Oklahoma optometrists doing LASIK

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devildoc2

devildoc2

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OK, got a wake up call this morning. Went in for routine eye exam and the optometrist has about 50 certificates on the wall proclaiming that he is a "qualified laser surgeon" and other stuff.

I knew ODs were allowed to do some extra stuff, but I didnt know PRK, LASIK and all the other subtypes of LASIK were included in that.

One thing was weird about it though. You'd think that since he was a "LASIK surgeon" that he would devote a big chunk of his practice to it, since its such a huge cash cow. But apparently thats not the case, because his shop seemed like a regular "refractor-hut" to me.

Perhaps he cant compete against all the opthalmologists? This was in Oklahoma City by the way.
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Is this for real? I've never heard of optometrists being able to get certified in performing Lasik...
 
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unbelievable. Are Oklahoma OD's allowed to perform Lasik? Call the state board, investigate him, this OD is a sick dude!
 
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Yes, apparently Oklahoma ODs have been doing LASIK since around 1998. This guy was the first OD "licensed" in Oklahoma for all anterior segment laser procedures. He's got letters from his optometry school posted on his walls (Northeastern State Univ in OK) praising him for being a "pioneer" in optometrists doing laser procedures.

Here's his website:

http://curtmassengale.com/


Here's a website of all the "LASIK surgeons" in Oklahoma City. More than half are ODs.

http://www.lasereyesurgery.com/lasik-surgeon/usa/ok-oklahoma-city.html
 
I believe these OD's advertise Lasik surgery and referral to OMD's. They manage pre-op and post- op Lasik with ophthalmology. I believe they don't actually perform the Lasik themselves but rather co-manage the care.
They do however perform YAG capsulotomies in the past.
Some people are scared of having the procedure done by MD's, who in their right mind would want an optometrist to perform lasik on them? Get a psych consult first and then go to an OD for lasik.
 
That is cool.....I am actually going to do a 3 month externship in OK for the sake of doing some of those procedures even though my home state does not have those privileges. Oklahoma is the model state for optometry and Dentistry is the model profession for us to emulate. I even have the anterior segment laser seminar courses brochure offered by the school----Trabs, SLT's, and Iridotomy courses. I know I will not be able to do these procedures after I finish my residency (post O.D. and 13 months in length to improve medical management and primary eye care skills) but It will be a good learning experience. I have a trip planned this summer to take a look at how they have been so legislatively successful because I am very politically active student in touch with my senators and state board members. I plan on earning a JD a few years from now as well. The future is bright.


Rock on Oklahoma.
 
hello07 said:
I believe these OD's advertise Lasik surgery and referral to OMD's. They manage pre-op and post- op Lasik with ophthalmology. I believe they don't actually perform the Lasik themselves but rather co-manage the care.
They do however perform YAG capsulotomies in the past.
Some people are scared of having the procedure done by MD's, who in their right mind would want an optometrist to perform lasik on them? Get a psych consult first and then go to an OD for lasik.
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Well some of them on the list only do co-management. However, ODs are allowed to do the laser surgery too, not just co-manage.

If you go to this guy's website, he's clearly advertising himself as the surgeon, not just a co-manager with referral to MD. There's a PDF document on that website where he clearly states that HE will be doing the surgery, not an MD. It states that he's "completed approximately 1500 successful LASIK surgeries"
 
Well, Oculomotor, the important thing is that you're modest:)

Give it a rest pal. The fact that you troll the web, posting comments in a tone to incite conflict makes it hard for me to take you seriously. Your credentials and aspirations don't concern me, or most other people on here. People who are the best at what they do don't need to advertise. Really, get over yourself, please.

Respectfully yours,
ophthal3
 
devildoc2 said:
Yes, apparently Oklahoma ODs have been doing LASIK since around 1998. This guy was the first OD "licensed" in Oklahoma for all anterior segment laser procedures. He's got letters from his optometry school posted on his walls (Northeastern State Univ in OK) praising him for being a "pioneer" in optometrists doing laser procedures.

Here's his website:

http://curtmassengale.com/


Here's a website of all the "LASIK surgeons" in Oklahoma City. More than half are ODs.

http://www.lasereyesurgery.com/lasik-surgeon/usa/ok-oklahoma-city.html
Click to expand...


I just wanted to say that this optometrist is not listed as a member of the International Society of Refractive Surgeons as he states in his website.
 
devildoc2 said:
OK, got a wake up call this morning. Went in for routine eye exam and the optometrist has about 50 certificates on the wall proclaiming that he is a "qualified laser surgeon" and other stuff.

I knew ODs were allowed to do some extra stuff, but I didnt know PRK, LASIK and all the other subtypes of LASIK were included in that.

One thing was weird about it though. You'd think that since he was a "LASIK surgeon" that he would devote a big chunk of his practice to it, since its such a huge cash cow. But apparently thats not the case, because his shop seemed like a regular "refractor-hut" to me.

