthos too. The glaucoma specialist MDs see at least 40 glaucoma patients every day in clinic.

So you bumped a month old thread to add this?

 

[IndianaOD]

So you bumped a month old thread to add this?

I second that. What a goober. There are many ODs who treat much more glaucoma that the average OMD. Glaucoma is NOT hard to treat.

 

[Olddog1]

Glaucoma is NOT hard to treat.

If it is not hard to treat why is it the second leading cause of blindness in the United States? Why is failure to diagnose glaucoma one of the leading cause of lawsuits for eye care providers in the United States? Why do I hear "I have been treated for 20 years, how did I go blind"? Some reasons are late referral to a specialist (no an IOP of 15 with threatened fixation may not be low enough), not breaking out the gonio lens on every patient, failure to realize an unreliable visual field cannot be used to make treatment decision, only using the prior field to establish a trend, etc... People that say glaucoma is not hard to treat may be the ones slowly dropping their patients into blindness.

 

[KHE]

If it is not hard to treat why is it the second leading cause of blindness in the United States? Why is failure to diagnose glaucoma one of the leading cause of lawsuits for eye care providers in the United States? Why do I hear "I have been treated for 20 years, how did I go blind"? Some reasons are late referral to a specialist (no an IOP of 15 with threatened fixation may not be low enough), not breaking out the gonio lens on every patient, failure to realize an unreliable visual field cannot be used to make treatment decision, only using the prior field to establish a trend, etc... People that say glaucoma is not hard to treat may be the ones slowly dropping their patients into blindness.

This is incredibly insightful, and I agree strongly. Glaucoma is not technically difficult to treat because for the vast majority of patients the treatment is "take these eyedrop twice a day" but there is most definately an art to managing glaucoma and the nuances can be subtle.

 

[Eyedoc1999]

If it is not hard to treat why is it the second leading cause of blindness in the United States? Why is failure to diagnose glaucoma one of the leading cause of lawsuits for eye care providers in the United States? Why do I hear "I have been treated for 20 years, how did I go blind"? Some reasons are late referral to a specialist (no an IOP of 15 with threatened fixation may not be low enough), not breaking out the gonio lens on every patient, failure to realize an unreliable visual field cannot be used to make treatment decision, only using the prior field to establish a trend, etc... People that say glaucoma is not hard to treat may be the ones slowly dropping their patients into blindness.

Glaucoma is the leading cause of preventable blindness in large part because of the insidious nature of the disease. I think the diagnosis is the hardest part of most glc patients if you care enough to try to catch them early. Many patients don't get checked by ANYONE because their vision isn't affected to the point that it forces them into an office. I agree that glaucoma is relatively easy to manage if you keep up and know your stuff...that's not to say that there aren't complicated glc patients that crash regardless of intervention, but they aren't the norm. Nor do I think that breaking out the gonio is going to lead to a large increase in the number of diagnoses. The realization by older ODs and MDs that IOP is reasonably worthless in making a diagnoses (huge IOPs not withstanding) and the recognition that the later the diagnosis is made, the poorer the prognosis would lead to a huge reduction in the number of folks blinded by glc.

 

[IndianaOD]

Just keep up with the studies and do a decent job and nobody will slip into blindness. You can't force anybody to come back for a glaucoma eval or have an exam in the first place. Lack of regular exams is the main reason anyone in this country will go blind for glaucoma.

For example, I had my first patient ever yesterday refuse a GDx exam after I educated him that his optic nerves were suspicious.

During my VA externships I probably saw on average of 3-4 glaucoma patients a day in various stages of the disease. This means the ODs were probably seeing around 6-8 of them a day.

What is so hard? If the GDx, ONH appearance, and visual fields get worse, you lower the pressures further. If they reach maximal medical therapy and still have trouble you send them for a trab. Patients with glaucoma don't go blind overnight. If you follow them every 3 months like I do I don't see how you could go wrong unless you were just incompetent.

 

[KHE]

The realization by older ODs and MDs that IOP is reasonably worthless in making a diagnoses (huge IOPs not withstanding) and the recognition that the later the diagnosis is made, the poorer the prognosis would lead to a huge reduction in the number of folks blinded by glc.

To say that IOP is "reasonably worthless" in making a diagnosis is irresponsible, in my opinion. The implication of that statement is that IOP plays little role in the development or progression of glaucoma. If that's the case, then why is the first thing we try to do when we diagnose someone with it is lower the IOP?

In your opinion, what is the number one risk factor for the development of glaucoma?

 

[Eyedoc1999]

To say that IOP is "reasonably worthless" in making a diagnosis is irresponsible, in my opinion. The implication of that statement is that IOP plays little role in the development or progression of glaucoma. If that's the case, then why is the first thing we try to do when we diagnose someone with it is lower the IOP?

