Optometrists are a joke - not a threat

[futuredoctorOD]

This forum is becoming less about real scope of practice issues and more about who has the larger ego... Permit me to bring some more perspective into the discussion (aka add feul to the fire). I'm finishing my 4th year at NSU and am currently shadowing an opthalmologist. I've not only taken classes with the ODs but also work with quite a few of them while on primary care rotations through the NSU clinic. There is indeed an interdisciplinary curriculum at NSUCOM; this idea of a team approach to health care spills over into the clinical realm as well. What is interesting is that ODs and DOs do take some of the exact same classes. While slugging through neuroanatomy, it was not uncommon to hear comments like:

"I don't understand why the DO students complain so much... we take the same classes.."
or
"We do the same things as the DOs for the first two years.."
or
"We have the same exams as the medical students.."

On paper, this is correct. In actuality, however, subtle differences exist. The OD students sit through similar lectures. Specifically, they take the head and neck anatomy with the medical students. Their written and practical examinations are different as is their 'wet lab' requirement. They are not required to prosect and do not take histology or pathology with the medical students. Does this make them any less prepared for primay care of the eye? Absolutely not! While they may not share the 'exact same classes' as the DO students, I'm sure they spend much more time on optometric-specific subjects. The job of the future OD is quite different from the career of the future osteopathic physician, and the discipline-specific curriculum reflects these necessary differences.
Trying to argue which curriculum is more intensive is an endeavor in futility. I don't think any optometrist would argue which professional is better suited to manage a brittle diabetic with chronic renal failure. Similarly, I find it hard to believe that a generalist osteopath or allopath would think themselves better qualified to medically manage glaucoma patients.
Its clear that tensions rise when the debate turns to the controversial issues of practice scope. Since optometrists are eye physicians (for lack of a more agreeable term), it makes sense that their professional societies want to ensure future viability and growth. As specialists in the field, opthalmologists will understandably be concerned over potential territory disputes.
In clinical practice, I've seen few if any professional disagreements over referrals or appropriate diagnosis and treatment. I'm shadowing a glaucoma specialist. He gets patients from ODs, DOs, MDs, and emergency rooms. His practice depends on a good working relationship between the professions. As physicians, everyone has an ethical obligation to act in the patient's best interest. I would guess that everyday clinical practice bears this out. Indeed, many ophthalmologists partner with ODs to expand their practice base.
I would hope that future scope of practice regulations take each profession's expertise and curriculum into accout. Patients need lens fitters, primary care docs, eye surgeons, and eye physicians. It seems that ODs and MDs/DOs will work together for the forseeable future. As inevitable colleagues, it seems prudent to stay away from disparaging each others education and instead shift the focus to more pressing issues like arranging a mutally beneficial working relationship.
If that doesn't pan out, then there's always these entertaining and lively mud-fests here on SDN.

-Pushinepi2

NOVA is one of my top choices because of the interdiscplinary and cooperative environment.....Thank you for your comments.....

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[futuredoctorOD]

Ben,

The training of ODs are so variable. I don't know your training, so I can't comment. However, I've worked with very "good" ODs who have watched severe non-proliferative diabetic retinopathy turn into proliferative disease with vitreous hemorrhage and CSDME before referring for laser. This is poor "primary care". Once ODs detect diabetic changes, then referral is needed.

General ophthalmologists do retina laser and don't always refer out. Your comment is a generalization. The limiting factor is the cost of maintaining a laser and having enough patients to support the laser. This may change for general ophthalmology in the near future! Read below-

Do you want to see optometrists really worry? Faculty at Iowa are working on technology (tele-medicine screening program) to help ophthalmologists work with the MDs that refer to optometrists directly to use telemedicine to screen diabetic patients. We want the primary care doctors to work with ophthalmologists directly. Currently, through this tele-medicine screening program, ophthalmologists screen the fundus and detect patients who need an evaluation by ophthalmology (physicians who can do lasers and really help).