Perhaps he cant compete against all the opthalmologists? This was in Oklahoma City by the way.
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I think you might read the web site more carefully. This practitioner is not advertising LASIK but PRK. The practitioner co manages LASIK. I agree, though, that his claim of being a member of ISRS is a bit suspicious.
 
As an Oklahooma OD, I can shed some light on the situation.

Our state law does not include LASIK. Oklahoma law specifically states:

"... the correcting and relief of ocular abnormalities by means including but not limited to ... laser surgery procedures, excluding retina, laser in-situ keratomileusis (LASIK), and cosmetic lid surgery." 59 O.S. Section 581

OD's that practice in ophthalmology practices routinely perform Yag's, PI's, ALT/SLT's. There are very few OD's statewide that are performing refractive surgery. Those that do perform PRK and used to do LASEK. I am not sure if there are any still doing LASEK. Certification by VISX for PRK is done by an OMD trainer alongside any OMD's that need certification.

Personally, I think it is a disservice to our patients to try and do refractive procedures when we can send them to an OMD/ODO who has performed hundreds if not thousands. How many procedures can an OD office produce?

I know that there are OD's that don't agree with that opinion. Yes, I enjoy our scope of practice, but we must still do what's right for the patient!

The anterior segment laser procedures have been performed with great success. During our last legislative "scuffle" the ophthalmology lobby could not produce any evidence in regards to adverse outcomes due to the type of provider performing the procedure and that's what the legislators wanted to see to prove their claims of injury to patients.

Hope that helps!
 
devildoc2 said:
I knew ODs were allowed to do some extra stuff, but I didnt know PRK, LASIK and all the other subtypes of LASIK were included in that.
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Dr. Massengale graduated from Northeastern State University College of Optometry in 1984, with a Doctorate of Optometry degree. He established a practice limited to contact lenses at the Tulsa Eye Clinic where he worked with ophthalmologists specializing in cornea, refractive surgery and cataract surgery. He gained valuable experience working with surgery patients and post-operative eye care.

In 1989, Dr. Massengale moved to Oklahoma City and opened a private practice in south Oklahoma City at Crossroads Mall where he remains practicing today. He opened his second office at Penn Square Mall in 1998.

Dr. Massengale has been a member of both the American Optometric Association and the Oklahoma Association of Optometric Physicians since 1984, and is a member of the International Society of Refractive Surgeons. He participates with the American Red Cross, Lions Club International and other local and national organizations in providing eye care to the underprivileged.

Dr. Massengale is a member of the national group of Association of Lenscrafters Leaseholding Doctors for which he held a seat on the board of directors for 3 years. In 1990 he was selected as a charter member of the Optometric Advisory Council for Lenscrafters. He is currently a Leadership Team member for Vistakon. He has participated in pre-release clinical trials for contact lenses and has lectured at a number of conferences about various aspects of eye care including the benefits of retinal photography, cataract post-operative care, glaucoma management and prescribing oral medications.

Dr. Massengale keeps abreast of the latest technology and annually completes at least 18 hours of continuing education. He is a leader among Optometric Physicians in the use of lasers in eye care. He is certified in the newest laser technology for the treatment of glaucoma, Selective Laser Trabeculoplasty (SLT), as well as Argon Laser Trabeculoplasty (ALT). He is experienced in Nd:YAG laser capsulotomy for post cataract surgery patients as well as laser peripheral iridotomy surgery for Narrow Angle Glaucoma. Dr. Massengale is also experienced performing PRK Laser Vision Correction Surgery.



His website doesn't seem to distinguish clearly whether he performs PRK and/or LASIK, but in his (detailed) biography, he makes no mention of doing LASIK. It would seem if he DID do LASIK, he would say he does here. There is the possibility his bio hasn't been updated, but my guess is that would be unlikely.


As for the Oklahoma OD, does ANY OD have the right to laser procedures, or do they have to do a laser/Ant.seg residency first?
 
qwopty99 said:
As for the Oklahoma OD, does ANY OD have the right to laser procedures, or do they have to do a laser/Ant.seg residency first?
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The school in Oklahoma teaches anterior segment laser procedures so if you graduate from NSUOCO and pass the boards (which includes a laser section) you are certified. If you graduate from another school and pass the boards including the laser section your are certified. If you are a practicing OD that did not have the education needed you can take a 3 day laser CME and if you pass the test then you can become certified.
 
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coppertopdoc said:
Personally, I think it is a disservice to our patients to try and do refractive procedures when we can send them to an OMD/ODO who has performed hundreds if not thousands. How many procedures can an OD office produce?

I know that there are OD's that don't agree with that opinion. Yes, I enjoy our scope of practice, but we must still do what's right for the patient!
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I think there are more OD's that agree with this than disagree.
 
Thank the lord I don't plan practicing in Oklahoma!!

