UOP123321

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why Ophthalmology is not part of the optometry school. I mean why should i go to medical school and then apply for residency to be Ophthalmology, isn't Ophthalmology the anatomy, functions, pathology, and treatment of the eye.
 

DopaDO

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Ophthalmologists are physicians. Anyone who aspires to be "Ophthalmology," must go through the requisite training. I'm only in intern year now, but I did numerous ophthalmology rotations in my 4th year of medical school. It is easily apparent that the breadth of knowledge acquired throughout medical training is necessary to be an ophthalmologist. To name a few things, Optometrists dont have the medical knowledge to understand the use of steroids in eye disease and systemically, and the clinical acumen to determine when surgery is necessary or what to do when something goes wrong. The above examples are few of many, but require a medical education. They are necessary to be "Ophthalmology."
 

PBEA

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Optometrists dont have the medical knowledge to understand the use of steroids in eye disease and systemically, and the clinical acumen to determine when surgery is necessary or what to do when something goes wrong.
Forgetting what you say or do, if you truly believe that then you have a large credibility gap to overcome....I know I would have a hard time trusting you with anything, and would not wish that you care for any of my pts. Since your kind of misleading statements suggest a deeper personality trait, it's likely to reveal itself in other areas, topics, discussions, etc. It's possible that your pts will also have a hard time trusting you as well.
 
Dec 4, 2014
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Forgetting what you say or do, if you truly believe that then you have a large credibility gap to overcome....I know I would have a hard time trusting you with anything, and would not wish that you care for any of my pts. Since your kind of misleading statements suggest a deeper personality trait, it's likely to reveal itself in other areas, topics, discussions, etc. It's possible that your pts will also have a hard time trusting you as well.
.

I used to go an optometrist every year for my annual "eye care." Over several days, I started having red eyes and blurry vision. I went to two different optometrists and both just sent me off with a different eye prescription. I still was having trouble seeing. The third optometrist finally told me to see an ophthalmologist, who immediately diagnosed me and started me on the appropriate drops. Since then, I have and will always go to an ophthalmologist for a non-prescription related eye care. It's not that optometrists do not know everything... It's about exposure and practice. There's a reason why residency is a requirement before being allowed to practice...to let us observe the breadth of ocular pathology that exists. So when we are on our own, we immediately recognize the condition/disease and start helping patients by restoring/improving their vision.
 
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PBEA

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I used to go an optometrist every year for my annual "eye care." Over several days, I started having red eyes and blurry vision. I went to two different optometrists and both just sent me off with a different eye prescription. I still was having trouble seeing. The third optometrist finally told me to see an ophthalmologist, who immediately diagnosed me and started me on the appropriate drops. Since then, I have and will always go to an ophthalmologist for a non-prescription related eye care. It's not that optometrists do not know everything... It's about exposure and practice. There's a reason why residency is a requirement before being allowed to practice...to let us observe the breadth of ocular pathology that exists. So when we are on our own, we immediately recognize the condition/disease and start helping patients by restoring/improving their vision.

Regardless of how unbelievable your anecdote is, even if it is true, it's still just a mere anecdote. Having served in a variety of multidisciplinary settings, would it make any difference to you if I relayed the many cases I have personally seen of misdiagnosis or mistreatment at the hands of ophthalmologists over the last 15 years of practice? I assure you my anecdotes far outweigh yours. Of course that doesn't include the malpractice cases, some of those are down right embarrassing.

Do they still teach humility in medical school?
 
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Regardless of how unbelievable your anecdote is, even if it is true, it's still just a mere anecdote. Having served in a variety of multidisciplinary settings, would it make any difference to you if I relayed the many cases I have personally seen of misdiagnosis or mistreatment at the hands of ophthalmologists over the last 15 years of practice? I assure you my anecdotes far outweigh yours. Of course that doesn't include the malpractice cases, some of those are down right embarrassing.