Here's the exciting fact for members of this forum. This technology can be automated with software that is MORE sensitive than the human eye in detecting exudates, hemorrages, and other diabetic changes! This means we will need less "eye doctors" for normal diabetic screening examinations and more surgeons for the evaluation to laser patients. This may be the technology needed to help ophthalmologists regain control. Medical doctors want to refer directly to medical doctors. I am very excited about this tele-diagnosis/screening because it develops a radiology-like sub-specialty for ophthalmologists.

http://webeye.ophth.uiowa.edu/dept/News/2005/0412Telediag.htm

http://webscreen.ophth.uiowa.edu/

That same technology would be in an OD's office as well---Optometry is all about technology....

 

[futuredoctorOD]

"Let me make sure that I'm reading this right. You are in favor of limiting the scope of practice in non-physician providers, I'm assuming on patient safety grounds. Yet you want to increase the scope for opticians who spend less time in school than ODs (who you clearly don't think have done enough time). So, you want increased scope for health care providers with even less medical education?"

The fact is that opticians will never pretend to be physicians and fundamentally speaking, the work of opticians and optometrists is benign and doesnt threaten the health of patients. What indeed threatens the health of patients is when ODs want to play medical physician and want to start treating medical problems. If optometrists stayed within their scope - fitting lenses...there wouldnt be a problem. Yet the fundamental problem is greed and a cheapening of healthcare. Optometrists want to do surgery....but dont want to go to medical school. They defend their use of scalpels and claim...oh we just want to remove warts from eye lids...etc etc. This is bullcr@p and is just an attempt to introduce gradual changes such that 10 yrs from now, they will want to remove cataracts as well. This isn't time for cooperation anymore. Ophthalmologists should fight back and support opticians and educate the public about the difference between lense fitters and physicians/surgeons. If optometrists want to play games, MDs can play it too.

"OD school is 4 years, medical school is 4 years. At the end of either, you can be addressed as doctor. This seems reasonable to me. Now, granted, after med school there is still at least 3 years of schooling before you can really practice medicine. Though I don't know of anyone who's ever done this, if you get through med school and don't do a residency, you are still entitled to be called doctor, right?"

This isnt about being called doctor, its about being a medical physician. I can get a doctorate in social studies, but that doesnt make me qualified in treating medical diseases. Any organization can start a 4 yr doctorate in whatever they want, and churn out doctors with diplomas from that school...it doesnt make them physicians. The medical education of medicine is not equivalent as optometry.

"Ignoring the scope battles in all these areas, I suspect that most MDs would have misgivings about getting rid of many of the professions you spoke of. Do you really think ENTs want to spend their days doing everything that a audiologist does?"

Ofcourse ENTs dont want to be bothered by the everyday work of an audiologist. I think ENTs feel doing simple tests is a waste of time. But I suggest that you go to the association of audiologists website and then tell me what you think. ENTs are upset when audiologists make claims like: "we are primary care providers" when it comes to hearing problems. Don't you see how silly that is? So basically if someone comes with a hearing problem, audiologists would like to decide if a medical referral is needed...they will refer to an ENT as needed. Which is just hogwash. Audiologists also advertise that their members should make "professional relationships" with primary care physicians (Family docs and internists) for the purpose of referrals. Well obviously I dont think that is much of a concern for ENTs, because any qualified internist understands that a hearing problem should be referred to an ENT.