I don't understand why OD's can't just stay in their scope of practice... I mean if you wanted to do eye surgery, you should have went to med school, residency, fellowship, etc like the rest of us. I think that most ODs are nice people, but reading about these OK OD's really annoys me.

-J
 
WhatNEyeTem said:
Thank the lord I don't plan practicing in Oklahoma!!

I don't understand why OD's can't just stay in their scope of practice... I mean if you wanted to do eye surgery, you should have went to med school, residency, fellowship, etc like the rest of us. I think that most ODs are nice people, but reading about these OK OD's really annoys me.

-J
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Thank you. Thank you for needlessly reviving a 10 month old thread that had died a peaceful death.
 
"Thank the lord I don't plan practicing in Oklahoma!!

I don't understand why OD's can't just stay in their scope of practice... I mean if you wanted to do eye surgery, you should have went to med school, residency, fellowship, etc like the rest of us. I think that most ODs are nice people, but reading about these OK OD's really annoys me.

-J "

OH PLEAAAAAAAAAASE! You and I both know that a monkey could do YAG's, SLT's, ALT's, etc..(it is ridiculously simple). The fact is your profession (Medicine spearheaded by ophthalmology) cares about ONE thing and one thing alone-----> market share. Period--I don't blame you. If I was indoctrinated as an MD (or a DO--lol)in med school (basically told that all other doctorate level health care practitioners are inferior to me) and did 4 yrs post med school in an ophtho residency I would have a "myopic view" of this topic as well. Now I really could give a rat's a s s about "real ocular surgery" (I have orals--including narcotics and steroids, injectibles, and all ocular meds in the state I am going to practice in) but let's not recycle the same "patient safety" nonsense that ophthalmology has used to fuel its scare tactics since the first state got prescription rights for OD's in the early 70's and ophthalmologists said," they will blind people" with diagnostic agents or later on in the 80's---"kill them with topical Beta-Blockers."--what is the chance of topical betaxolol (Betopic-S) used properly killing somebody? :) I am just sick and tired of all of these lies. blah blah Blah-- Just be honest and say that you don't want your "market share" infringed upon and I will have a lot more respect for your argument. That would be a very valid argument. $$$money matters.
 
Oculomotor said:
"Thank the lord I don't plan practicing in Oklahoma!!

I don't understand why OD's can't just stay in their scope of practice... I mean if you wanted to do eye surgery, you should have went to med school, residency, fellowship, etc like the rest of us. I think that most ODs are nice people, but reading about these OK OD's really annoys me.

-J "

OH PLEAAAAAAAAAASE! You and I both know that a monkey could do YAG's, SLT's, ALT's, etc..(it is ridiculously simple). The fact is your profession (Medicine spearheaded by ophthalmology) cares about ONE thing and one thing alone-----> market share. Period--I don't blame you. If I was indoctrinated as an MD (or a DO--lol)in med school (basically told that all other doctorate level health care practitioners are inferior to me) and did 4 yrs post med school in an ophtho residency I would have a "myopic view" of this topic as well. Now I really could give a rat's a s s about "real ocular surgery" (I have orals--including narcotics and steroids, injectibles, and all ocular meds in the state I am going to practice in) but let's not recycle the same "patient safety" nonsense that ophthalmology has used to fuel its scare tactics since the first state got prescription rights for OD's in the early 70's and ophthalmologists said," they will blind people" with diagnostic agents or later on in the 80's---"kill them with topical Beta-Blockers."--what is the chance of topical betaxolol (Betopic-S) used properly killing somebody? :) I am just sick and tired of all of these lies. blah blah Blah-- Just be honest and say that you don't want your "market share" infringed upon and I will have a lot more respect for your argument. That would be a very valid argument. $$$money matters.
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Did I say in my post that I did not care about market share? Of course I care about market share.

But the bigger point is that these procedures/surgeries are privileges that should be earned via the established and proper route. Any human being can do any procedure/surgery in this world. I'm pretty sure I could do breast implants, carpal tunnel surgery, amputations, etc if I wanted to... but that does not mean I have earned the privilege to do them, because I have not gone through the proper channels to earn these rights.

So please, just go through the proper training route (ie. med school, residency, +/- fellowship) and I won't be annoyed that you are doing things that we (Ophthalmologists) have the privilege to do.

Thanks,

-J
 
WhatNEyeTem said:
Did I say in my post that I did not care about market share? Of course I care about market share.

But the bigger point is that these procedures/surgeries are privileges that should be earned via the established and proper route. Any human being can do any procedure/surgery in this world. I'm pretty sure I could do breast implants, carpal tunnel surgery, amputations, etc if I wanted to... but that does not mean I have earned the privilege to do them, because I have not gone through the proper channels to earn these rights.

So please, just go through the proper training route (ie. med school, residency, +/- fellowship) and I won't be annoyed that you are doing things that we (Ophthalmologists) have the privilege to do.