In your opinion, what is the number one risk factor for the development of glaucoma?

In my opinion? I would say it's a combination of factors. Likely a combination of the inability of perfusion to overcome the mechanical effects of IOP (high or not) combined with a mechanical pressure of the lamina cribosa on the nerve fibers cutting off axoplamic flow.

I didn't say that IOP wasn't a factor in glc, I said that it's MEASUREMENT relatively worthless in making a diagnosis (excluding really high pressure). You simply can't make a diagnosis based on a measurement of IOP. There are a lot of factors that influence IOP such as diurnal curves and cct AND there are plenty of normal tension glc patients. To me, I use PATTERN of IOP as a measurement of how effective my treatments are over the short term since it's all we have to work with. Even if you buy into the claims of increasing perfusion by brimonidine, it's not something measureable or provable. Decreasing the IOP is important in the treatment because it obviously takes care of the above causes. That being said, unless you've seen a patient for a number of years and can verify the increase in IOP (again based on pattern) or you have a statistically high pressure that you can say is not OHTN, a snapshot measurement of IOP does you little good.

Evaluation of the ONH and NFL is a much better tool in evaluating glc than IOP. I have to assume that you know this and are simply asking to see if I do. Do I call you Devil's or Mr. Advocate?

 

[KHE]

In my opinion? I would say it's a combination of factors. Likely a combination of the inability of perfusion to overcome the mechanical effects of IOP (high or not) combined with a mechanical pressure of the lamina cribosa on the nerve fibers cutting off axoplamic flow.

Evaluation of the ONH and NFL is a much better tool in evaluating glc than IOP. I have to assume that you know this and are simply asking to see if I do. Do I call you Devil's or Mr. Advocate?

I don't play silly games like that. Even the dimmest of providers does not manage glaucoma using IOP in isolation. But I am very concerned by what appears to be an incredibly cavalier attitude displayed by a few providers on this forum regarding glaucoma management.

Statements like "glaucoma is easy to treat" and "IOP is a relatively worthless measurement" and "just keep up with the studies and no one will go blind" border on irresponsible. Thousands of people go blind every year under the care of specialists who not only keep up with the studies, they create the studies.

If glaucoma isn't difficult to treat, then what is?

 

[Olddog1]

see below

 

[Olddog1]

Just keep up with the studies and do a decent job and nobody will slip into blindness. You can't force anybody to come back for a glaucoma eval or have an exam in the first place. Lack of regular exams is the main reason anyone in this country will go blind for glaucoma.

For example, I had my first patient ever yesterday refuse a GDx exam after I educated him that his optic nerves were suspicious.

During my VA externships I probably saw on average of 3-4 glaucoma patients a day in various stages of the disease. This means the ODs were probably seeing around 6-8 of them a day.

What is so hard? If the GDx, ONH appearance, and visual fields get worse, you lower the pressures further. If they reach maximal medical therapy and still have trouble you send them for a trab. Patients with glaucoma don't go blind overnight. If you follow them every 3 months like I do I don't see how you could go wrong unless you were just incompetent.

The short response to this thread is ARRRRRGH. The flippant attitude is depressing, and shows why people lose vision from this disease. It is easy if you are throwing medicine at someone with a borderline IOP, thick cornea, full field and a large nerve. It tends to get more tricky when you are actually managing the disease.

First, I'll start with the prior post that stated breaking out the gonio lens will not lead to a surge in glaucoma diagnosis. True, but the treatment for Narrow angles/CACG is different than the tx for POAG, esp when the early goal is to prevent PAS. Also, a simple LPI may open the angle and increase outflow eliminating the need for gtts in patient with OHT and healthy nerves.

The above post mostly reflects a lack of practice experience, especially the nobody will slip into blindness comment. That is clearly someone who has not watched people go blind with full medical and surgical approaches, and with a pressure of 10. The "What is so hard? If the GDx, ONH appearance, and visual fields get worse, you lower the pressures further. If they reach maximal medical therapy and still have trouble you send them for a trab." is scary more than any thing else. How do you know the GDX is getting worse? Where is the ranodomized prospective study which tells how to predict progression from ONH imaging? Is there a prospective study that shows concordance of VF progression and loss of nerve fiber layer (hint:no)? People act like you get a GDX/OCT/HRT and it will tell you what to do and the reality is the technology is not there yet. You talk about optic nerve head appearance. Is that from drawings? Is it based on you filling in the cup/disk bank on your chart with 0.7 today vs 0.6 six months ago, or do you actually have stereo photos on every patient? If you do, have you really looked at enough to tell there is progression. Then there is the visual field test. While it is probably the best thing we have, the determination of progression is based on a subjective test taken by the patient and a subjective evaluation by the interpreter to determine if there is progression. After you think they are progressing and feel surgical intervention is needed do you refer when that little 5 degree field is left, or do you think it would be smarter to intervene when there is alot of vision left to save? Nothing says fun like performing a trab on someone who has two ganglion cells left because someone has been waiting for them to really get worse while trying assorted drop combinations. However, you are correct that patients don't go blind overnight, so I wonder why you see them every three months? After establishing a baseline IOP what are you doing at all of those visits besides increasing your portfolio? I think I have made my point that glaucoma management (we haven't even touched on uveitic, JOAG, neovascular, etc...) is not like following a cook book. You need to see alot of nerves and alot of fields (and sometimes have some good luck) to effectively manage the patients that truly have glaucoma.