Yet audiologists are now starting doctorates in their profession: AuD...another gimmick like the DrNP (doctorate of nurse practitioner degree). Now they will say, "oh we just want to be doctorates in our profession." The real reason is to bring confusion in healthcare. To the lay person a Audiologist sounds like a medical physician. Now with a Dr., it makes that confusion even more likely. It is all about greed and money. For example, I went to the University of Nebraska's website, for info on their audiologist program. On this site it tells prospective applicants how much money they can make in their lifetime if they became audiologists. Show me one ENT residency program that lists the expected income they can make as an ENT surgeon. I guarantee you that you wont find one - because it is cheap. Sure many medical websites will list incomes, but lifetime wealth isnt stated on a residency admissions website. If it did, it would look so cheap. Regardless, it just tells you the mentality these pseudo-docs are coming from. Its a huge inferiority complex. The same is for optometrists. If you browse through optometry websites you will find articles that focus so much on the injustice of why do ophthalmologists get paid more than optometrists, and how can we as optometrists narrow the gap in incomes with ophthalmologists...etc. These people delude themselves with the word Dr and feel they can be physicians. Its a huge inferiority complex. I bet many optometrists wished they had the dedication and work ethic to go into medical school. Yet, instead of being content with their respectable job as an optometrist. They would rather play dirty and bribe congressmen to increase their scope of practice and play physician and surgeon.

"Orthopedic surgeons certainly have better uses of their time than seeing diabetic foot all day long."

oh i agree. but even with podiatrists...now they just dont want to treat diabetic toes...they want to treat ankle problems as well. The scope of practice of a podiatrist 20 yrs ago has changed drastically to what it is now.

"As a contact lens wearer, I'd much rather go to my OD for any problems there but let the MD handle my cataracts in my later years."

oh i agree. but ODs want to do lasix, and diagnose and treat medical problems with the eyes and do eye surgery. I go to ODs too for my glasses, but i dont want them playing physician/surgeon.

"Its quite alright to disagree with scope of practice expansions, and by all means fight for what you think is right. But don't you think what you're suggesting is a bit much?"

It isnt a bit much. Physicians and surgeons, are beginning to realize how much a danger this is to the health profession. Its time for MDs to go with all guns blazing and become as determined as these allied health people when it comes to defending our interests. If it means playing dirty in congress, then we will do it. In this respect, I feel the AMA has been a dead medical organization. If this organization truly took a strong stand for the 500,000 + MDs in this country, things wouldnt have become as crazy as it is today.

You are very hostile towards all non-allopathic/osteopthic professions....Optometrists, Podiatrists, Dentists and Vets are all DOCTORS---in the medical sense.....they are "limited scope" doctors...All these professions spent hundreds of millions of dollars collectively fighting your profession for thier existance and ability to thrive. This is America where things like the Oil Trust at the turn of the century, or Allopathy's monopoly in the past on medicine, will not happen again----it is a Capitalisitic econonmical system--competition is a healthy thing.....You have a axe to grind or some kind of personal insecurity. What's up?

 

[JennyW]

Ben,

The training of ODs are so variable. I don't know your training, so I can't comment. However, I've worked with very "good" ODs who have watched severe non-proliferative diabetic retinopathy turn into proliferative disease with vitreous hemorrhage and CSDME before referring for laser. This is poor "primary care". Once ODs detect diabetic changes, then referral is needed.

General ophthalmologists do retina laser and don't always refer out. Your comment is a generalization. The limiting factor is the cost of maintaining a laser and having enough patients to support the laser. This may change for general ophthalmology in the near future! Read below-
[/url]

I don't understand this.

The EDTRS and other various diabetic retinopathy studies are pretty clear when laser treatment is indicated and when it is not.

Why would an OD refer to a surgeon when surgery is not indicated?

Needless to say, I do not refer mild or moderate NPDR to ophthalmologists.

Jenny

 

[Ben Chudner]

I don't understand this.

The EDTRS and other various diabetic retinopathy studies are pretty clear when laser treatment is indicated and when it is not.

Why would an OD refer to a surgeon when surgery is not indicated?

An OD wouldn't and neither would a medical ophthalmologist (whether or not they have a laser)

 

[Ben Chudner]

Ben,

The training of ODs are so variable.

"So variable" is a groos overstatement. No more variable than MD's (notice I didn't say the same as MD's). Our national boards serve to standardize training just as yours do.