Thanks,

-J
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I just wanted to quote a VERY interesting article in this month's Ophthalmology Management "Consider Adding a Hearing Center" by oMD Peter Polack...

As reimbursements have declined, we have all seen physicians from different specialties add complementary (and not-so-complementary) services: the family practice doctor offering Botox, the Ob-Gyn performing tummytucks, or the dermatologist doing blepharoplasty.

And you though me doing LASIK was so sinful... :laugh:
 
Meibomian SxN said:
I just wanted to quote a VERY interesting article in this month's Ophthalmology Management "Consider Adding a Hearing Center" by oMD Peter Polack...

As reimbursements have declined, we have all seen physicians from different specialties add complementary (and not-so-complementary) services: the family practice doctor offering Botox, the Ob-Gyn performing tummytucks, or the dermatologist doing blepharoplasty.

And you though me doing LASIK was so sinful... :laugh:
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Not sinful... but a privilege that was not earned.

At least the aforementioned folk are MD's :)

Remind me never to let my friends/family live in Oklahoma!

-J
 
Dude, get over yourself. In the primary eye care realm we do what you do! LOL "At least they are MD's" that is an idiotic comment...No ophthalmologist has any business prescribing hearing aids....hell at least an optometrist is a primary eye doctor---> doing lasik is an "eye care" procedure! Your analogy is piss poor. Your MD is just a clinical doctorate degree like OD, DDS, DPM, etc....so stop self-aggrandizing! :laugh:
 
Meibomian SxN said:
I just wanted to quote a VERY interesting article in this month's Ophthalmology Management "Consider Adding a Hearing Center" by oMD Peter Polack...
Click to expand...

I would totally add a hearing center.... imagine your patients actually being able to hear you?!?! Brilliance!
 
Oculomotor said:
Dude, get over yourself. In the primary eye care realm we do what you do! LOL "At least they are MD's" that is an idiotic comment...No ophthalmologist has any business prescribing hearing aids....hell at least an optometrist is a primary eye doctor---> doing lasik is an "eye care" procedure! Your analogy is piss poor. Your MD is just a clinical doctorate degree like OD, DDS, DPM, etc....so stop self-aggrandizing! :laugh:
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"Dude", you hardly do what I do... I don't say "1" and "2" all day :)

We have OD students rotating in our clinic sometimes -- your comment will make me less inclined to teach them anything.

-J
 
Refraction is a very important part of Primary Eye Care.

I think those OD student's will live LOL! In either case you obviously understand that most of primary eye care is refractive-----65% based on 3 different scientific surveys I can send you at your pleasure. The remaining 35% is eye health related----> comprehensive eye exams, treatment of primary eye disease (92% of the time with topical ocular meds---7-8% of the time with oral meds and less than 0.5 % of the time ocular injectable meds). More than half the country 150 million people have visual correction---glasses and contacts.... So I don't know what planet you are living on!! This is the type of eye health care utilized by the majority of the population. This is why optometrists perform 75% of the primary eye care in this country and ophthalmologists do 99% of the surgical eye care (Oklahoma has 200 OD's that utilize the laser surgery procedures). And no "1 or 2" is not ALL we do but it is a BIG part of it! lol I like what I am learning and a couple ophthalmologists that I rotate through their clinics are very helpful and teach me anything they can.
I just got back from an ocular pharmacology test and learned about systemic corticosteroids that I will be prescribing along with glaucoma medications (mostly topical unless an angle closure occurs in my future office----> oral CAI to the rescue lol). The point is optometry and ophthalmology cohabitate and might as well declare a marriage! lol (45% of ophthalmology practices are integrated MD + OD)
Back to the point of Ophthalmologists being persuaded to prescribe hearing aids by Ophthalmology Management---> even ENT's I have talked to about it think that is turf violation that is worse because it is one of their own----> a fellow MD! :laugh: You have no argument here Ophthalmologists should stick to zapping eyes and leave the hearing aids up to the Doctors of Audiology (AuD's) and ENT Physicians.
 
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Oculomotor said:
I just got back from an ocular pharmacology test and learned about systemic corticosteroids that I will be prescribing
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I'd like to know what you plan on treating with these systemic corticosteroids.
 
Oculomotor said:
Refraction is a very important part of Primary Eye Care.