Do they still teach humility in medical school?
Talking about humility - I mentioned that I wasn't saying optometrists do not know anything.

And I'm happy that you have as much experience as any other ophthalmologist - your patients will benefit from your knowledge and experience. I just don't understand why you are arguing about this. You got anesthesiologists and nurse anesthetists performing similar work at the basic level. You have family medicine practitioners doing colonoscopies like GI docs and pelvic exams like an obgyn doc. It's really up to the patient to decide who to seek for his or her care. Are you upset over not being able to do something that ophthalmologists can? Then lobby for it...not troll on this forum. We really all have the same goal - patient care as our number one priority. So...live and let live?
 

DopaDO

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Forgetting what you say or do, if you truly believe that then you have a large credibility gap to overcome....I know I would have a hard time trusting you with anything, and would not wish that you care for any of my pts. Since your kind of misleading statements suggest a deeper personality trait, it's likely to reveal itself in other areas, topics, discussions, etc. It's possible that your pts will also have a hard time trusting you as well.
I apologize if I offended you. I was not trying to belittle optometry in my previous statement. Everyone from CNA to tech to RN to physician has a role in patient care and I truly believe optoms have a vital role as well. Even though I will admit that I am very early in my career, it is my understanding that they are very qualified and do a great job with routine eye exams and lens fitting. I don't believe my statements to be misleading, in fact my above statements echo what I have been taught from several mentors regarding optoms role in eye care. I truly believe working together is vital to achieve the best outcomes for our patient.
 

PBEA

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To be fair I have seen my fair share of optometry blunders, but again that is an anecdote, not to be relied on too heavily. I would also consider myself lucky in (thankfully only) a few cases, having possibly compromised the care of my pt. Those were long ago now but I daresay any ophtho/optom might find themselves in a similar situation. Medical care is the bulk of my experience and practice, with routine care being a minority. Excluding your typical spin and grin corporate store I'd say my office was pretty typical. I use steroids regularly, everyday this month so far as I can remember. Definitely requires prudence, training, experience, etc. Not to be included in any non ophtho/optom toolbox.

As for mentors, all I can say is to not take everything at face value. People have bias, hard to trust sometimes. Even harder when blanket accusations are made from a presumed position of authority. I think that's similar to telling a lie. Doesn't sit well with that position. I'd try and avoid the politics as long as you can, hard to have good perspective on these things when in training. You've got bigger fish to fry, focus on the work.
 

310

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I used to go an optometrist every year for my annual "eye care." Over several days, I started having red eyes and blurry vision. I went to two different optometrists and both just sent me off with a different eye prescription. I still was having trouble seeing. The third optometrist finally told me to see an ophthalmologist, who immediately diagnosed me and started me on the appropriate drops. Since then, I have and will always go to an ophthalmologist for a non-prescription related eye care. It's not that optometrists do not know everything... It's about exposure and practice. There's a reason why residency is a requirement before being allowed to practice...to let us observe the breadth of ocular pathology that exists. So when we are on our own, we immediately recognize the condition/disease and start helping patients by restoring/improving their vision.
I'm an optometrist, and while I'm not disputing your story, there is a lot of variability between optometrists.

Some optometrists, with a tendency toward the older crowd, are clinically less skilled at treating diseases. Others are very sharp.

I fell into a situation where I deal with a very high volume of sick patients and rarely refer anything out that doesn't require surgery. After seeing thousands of patients in this setting, I'm comfortable with a lot of things that other doctors aren't (including lots of glaucoma). On the other hand, I have rudimentary skills when it comes to fitting a hard contact lens or a pair of glasses on someone's face and am clueless at prescribing low vision devices. Again, it's a profession with lots of variability between doctors as is ophthalmology.