I've worked with very "good" ODs who have watched severe non-proliferative diabetic retinopathy turn into proliferative disease with vitreous hemorrhage and CSDME before referring for laser. This is poor "primary care".

Here we go again. Unsubstantiated claims of mistakes do not impress anyone except those who agree with your position. Each side has their share of "stories".

Once ODs detect diabetic changes, then referral is needed.

I'm sure the retinal specialist down the road wants to fill his spots with patients that have mild NPDR and do not require treatment. If you ever decide to go into private practice, I can assure you that you will want those slots filled with surgical patients. You will realize it makes sense to have the OD follow those diabetic patients until they develop severe NPDR because the big money for you is in the laser.

General ophthalmologists do retina laser and don't always refer out. Your comment is a generalization. The limiting factor is the cost of maintaining a laser and having enough patients to support the laser. This may change for general ophthalmology in the near future!

You are right this is a generalization. The point was simply that as a primary care provider an OD can control when the patient is referred just like an OMD without a laser, or for that matter the general OMD that has a retinal specialist in the same practice.

Do you want to see optometrists really worry? Faculty at Iowa are working on technology (tele-medicine screening program) to help ophthalmologists work with the MDs that refer to optometrists directly to use telemedicine to screen diabetic patients. We want the primary care doctors to work with ophthalmologists directly. Currently, through this tele-medicine screening program, ophthalmologists screen the fundus and detect patients who need an evaluation by ophthalmology (physicians who can do lasers and really help).

Do you want to see OMD's really worry? OD's buy into this technology (because as you have all said we are more business minded) and make the PCP's realize that since we see the majority of eye patients in this country, we see plenty of undiagnosed hypertensives and diabetics that may need a doctor. We refer to them, and they start referring to us using this new technology and avoid the need for general ophthalmologist all together. Let the cornea docs do cataracts, glaucoma do surgical glaucoma, retina do surgical retina, etc.

 

[Mirror Form]

Amblyopia.

Yeah, a lot of 5 y/o's wear their glasses 24/7.

 

[Mirror Form]

I will preface my comments by saying that you seem like an intelligent person. There are many residency programs I can give you the links to for optometry.

http://www.nova.edu/optometry/residency/residency.html

this is just one link from NOVA.....look at it..... The residency programs in this field help better prepare OD's for Pediatrics, Geriatrics, Ocular Disease Management, Sports Vision, Vision Rehabilitiation, Primary Care, Pre-Post--Opterative Management, and so on. I shadow on OD right now whose primary responsibility at the Eye Institute he works at is treating Glaucoma----he works hand in hand with OMD's there and they never question a script he writes....

I agree that the "residency" training you do is most likely good training and prepares you to take good care of patients. However, it's not at all like what "residencies" have traditionally been. I think the reason it's called a residency is b/c then the OD's can go in front of their state legislatures and say "see, we do residencies too, just like ophthalmologists, so we should also be able to do surgery." Then OD's also called some of their rotations during medical school to be "internships," so that they can tell the state legislatures that they do internships too, just like OMD's (even though their internships are in no way, shape, or form similiar to medical internships). This name game stuff is dishonest and the fact that OK OD's used it as one of their tools to gain surgical rights is a big reason why many OMD's on this board are pissed off at the whole field of optometry. As long as OD's keep trying to encroach on OMD's turf, there's going to be lots of bad blood (and especially if the OD's use such tactics).

 

[bustbones26]

Not true. Some of the best strabismus surgeons had strabismus themselves! In fact, a former faculty at Iowa has strabismus.

Also, there is a surgeon in India (famous one too) who suffers greatly from rheumatoid arthritis with deformed hands. He too is a great surgeon.


http://myhero.com/myhero/hero.asp?hero=Venkataswamy

I personally know a general surgeon that once had a case of optic neuritis secondary to multiple sclerosis. He has significant lost vision in one of his eyes. He now enjoys colonscopies and working in the ER. He is no longer allowed to do surgeon unless another surgeon is scrubbed in on the case with him. Fortunately, he had enough skills as a surgeon to make it as an attending in the ER. I hate to ask, but what if this man had been an ophthalmologist? He'd really have no choice but to do non-surgical eyecare on the same level as an optometrist.