I think those OD student's will live LOL! In either case you obviously understand that most of primary eye care is refractive-----65% based on 3 different scientific surveys I can send you at your pleasure. The remaining 35% is eye health related----> comprehensive eye exams, treatment of primary eye disease (92% of the time with topical ocular meds---7-8% of the time with oral meds and less than 0.5 % of the time ocular injectable meds). More than half the country 150 million people have visual correction---glasses and contacts.... So I don't know what planet you are living on!! This is the type of eye health care utilized by the majority of the population. This is why optometrists perform 75% of the primary eye care in this country and ophthalmologists do 99% of the surgical eye care (Oklahoma has 200 OD's that utilize the laser surgery procedures). And no "1 or 2" is not ALL we do but it is a BIG part of it! lol I like what I am learning and a couple ophthalmologists that I rotate through their clinics are very helpful and teach me anything they can.
I just got back from an ocular pharmacology test and learned about systemic corticosteroids that I will be prescribing along with glaucoma medications (mostly topical unless an angle closure occurs in my future office----> oral CAI to the rescue lol). The point is optometry and ophthalmology cohabitate and might as well declare a marriage! lol (45% of ophthalmology practices are integrated MD + OD)
Back to the point of Ophthalmologists being persuaded to prescribe hearing aids by Ophthalmology Management---> even ENT's I have talked to about it think that is turf violation that is worse because it is one of their own----> a fellow MD! :laugh: You have no argument here Ophthalmologists should stick to zapping eyes and leave the hearing aids up to the Doctors of Audiology (AuD's) and ENT Physicians.
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This is fun...how many times can one person type "lol"...and the only reason people antagonize you on here is because you constantly pick fights

(no this post isnt the main point of reference, but I'm sure anyone can click on your name and see on previous posts that you basically admit to doing it and say it's because you're anonymous and that most people in "real life" like you...or something along those lines)
 
Oculomotor said:
Refraction is a very important part of Primary Eye Care.

I think those OD student's will live LOL! In either case you obviously understand that most of primary eye care is refractive-----65% based on 3 different scientific surveys I can send you at your pleasure. The remaining 35% is eye health related----> comprehensive eye exams, treatment of primary eye disease (92% of the time with topical ocular meds---7-8% of the time with oral meds and less than 0.5 % of the time ocular injectable meds). More than half the country 150 million people have visual correction---glasses and contacts.... So I don't know what planet you are living on!! This is the type of eye health care utilized by the majority of the population. This is why optometrists perform 75% of the primary eye care in this country and ophthalmologists do 99% of the surgical eye care (Oklahoma has 200 OD's that utilize the laser surgery procedures). And no "1 or 2" is not ALL we do but it is a BIG part of it! lol I like what I am learning and a couple ophthalmologists that I rotate through their clinics are very helpful and teach me anything they can.
I just got back from an ocular pharmacology test and learned about systemic corticosteroids that I will be prescribing along with glaucoma medications (mostly topical unless an angle closure occurs in my future office----> oral CAI to the rescue lol). The point is optometry and ophthalmology cohabitate and might as well declare a marriage! lol (45% of ophthalmology practices are integrated MD + OD)
Back to the point of Ophthalmologists being persuaded to prescribe hearing aids by Ophthalmology Management---> even ENT's I have talked to about it think that is turf violation that is worse because it is one of their own----> a fellow MD! :laugh: You have no argument here Ophthalmologists should stick to zapping eyes and leave the hearing aids up to the Doctors of Audiology (AuD's) and ENT Physicians.
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Your post just denigrated all OD's out there. Good job.

The SCOPE fund won't need too many more contributions after your post :)

Thank you,

-J
 
Oculomotor,

When are you going to grow up? You're post are painful to even glance at, and frankly are full of BS. Yes we know you, me, and all the other optometrist gets a great education, but why berate this endlessly. Of course you've learned about systemic steroids, everyone does, but that doesn't mean you're going ot be writing for prednisone five times a day. Frankly, most of the ophthalmologist I have worked with shy away from any type of systemic corticosteroid treatment, hell most of them don't even like to Rx doxy.
 
JMK2005,


Actually I would use oral corticosteroids for for allergies of the eye and visual system such as Acute allergic blepharodermatoconjunctivitis, Contact Blepharodermatitis not responding to topical therapy, Epicleritis not responding to topical therapy, bee stings to the ocular adnexa, Uveitis not responding to topical therapy, and orbital pseudotumor. I will use them in the not very common instances a patient would present with one of these situations and refer for more advanced treatment if my Rx is not achieving therapeutic goals. :smuggrin:
 
Grow up? LOL you have a lot to learn about politics (I am involved in the "mud-slinging" that goes on in the legislative arena. You didn't understand what my point was in my post----> how old are you? like 22 or 23 (still going out and getting trashed huh?:laugh: I am in my low 30's and my message was that we get more training than just in refraction (one or two). You missed that point altogether. I was trying to explain this to one of these OMD cheerleaders (WhatNEyeTem) that we are going to be colleagues in the future. You are the one who needs to grow up! LOL
 
WVUPharm2007,

You are right dude! You know more about the drug mechanisms than anybody else and you cannot diagnose or treat ANYBODY!!!!! You are not an IDLP (Independent Doctorate Level Prescriber)---MD,DO,OD,DDS,DPM. rather you are a patient advocate and a check and balance for health care professionals...I will give you a call when I have a question about a drug! My best friend is an pharmacist and I will pick his brain in the future.


