Opticians Refracting Indepently

[VA Hopeful Dr]

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It's very easy to determine if a retinal photo shows a normal retina or one that is abnormal (and needs referral). A tech can be trained to do that in a few weeks/months.

For what it's worth, our local VA hospital recalls diabetic patients every two years. The tech checks the acuity and takes a retinal photo. If the pts acuity is 20/25 and they have no complaints and the tech determines the photos looks normal, the patients is done. Sent home. No exam.

I'm not saying this is ideal. But it has been determined, for the busy VA system, it's "good enough".

I would be hesitant to use "because that's how the VA does it" as an argument FOR anything.

 

[PBEA]

Yes, I understand you know more than me about the eyes. And yes, I am a terrible doctor who happens to be very successful thorough 'word-of-mouth' referrals.

P.S. Only an idiot would not be able to tell a CRVO appearing in a photo that is a 'problem' needing referral. Have you ever even seen one? Pull out your text book and look it up. I never said a homeless person can do it. But the certifed ophthalmic techs working in many OMD offices could probably do it better than many ODs today. My techs (whom I've trained personally) can do it.

OPTOMETRY AIN'T ROCKET SCIENCE YA'LL. Optometry work is about on a 7th grade education level. Sorry for reality.😀

ok now you are just losing control.....take a deep breath, have a nap, whatever....your SDN credibility is at risk (gasp!)

 

[Hightide12]

Here's a thought for you, what about OD's doing refractive surgery after "x" amount of years in practice? If your argument against us performing laser procedures is lack of patient encounters, well, how about after we have enough patient encounters to equal the amount an OMD has after residency?

The refractive surgeon fellow who has performed tens of thousands of procedures at one point in his/her training had to perform their 1st LASIK, and at that point in their career they had just as much experience with refractive surgery as an OD.

Also, I can guarantee you that EVERY OMD will have something in their chair that they can not definitively diagnose as well, just like every OD and GP, and neurologist, etc. It's called practicing optometry, ophthalmology, medicine, for a reason.

Students, if you want to do refractive surgery, graduate, and do your residency down in Tahlequah.

So, your'e saying that an optometrist should perform surgeries for YEARS before they can perform them on their own without supervision? How is this practical? At least OMD's are paid during residency. Are optometrists supposed to go unpaid while they do this? And I'm not sure there are enough guinea pig patients for OD's to operate on to match what an OMD goes through in residency. As mentioned above, there isn't THAT big of a demand for refractive surgery.

The comment about the number of patient encounters was more of a side note in response to a post above by an optometry students. My real problem with it is not that OD's wouldn't see enough patients (even though they'd never match an OMD), but more that the refractive surgery idea grew from the idea of doing emergent, urgent, or prophylactic surgery for those who could not access an OMD in the near future. Then OD's got the idea of doing refractive surgery because it's a money cow if you can find enough patients. It comes off as very greedy on the part of optometrists and intrusive onto Ophthalmology. And also, I don't like the idea that optometrists wouldn't have the clinical knowledge nor the legal ability to clean up a worst-case scenario (ex. endophthalmitis). No one has been trained to insert an IV, let alone administer Vancomycin/Ceftriaxone or whatever medication is warranted. I know the chance of this happening is next to zero, but at least OMD's can clinically and legally do something about it.

And you're right, every OMD at some point performed their first LASIK procedure...under the guidance of an ophthalmologist who has completed a fellowship in cornea/refractive surgery. No optometry residency can compete with that. And yes, I'm sure an ophthalmologist doesn't always know the root of an ocular problem. But what an optometrist doesn't know is way different than what an OMD doesn't know. Again, not trying to bash optometry, but facts are facts.

 

[DrVinzKlortho]

So, your'e saying that an optometrist should perform surgeries for YEARS before they can perform them on their own without supervision? How is this practical? At least OMD's are paid during residency. Are optometrists supposed to go unpaid while they do this? And I'm not sure there are enough guinea pig patients for OD's to operate on to match what an OMD goes through in residency. As mentioned above, there isn't THAT big of a demand for refractive surgery.

The comment about the number of patient encounters was more of a side note in response to a post above by an optometry students. My real problem with it is not that OD's wouldn't see enough patients (even though they'd never match an OMD), but more that the refractive surgery idea grew from the idea of doing emergent, urgent, or prophylactic surgery for those who could not access an OMD in the near future. Then OD's got the idea of doing refractive surgery because it's a money cow if you can find enough patients. It comes off as very greedy on the part of optometrists and intrusive onto Ophthalmology. And also, I don't like the idea that optometrists wouldn't have the clinical knowledge nor the legal ability to clean up a worst-case scenario (ex. endophthalmitis). No one has been trained to insert an IV, let alone administer Vancomycin/Ceftriaxone or whatever medication is warranted. I know the chance of this happening is next to zero, but at least OMD's can clinically and legally do something about it.

And you're right, every OMD at some point performed their first LASIK procedure...under the guidance of an ophthalmologist who has completed a fellowship in cornea/refractive surgery. No optometry residency can compete with that. And yes, I'm sure an ophthalmologist doesn't always know the root of an ocular problem. But what an optometrist doesn't know is way different than what an OMD doesn't know. Again, not trying to bash optometry, but facts are facts.

While I agree with certain portions of your post one small thing I do disagree on is the IV statement. Injections are now a mandatory portion of part III of boards; all recent grads are taught pretty well on indications/contraindications of systemic (non-ocular) injections. What we lack in our education is the massive experience of using said knowledge.

 

[Hightide12]

While I agree with certain portions of your post one small thing I do disagree on is the IV statement. Injections are now a mandatory portion of part III of boards; all recent grads are taught pretty well on indications/contraindications of systemic (non-ocular) injections. What we lack in our education is the massive experience of using said knowledge.

True, but new students are trained to perform injections in order to do a FANG. That's not the same thing as inserting an IV.

 

[thiaeyemd]

I would be hesitant to use "because that's how the VA does it" as an argument FOR anything.

I agree...when I was in training a local VA used generic blue dye to stain capsules during cataract surgery made at a local compounding pharmacy...that was "good enough" because it cut costs (though everyone else got the sterile sealed supply from a major pharmaceutical company) This was good until 7 consecutive patients got raging endophthalmitis and lost vision. They then decided it was "not good enough". I think the VA has a long way to go to set standards for medicine in this country.

 

[mclem222]

If there was some training for optometrists to do refractive surgery then it would be ok. Like a two or three year residency or something. Not the one year "residency" where you shadow doctors and see a few patients on your own and "watch" some surgeries etc.. That is a joke and will never be taken seriously by OMDs. That is why maxillofacial surgeons train for 10 years. 4 years dental school and 6 years residency. Imagine if they did a 1 year "residency"..most OMDs, ENTs would think it was a freaking joke...(which I think is the viewpoint on optometry "residencies" by most OMDs...I could be wrong)