I see your point that many surgeons out there live with their so called "handicaps" and still make great surgeons. But I tend to think of it this way, if I were one of these people, it would scare me to hell everyday to think that no matter how great my training was, no matter how many satisfied customers I have had, that when that one day comes that I f*&k up, and I don't care how good you are, it will happen, that when they drag my a$$ to court the first thing the defense if going to say is, this man has X,Y,Z and has no business performing surgery.

Lastly, I ask, where is there any residency training for an MD/DO to perform non-surgical eyecare? I suppose the only point I am trying to make here is that if that is what you want to do, non-surgical eyecare, then your only choice is optometry school. And I don't view that as a joke, it would be real easy for me to get up on my high horse and say, "Hey, I finished DO school and optometrist are a damn joke!" But in reality OD's have a legitimate role in healthcare, a role that I can respect. I do not view them as a threat to MD/DO's, I certainly do not view them as a joke either.

 

[Andrew_Doan]

Do you want to see OMD's really worry? OD's buy into this technology (because as you have all said we are more business minded) and make the PCP's realize that since we see the majority of eye patients in this country, we see plenty of undiagnosed hypertensives and diabetics that may need a doctor. We refer to them, and they start referring to us using this new technology and avoid the need for general ophthalmologist all together. Let the cornea docs do cataracts, glaucoma do surgical glaucoma, retina do surgical retina, etc.

You miss the point.

Why refer to optometrists who can't treat diabetic disease surgically? Your desire to become a general ophthalmologist really requires you to have surgical training.

 

[bigfrank]

see attachment

 

[VA Hopeful Dr]

I find it slightly upsetting that you Iowa guys are working on this fantastic new technology, yet one of your big sellings points seems to be how great this imaging system will be at circumventing ODs.

 

[vanessh]

You are very hostile towards all non-allopathic/osteopthic professions....Optometrists, Podiatrists, Dentists and Vets are all DOCTORS---in the medical sense.....they are "limited scope" doctors...All these professions spent hundreds of millions of dollars collectively fighting your profession for thier existance and ability to thrive. This is America where things like the Oil Trust at the turn of the century, or Allopathy's monopoly in the past on medicine, will not happen again----it is a Capitalisitic econonmical system--competition is a healthy thing.....You have a axe to grind or some kind of personal insecurity. What's up?

Actually it isnt healthy. The rise of allied healthcare will only raise the health costs to this country. When a future NP, who bills medicare to see a patient for an equal price as a doc (NPs are pushing for equal pay from medicare billing) - but who doesnt know how to treat the patient refers the patient to an internal medicine doc...who will also bill medicare to see the patient...is it really cost effective for this double billing? Why not just have these patients see the MD...and cut to the chase...rather then send through a welfare-like gatekeeper. Allied healthcare is nothing more than filler healthcare...just filling bodies with people in white coats. I have respect for those who are willing to work in a coordinated setting (i.e integrated medicine and physician assistant practice where if a PA cant manage a case, the doc will be available to manage because the doc is the PA's employer). But once other independent midlevel practices (NPs) become fully independent, u will have NP billing independently and studies have shown that midlevel providers refer to docs at a much higher rate than a comparable Family doc or any primary care medical physician. Sure specialist docs will see huge increases in their income (and they are seeing it already)...but honestly is that what our healthcare needs?