I never made the association that prescribing oral steroids = the right to do LASIK........geeeez can you please get off my back?? LMAO
 
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That's all well and good, but the more important point is that you make the right diagnosis and exclude other stuff such as infectious etiologies. It's one thing to read it in a book and have everything clearly defined. Patients don't always come with clearly defined signs and symptoms.

You sound pretty cavalier about using steroids. I hope you have more restraint than is conveyed in your anonymous internet posting.
 
MAYOphtho,

My goal is not to antagonize people.....I am just being honest about my opinions.....Some of these OD's and OD students on here just don't have the audacity nor the stomach to say what they REALLY think on here......I know at least 20 people in my class that have VERY similar opinions to mine. People want to gang up on me on here for being honest! Well I am a person of principle and I will continue to be honest in what I think and believe. Actually I have a bunch of Ophthalmologist buddies that I learn from on a regular basis. They are pro-optometry and they will get ALL of my tertiary care referrals in the future. But of course someone will attack my posts AGAIN !!!!!! :D Bring it on.........lol
 
JMK2005,

I absolutely agree with you that the proper diagnosis needs to be made before systemic steroids would be prescribed (many possible side effects---Cushing's, immunosuppression, etc...). I am going to do alot of eye disease based exposure in my elective rotations and do a post-doctoral one year residency to see many more medical eye type of patients. I am a very well-read person and I actually learn a-lot from family friends who are ophthalmologists whenever I get a chance. I will know my limits and prescribe what is within my comfort zone and what is best for the patient. I am actually very risk averse believe it or not! And no I am not cavalier about prescribing steroids, I was just making a point that as future OD I have some serious responsibility other than "one or two." lol
 
Oculomotor said:
JMK2005,

I absolutely agree with you that the proper diagnosis needs to be made before systemic steroids would be prescribed (many possible side effects---Cushing's, immunosuppression, etc...). I am going to do alot of eye disease based exposure in my elective rotations and do a post-doctoral one year residency to see many more medical eye type of patients. I am a very well-read person and I actually learn a-lot from family friends who are ophthalmologists whenever I get a chance. I will know my limits and prescribe what is within my comfort zone and what is best for the patient. I am actually very risk averse believe it or not! And no I am not cavalier about prescribing steroids, I was just making a point that as future OD I have some serious responsibility other than "one or two." lol
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Ok ok... maybe you'll be saying "three" and "four"... and not just "one" and "two" :)

How many cases of orbital pseudotumor have you actually managed Oculomotor?

Just curious,

-J
 
Oculomotor said:
JMK2005,


Actually I would use oral corticosteroids for for allergies of the eye and visual system such as Acute allergic blepharodermatoconjunctivitis, Contact Blepharodermatitis not responding to topical therapy, Epicleritis not responding to topical therapy, bee stings to the ocular adnexa, Uveitis not responding to topical therapy, and orbital pseudotumor. I will use them in the not very common instances a patient would present with one of these situations and refer for more advanced treatment if my Rx is not achieving therapeutic goals. :smuggrin:
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My God...you're embarrassing every OD out there. Please, for the love of God, stop posting. You're a second year optometry student. You barely know your retinoscope from your ophthalmoscope. I know you probably just took part I of your boards so you're all full of textbook knowledge but out in the real world, episcleritis responds to topical therapy. Please...stop embarrassing yourself and other ODs. The tragic part of all this is that you don't even realize you're doing it.
 
Oculomotor said:
WVUPharm2007,

You are right dude! You know more about the drug mechanisms than anybody else and you cannot diagnose or treat ANYBODY!!!!! You are not an IDLP (Independent Doctorate Level Prescriber)---MD,DO,OD,DDS,DPM. rather you are a patient advocate and a check and balance for health care professionals...I will give you a call when I have a question about a drug! My best friend is an pharmacist and I will pick his brain in the future.
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Huh. I didn't even know "IDLP" was a term. According to acronymfinder.com, it stands for Integrated Data Link Pod. Honestly, that sounds way cooler than being a pharmacist, ophthalmologist, optomotrist, and even Dave & Buster's bartender. I betcha that'd pick up the chicks. Hey, baby, I'm an integrated data link pod. Want to go have a nightcap over at my loft by the river?


But, yeah, I don't do physical diagnosis and, frankly, I don't want to. It just doesn't interest me. But I only went to school for 6 years, get paid an obnoxious amount for it, only work 40 hours a week, and I don't have a pager on me. I may as well not even know what being on-call means because I will never encounter it. Personally, I wish I thought it meant "out doing price comparisons on the latest models of bidets." Then when I call the operator at my hospital and she tells me I can't talk to the original prescriber, but his colleague is on call and available, I will think she said, "Dr. A isn't on tonight, but Dr. B is out doing price comparisons on the latest models of bidets, let me connect you to his cell phone." That minute change alone will drastically improve my overall quality of life.