 

[redrockprincess]

The short response to this thread is ARRRRRGH. The flipant attitude is depressing, and shows why people lose vision from this disease.

There are optometrists in this thread who are agreeing with you. Really, it is only one poster who has completely trivialized the management of glaucoma, and he DOES NOT speak for everyone here.

 

[hello07]

Having read all the aforementioned posts here's my 2 cents folks. Glaucoma IS NOT EASY TO TREAT! Sure, you get your straightforward cases but alot of OAG/ primary and secondary glaucomas can be difficult to manage. Not only do you have to use your full arsenal of glaucoma meds you gotta be surgically skilled (trabeculectomies, iridotomies, cyclodestruc, etc........
For the challenging ones, these are not for optometrist to handle. I am sorry. Why are they called glaucoma specialists?
I don't want to go off on Indiana OD so i am being nice about it.
MD's treat MORE glaucoma than us. Come on buddy. Let's not flatter ourselves.

 

[KHE]

For the challenging ones, these are not for optometrist to handle. I am sorry. Why are they called glaucoma specialists?
I don't want to go off on Indiana OD so i am being nice about it.
MD's treat MORE glaucoma than us. Come on buddy. Let's not flatter ourselves.

I don't think the issue is whether they treat "more" glaucoma than optometrists do because it's pretty much a given. The question is really "are optometrists adequately trained to manage the cases they currently manage?" and I think for that, the answer is YES.

Optometrists by their very nature tend to be incredibly conservative and 99% of them are going to refer out at the first sign of trouble, and very very few are going to attempt to manage complex glaucomas such as uveitic, neovascular, and pseudoexfoliative.

Now I can bet that there is going to be some ophthalmology residents posting on and on about how "they saw this patient or that patient in glaucoma clinic who was seen by an OD and they went blind because they were misdiagnosed or not referred soon enough and ODs suck and blah blah blah." Yes...I'm sure that happens. But spend even a short time in any glaucoma specialists office and you will see just as many cases of patients who were misdiagnosed by OMDs, or who were held onto for too long by generalists before being referred for surgical intervention. So lets not even bother trading anecdotes.

The point of all this though is that I agree strongly with olddog and hello07. Glaucoma is NOT easy to treat and the somewhat cavalier attitude displayed on this thread by some is very disconcerting.

 

[IndianaOD]

Everything is ridiculously hard to handle. I mean without an MD how could I ever treat anything? MDs will always say its complicated to inflate their egos.

This is crazy talk. No, Glaucoma is not a trivial disease, but it really doesn't take a rocket scientist to do a competent job for your patients.

There is no doubt that a glaucoma subspecialist has the most experience, but I completely disagree that everyone who is at risk should see these folks. I'm sure there are a lot of ODs in referral centers who manage twice the glaucoma load as general OMDs.

I had several glaucoma patients on rotations with 10 degree fields or less. Regardless of OD or OMD we have access to the same studies and if you are not a total goober, most follow an almost identical treatment course.

How many treated glaucoma patients progress to sever glaucoma? I'm betting not very many. Most of the ones I saw had a Hx of poor compliance and let themselves go this way. If its over my head, sure I will happily refer, and yes I do gonio on all my suspects.

 

[Eyedoc1999]

Ok....this is going nowhere. How about we meet in the middle and say that it takes a skilled practitioner to manage glaucoma, BUT the treatments are straight forward and it is relatively easy to determine the effectiveness of your treatment given the correct equipment.

 

[Olddog1]

The question is really "are optometrists adequately trained to manage the cases they currently manage?" and I think for that, the answer is YES.

Yes

Optometrists by their very nature tend to be incredibly conservative and 99% of them are going to refer out at the first sign of trouble, and very very few are going to attempt to manage complex glaucomas such as uveitic, neovascular, and pseudoexfoliative.

Absolutely yes and most of the referrals are not for surgery. Usually something does't make sense in the dz course and the doc wants a fresh perspective. They get a letter and the patient back.

But spend even a short time in any glaucoma specialists office and you will see just as many cases of patients who were misdiagnosed by OMDs, or who were held onto for too long by generalists before being referred for surgical intervention.

Sadly yes, esp. the latter.