Now back to the topic of ODs. Sorry to lambast your colleagues. But organized optometry's future goals do not show evidence of cooperation. Ophthalmologists understand this. ODs are slowly adding pseudo-residency programs in treating medical eye diseases. Once these programs become widespread, since ODs control a large portion of patients in ...they will just refer to themselves once they feel they can successfully expand scope. Do you think ODs give a !@#$ if these patients develop long term problems from mismanagement...ofcourse not. At the end of the day, ophthalmologists will just be either fixing complications from OD mismanagement, or will be seeing the most sickest eye patients. So the time is now to educate patients about the difference and it indeed works very well. I dunno how many times in my dad's office have patients been confused between optometrists and ophthalmologists (my dad is a cardiologist...but i'd say 60% of his patients make the mistake when he suggests that they see their eye doc). But my dad always makes it a point to educate patients on the importance of seeing MDs.

Lastly, once in medical school, there is no insecurity. You are at the top when it comes to clinical medicine. Sure we may seem proud, but who wouldnt after the study and training we go through? Okay, so we may not be able to do needle sticks and place IVs as good as nurses, but who cares. I have run into scores of former nurses and other midlevel providers who went through med school and residency and mentioned that they never expected how much a difference medical school and residency would make in their approach to a medical problem. Before they simply used cookie cutter memorizing formats...medical schools get people to think and analyze. When you are a midlevel provider...you dont know what you dont know. You may think you know everything, but it isnt until you do medicine that you realize what being a real clinical physician is all about. My friend, as an OD, you would feel the same if you became an Eye Physician and Surgeon.

Its a sacrifice that begins with hard work excelling in school and never accepting mediocre results. We by nature have a disproportionate number of Type A's and obsessive compulsive people. And we should, we only accept the best. And ultimately, no one can manage medical problems better than we can. Yet the inferiority complex and often arrogance of midlevel providers is astounding. After rounds once, I nodded my head in shocking amazement when I saw a CTS-CRNP nurse vigorously debating her absolutely stupid and wrong patient management decision choice with a fourth year medical student at my school in regards to CHF. The head of cardiothoroacic surgery was also leaving from rounds at the same time. So the NP was acting up because she though she was right and was making a show hoping she would win brownie points from staff and was getting flustered trying to explain her stupid understanding of pathophysiology with the student. She was wrong, proved wrong by a surgery intern, yet she still tried until a CTS fellow politely explained. I wish you all had the chance to look at her face...I bet she secretly wished she could drop the CTS (cardiothoracic surgery initial) from her CTS-CRNP and hide somewhere in the nursing quarters. How did she get the guts to act so stupid in front of the whole team of surgeons? I will never know.

It comes down to this, if one wants to know medicine...then prove it and join the club. If one cant do it through hardwork and a demonstration of ones abilities, thats fine...become an optometrist, audiologist, CRNP or whatever. But dont go to your doc school and just attend lectures on eyes and basic pathology and pharm and then call yourself a clinical eye physician to the public and consider yourself an equal to an ophthalmologist.

People cant have it both ways like the CRNP tried. Adding CTS to her name didnt do anything to her knowledge base...at the end of the day...she was still a nurse. She couldnt even hold her ground with a 4th year medical student despite her 10 yrs of clinical experience working in a CTICU. I have seen this repeated over and over again in the hospital. Some of it doesnt harm patient healthcare, but some of it potentially can.

The rigors and challenges of medical school naturally selects for people who desire to excel. We cant expect anything less when it comes to health.

 

[Andrew_Doan]

I find it slightly upsetting that you Iowa guys are working on this fantastic new technology, yet one of your big sellings points seems to be how great this imaging system will be at circumventing ODs.

Yet you don't find it upsetting when non-surgeons (i.e., optometrists) are legislating for scalpel surgery in Oklahoma, New Jersey, and New Mexico???

Optometry is trying to circumvent the general ophthalmologist, who is trained to be a comprehensive medical and surgical eye care provider.

 

[VA Hopeful Dr]

Yet you don't find it upsetting when non-surgeons (i.e., optometrists) are legislating for scalpel surgery in Oklahoma, New Jersey, and New Mexico???

Optometry is trying to circumvent the general ophthalmologist, who is trained to be a comprehensive medical and surgical eye care provider.