I'd rather have that than the super-magical ability to write things down on a piece of paper that can be exchanged for goods/service. What the hell do I need with prescriptive authority, anyway? The only reason I'd want it is so that I don't have to go to a physician for something stupid. If I need a drug, I can just yank some of the shelf behind me. (It helps if you imagine me saying that in a labcoat standing in front of a fully stocked pharmacy with my hand extended outward like Vanna White on Wheel of Fortune after she flips one of the letters.)


I never made the association that prescribing oral steroids = the right to do LASIK........geeeez can you please get off my back?? LMAO
Click to expand...

And I'm just a smart ass. I enjoy my work.

Though I must ask...and this is just curiosity...is your class literally pharmacology (i.e. the science behind drug-receptor-cellular response mechanisms) or is it pharmacotherapeutics (what drugs do to the body with a focus on clinical outcomes) that is erroneously labeled as "pharmacology."

Pharmacology is the most horrendous, god awful thing ever and I can't fathom an optometrist actually having to know anything about it. And if they make you study that crap, I find it humorous...
 
Oculomotor, people on this board are not trying to disparage you or your profession. Most of us work closely with optometrists during our training/practice and respect the abilities that our optometry colleagues possess. The problem with you prescribing oral corticosteroids is that you (and many of the optometrists arguing for scope expansion) have no idea how much you don't know. If a patient has recurrent/chronic episcleritis you should send them to see an MD to evaluate for a systemic disorder not give them oral Prednisone. If a child comes in with possible orbital pseudotumor (a diagnosis of exclusion) you should send them to an MD to be evaluated for the numerous, potentially lethal conditions (orbital cellulitis, rhabdomyosarcoma, neuroblastoma, lymphoma, ect.) that are in the differential, not given them oral Prednisone. If a patient has chronic or recurrent uveitis not responding to topical treatments, you should again send them to see an MD to evaluate for an underlying etiology. He/she may then consider periocular steroids, treat any infectious etiology if present (steroids could exacerbate an infectious cause if given alone), +/- obtain a rheumatologic consult, and at that point consider systemic immunosuppression with Prednisone or more likely a different less toxic immunosuppressant if long-term treatment is required. Most OMDs aren't even comfortable managing these patients alone (i.e. without the input of a Rheumatologist) when they are placed on systemic immunosuppression due to issues with systemic toxicity monitoring. If a person has angle closure glaucoma with elevated IOP as you mention in a prior post amidst your laughing out loud, they should see an MD to determine the underlying cause and possibly undergo an LPI in many instances, not be given topicals and Diamox. Those are simply temporizing measures that often are not treating the underlying etiology. It isn't the ability to simply perform an LPI that is required, it is the clinical judgement of how to proceed with management depending on the patient response that is imperative. These are just a few of the examples of the gaps in your knowledge that are presumably present in all areas that you do not receive extensive training. I'm not going to rehash the differences in the training between ODs and OMDs and their respective capabilities in treating pathologic conditions of the eye. I certainly respect the primary eye care professionals that I work with and they have significantly more training than I do in many areas. However, your posts clearly illustrate why many argue that optometry practice scope should be limited. Please try thinking and having a bit of self-knowledge before you begin making inflammatory posts in the future.
 
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Meh...it's just a steroid...I have no problem with optometrists prescribing it, honestly. Now when they start trying to dole out Synthroid for a dude's exophthalmos...uh...no...
 
I'm not suggesting that when optometrist prescribe Prednisone a rash of blindness and death results. I'm trying to convey that simply noting ocular inflammation and throwing oral steroids at it is not how patients are managed when they don’t respond to topical treatment. There is much more that goes into it. It doesn't make sense to open yourself up to liability and potential bad outcomes by managing these types of patients if you don't see them frequently and aren't completely comfortable with the decision making process involved in their care. Along the same lines, I am technically allowed to prescribe an RGP contact lens to a keratoconus patient. However, this is something I never do and it is in the patient's best interest for me to send them to an optometrist who has much more experience and skill than I do in this area.
 
Geez KHE chill out!