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airplanes

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I apologize if I offended you. I was not trying to belittle optometry in my previous statement. Everyone from CNA to tech to RN to physician has a role in patient care and I truly believe optoms have a vital role as well. Even though I will admit that I am very early in my career, it is my understanding that they are very qualified and do a great job with routine eye exams and lens fitting. I don't believe my statements to be misleading, in fact my above statements echo what I have been taught from several mentors regarding optoms role in eye care. I truly believe working together is vital to achieve the best outcomes for our patient.
Optometrists are more than qualified to prescribe steroids for ocular disease and are trained to treat a wide array of medical eye disease. It is part of their training. Is their training as extensive as a comprehensive Ophthalmology residency? No, but that does not mean they are only qualified to perform routine eye exams and contact lens fittings. Optometrists regular treat medical conditions and refer onward when appropriate.

Unfortunately, your initial post makes your limited experience very evident.
 

DopaDO

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Optometrists are more than qualified to prescribe steroids for ocular disease and are trained to treat a wide array of medical eye disease. It is part of their training. Is their training as extensive as a comprehensive Ophthalmology residency? No, but that does not mean they are only qualified to perform routine eye exams and contact lens fittings. Optometrists regular treat medical conditions and refer onward when appropriate.

Unfortunately, your initial post makes your limited experience very evident.
Once again, I wasn't trying to offend but this is what I have been taught from my mentors as a med student. Additionally, my statements are not outlandish. There was an independent review performed by the Washington State Board of Health that assessed the scope of practice of optometrists in 2009, here is a quote from the paper.

"The department’s mission is to protect and improve the health of the citizens of Washington State. In
addition, the department must consider the criteria set out in chapter 18.120 RCW when reviewing a sunrise proposal. Based on those two considerations, the department makes the following
recommendations regarding the proposal:

The department supports the following changes:
• RCW 18.53.010(1)(b) explicitly stating that optometrists may dispense eyewear including
cosmetic lenses.
• RCW 18.53.010(2)(d) reducing the hours of didactic and supervised clinical instruction for the
injection of epinephrine to treat anaphylactic shock from four hours to two hours.
• RCW 18.53.010(3) allowing optometrists to provide free drug samples to patients.

The department does not support the following changes:
• RCW 18.53.010(1) expanding the definition of the practice of optometry.
• RCW 18.53.010(1)(e) allowing office-based medical procedures.
• RCW 18.53.010(2)(e) allowing optometrists to use injectable drugs.
• RCW 18.53.010(4) allowing optometrists to prescribe oral corticosteroids."

Obviously, optoms do prescribe steroids in some states, which is pretty dangerous, as they don't have the requisite training. I've heard horror stories in Oklahoma regarding patients seen by optoms. I believe in order to do what's right for our patients, we need to stop and decrease optoms expansion scope back to what this review suggests. Like all mid levels, optoms are a great resource when they know their role. The problem, like with all mid levels fighting for increase practice rights, is that they don't know what they don't know.
 
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DrZeke

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Obviously, optoms do prescribe steroids in some states, which is pretty dangerous, as they don't have the requisite training. I've heard horror stories in Oklahoma regarding patients seen by optoms. I believe in order to do what's right for our patients, we need to stop and decrease optoms expansion scope back to what this review suggests. Like all mid levels, optoms are a great resource when they know their role. The problem, like with all mid levels fighting for increase practice rights, is that they don't know what they don't know.

This is true. People don't know what they don't know and if these mistakes don't happen in training then people don't get burned. For example, in residency when you're overconfident or don't know
When to ask for backup, you get burned or in trouble or whatever. There are usually consequences. If you're an optom whose scope of practice just expanded and you develop a complication that is then beyond your scope of practice, you just refer out. What repercussions exist? What liability exists? I know little about this and I've been curious how liability expands with these scope of practice expansions.
 

ophthope

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I see some claims that younger ODs are better qualified to treat medical problems than older ones. I have seen the same trend and I am glad to see it because the population is aging and you guys are going to have to share some of that load of patients and 'do more medical' or whatever you guys call it. But maybe us younger MDs/DOs are similar, because I've seen some referrals to retina and glaucoma from ODs that in my opinion could have been very easily managed by a comprehensive Ophthalmologists and that I would definitely not have referred out of my practice at that time. Perhaps there is also a lack of understanding about how good our residency training has become.