Ok, MullerCell , I am not saying that I have the knowledge of you or an optometrist at this point (I am a neonate LOL) but I am telling you I know of MANY circumstances where OD's I know have used oral corticosteroids for a short course of therapy (a week or less) to remedy ocular allergic problems that are unresponsive to topical therapy (less than a week of systemic corticosteroid therapy in a patient who is not contraindicated is relatively safe (source)--->Medical Pharmacology Dept at my school. Methylprednisolone seems to be popular because of the medrol dose packs aiding in patient compliance. I am not at a point in my education where I can have an argument with you about this......what I can do is direct you to these links that give you an idea about what is "standard of care" in the optometric world:

http://www.eyeupdate.com/

http://www.eyeupdate.com/pages/oral/corticosteroids.html

My posts are NOT inflammatory-----> I have the right to have an opinion right or wrong. God knows how many of your fellow OMD posters on here and on the optometry forum have made very degrading and inflammatory comments about OD's. I am beginning to realize that everybody on SDN is full of s h i t. I have had many open conversations about these topics with ophthalmologists and OD's recently and the response I get face to fact is VERY different EVEN if they disagree. For some reason (lol) you put a computer screen in front of people and suddenly they become unprofessional and crass (although these same people will $$$GLADLY$$$ take referrals from OD's) The last OMD I talked to thinks that OD's (because of the progress of education in optometry school) should have open access to drugs (all orals, injectables, topicals, etc....) but he draws the line at surgery (real surgery). He thinks that if there was a very competitive "OMFS like" 4 yr surgery residency for OD's (where only a very small number would get spots) that would be reasonable pathway to perform ophthalmic surgery. But the politics will prevent that from happening for some. Again this is a public forum and I have every right to my opinion. (do you hear that KHE?)

I recognize that OD and OMD's have different training (with significant overlap) and each serves an important role........


OK....let the onslaught begin......:)
 
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Fair enough WVUPharm2007!

Actually at my school we get one solid academic year of general pharmacology. This class covers pharmacokinetics, pharmacodynamics, pharmacotherapeutics, etc....The vast majority of it is clinical pharmacology and we do cover receptor--receptor ligand response (such as the u ("mew") receptor agonism of narcotics such as Codeine or Hydrocodone or how Fentanyl is very lipophillic leading to its quick absorption--CNS penetration). We had to memorize something on the order of 900 + drugs in the year covering every drug class. The last 8 weeks of general pharmacology in the 1 year course focuses on ocular pharmacology. The ocular pharmacology focuses on the most germaine classes to primary eye care:
1) topical ocular medications
----everything that is currently available
2) oral systemic drugs in the classes of Anti-infectives, Anti-allergy, Anti-glaucoma, Analgesics, Anti-inflammatory, etc......
3) parenteral routes and medications used in ophthalmic care

We take our year of general pharmacology with the Dental Medicine students along with human physiology, gross anatomy, and general neuroanatomy. Our didactic medical science education is very similar to theirs. I am finishing up ocular pharmacology soon so I feel like I have had pharmacology pounded into my brain! lol The next two years I will have a sequence of ocular disease courses that are about 33% pharmacology so it will be reinforced and then the last two years of clinical rotations (with the 4rth yr being exclusively clinical, while the 3rd year being didactic and clinical) will reinforce the pharmacology I learned. So all in all I feel like the education I am getting is top notch---> although I average 4.5 hours of sleep a night! zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz
 
Oculomotor said:
For some reason (lol) you put a computer screen in front of people and suddenly they become unprofessional and crass
Click to expand...

really? did YOU just type this? I mean, really?

"lol"
 
Oculomotor said:
Actually at my school we get one solid academic year of general pharmacology. This class covers pharmacokinetics, pharmacodynamics, pharmacotherapeutics, etc....The vast majority of it is clinical pharmacology and we do cover receptor--receptor ligand response (such as the u ("mew") receptor agonism of narcotics such as Codeine or Hydrocodone or how Fentanyl is very lipophillic leading to its quick absorption--CNS penetration).
Click to expand...

Hmmm....lots of big, fancy, medical sounding words there.
 
Oculomotor said:
Fair enough WVUPharm2007!

Actually at my school we get one solid academic year of general pharmacology. This class covers pharmacokinetics, pharmacodynamics, pharmacotherapeutics, etc....The vast majority of it is clinical pharmacology and we do cover receptor--receptor ligand response (such as the u ("mew") receptor agonism of narcotics such as Codeine or Hydrocodone or how Fentanyl is very lipophillic leading to its quick absorption--CNS penetration). We had to memorize something on the order of 900 + drugs in the year covering every drug class. The last 8 weeks of general pharmacology in the 1 year course focuses on ocular pharmacology. The ocular pharmacology focuses on the most germaine classes to primary eye care:
1) topical ocular medications
----everything that is currently available
2) oral systemic drugs in the classes of Anti-infectives, Anti-allergy, Anti-glaucoma, Analgesics, Anti-inflammatory, etc......
3) parenteral routes and medications used in ophthalmic care
Click to expand...

Yeah...sounds like you just got the clinically relevant pharmacology. You should thank God you don't have to take the hardcore stuff. It made me cry. Well, not literally, but it certainly sucked.
 
MAYOphtho,

If you notice in ALL my posts I have never degraded or diminished the ability or training of OMD's. The same be said by your own colleagues on here. When I say "unprofessional" that is what I am referring to. Hell, Optometrists and Ophthalmologists are both eye doctors and don't practice in a vacuum....:)
 
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