But I do not think an ODs training prepares them to know what does and does not require surgery because quite frankly it does not offer you surgical training. In the same way that a Hospitalist places a Gen Surg consult early on in the course of suspected cholecystitis but is not qualified to make the call on whether or not a patient needs surgery because again, they aren't trained to make that call.
 
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airplanes

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Obviously, optoms do prescribe steroids in some states, which is pretty dangerous, as they don't have the requisite training. I've heard horror stories in Oklahoma regarding patients seen by optoms. I believe in order to do what's right for our patients, we need to stop and decrease optoms expansion scope back to what this review suggests. Like all mid levels, optoms are a great resource when they know their role. The problem, like with all mid levels fighting for increase practice rights, is that they don't know what they don't know.
You did not specify oral steroids. You said "To name a few things, Optometrists dont have the medical knowledge to understand the use of steroids in eye disease and systemically, and the clinical acumen to determine when surgery is necessary or what to do when something goes wrong." When I read this, I interpreted it to mean you were referring to topicals, which are the vast majority of corticosteroids used in the ophthalmic setting. Perhaps you meant to say orals but you did not and I am not arguing that optoms should be regularly prescribing and managing prednisone.

And regarding your campaign for patient safety, most optometrists actually refer too much, not too little.
 

Slide

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You did not specify oral steroids. You said "To name a few things, Optometrists dont have the medical knowledge to understand the use of steroids in eye disease and systemically, and the clinical acumen to determine when surgery is necessary or what to do when something goes wrong." When I read this, I interpreted it to mean you were referring to topicals, which are the vast majority of corticosteroids used in the ophthalmic setting. Perhaps you meant to say orals but you did not and I am not arguing that optoms should be regularly prescribing and managing prednisone.

And regarding your campaign for patient safety, most optometrists actually refer too much, not too little.
I do find that optometrists do refer out a lot; when I was a resident I wasn't too happy about it at first but as a fellow I appreciate it a lot more. I'd rather see more referrals out of caution than an overly confident optometrist handling something that might need a specialist's opinion.

I've become more appreciative of optometrists because there are eye problems that can be handled by them easily. My main issues are the very few who are itching to gain more surgical and procedural privileges, and the issue stated above. Luckily, I've yet to meet an optometrist that claimed to be able or want to perform phaco/vitrectomies and intravitreal injections.
 
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310

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I don't actually think the surgery thing is that much of real world issue for optometrists. Very few optometry practices would be able to profit off YAG and SLT bc they wouldn't be able to pay for the equipment. The only OD's doing it would be in VAs, working for OMDs, etc.


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PBEA

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one other factor that sometimes plays a role in OD referrals (or over referrals) is that some ODs work in a setting not conducive to more medical management. Either they are not in network for the medical insurance and the pt had just come in for "blurred vision" thinking they need glasses or they work in the mall where often their practice is pigeon-holed by that setting. Either way they may just want any little non-refractive concern off their service. I don't like it but I understand that it happens. Heck if I was only getting a vision plan payment for the visit (low $), then you can be sure that I'm not going to trouble shoot very much.....
 

VA Hopeful Dr

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But I do not think an ODs training prepares them to know what does and does not require surgery because quite frankly it does not offer you surgical training. In the same way that a Hospitalist places a Gen Surg consult early on in the course of suspected cholecystitis but is not qualified to make the call on whether or not a patient needs surgery because again, they aren't trained to make that call.
This might be technically true, but I think you're splitting hairs here. Its not optometry (or family med, in my case) making the call of "patient needs surgery" but more "you have problem X which can often be fixed surgically, so go see the surgeon".

If an OD sees a patient with cataracts, can't refract their vision better than 20/60 because of them, an ophthalmologist is going to be getting that patient and, let's be honest, will likely operate.