Best as I can remember, my positions have always been a) is there proof, either for or against, ODs doing surgery and b) whatever your opinions, don't be a jerk about ODs in your posts. You, and others, are always very good about stating your opinion in a polite way so B is usually moot except in the last week or two. As for A, well neither OMDs nor ODs will give evidence about OD surgery outcomes one way or another (other than malpractice insurance rates, of course).

Besides, I just don't know enough about eye surgery to have a strong opinion one way or the other. Until I do, I'll rely on whatever statistics are out there.

 

[Mirror Form]

Yet you don't find it upsetting when non-surgeons (i.e., optometrists) are legislating for scalpel surgery in Oklahoma, New Jersey, and New Mexico???

Optometry is trying to circumvent the general ophthalmologist, who is trained to be a comprehensive medical and surgical eye care provider.

Exactly, OD's are the ones who started the current battle. Why shouldn't OMD's fight back? Jenny may be right that optometrists will take advantage of this technology too. However, if things get really nasty, MD's can use this as a way to get other MD's to circumvent the OD's who are pushing for surgical rights (similiar to how OD's justifiably don't refer catact surgery patients to MD's who are disrespectful).

 

[Mirror Form]

neither OMDs nor ODs will give evidence about OD surgery outcomes one way or another (other than malpractice insurance rates, of course).

That's b/c there is no such data available since OD's aren't eye surgeons. By your logic, one could say that we shouldn't stop opticians from performing eye surgery until there is strong evidence that they have worse outcomes. And heck, why shouldn't we let surgical PA's just start doing appendectomies independantly? After all, there isn't any strong data showing that they do a worse job then general surgeons.

But seriously, we already have a track for becoming an eye surgeon. Currently, we're apparently producing a more then adequate amount of them too. Therefore, there is no good reason to license other professionals to become eye surgeons, especially when it's an experimental program that could cause worse outcomes in eye surgery.

 

[futuredoctorOD]

Actually it isnt healthy. The rise of allied healthcare will only raise the health costs to this country. When a future NP, who bills medicare to see a patient for an equal price as a doc (NPs are pushing for equal pay from medicare billing) - but who doesnt know how to treat the patient refers the patient to an internal medicine doc...who will also bill medicare to see the patient...is it really cost effective for this double billing? Why not just have these patients see the MD...and cut to the chase...rather then send through a welfare-like gatekeeper. Allied healthcare is nothing more than filler healthcare...just filling bodies with people in white coats. I have respect for those who are willing to work in a coordinated setting (i.e integrated medicine and physician assistant practice where if a PA cant manage a case, the doc will be available to manage because the doc is the PA's employer). But once other independent midlevel practices (NPs) become fully independent, u will have NP billing independently and studies have shown that midlevel providers refer to docs at a much higher rate than a comparable Family doc or any primary care medical physician. Sure specialist docs will see huge increases in their income (and they are seeing it already)...but honestly is that what our healthcare needs?

Now back to the topic of ODs. Sorry to lambast your colleagues. But organized optometry's future goals do not show evidence of cooperation. Ophthalmologists understand this. ODs are slowly adding pseudo-residency programs in treating medical eye diseases. Once these programs become widespread, since ODs control a large portion of patients in ...they will just refer to themselves once they feel they can successfully expand scope. Do you think ODs give a !@#$ if these patients develop long term problems from mismanagement...ofcourse not. At the end of the day, ophthalmologists will just be either fixing complications from OD mismanagement, or will be seeing the most sickest eye patients. So the time is now to educate patients about the difference and it indeed works very well. I dunno how many times in my dad's office have patients been confused between optometrists and ophthalmologists (my dad is a cardiologist...but i'd say 60% of his patients make the mistake when he suggests that they see their eye doc). But my dad always makes it a point to educate patients on the importance of seeing MDs.

Lastly, once in medical school, there is no insecurity. You are at the top when it comes to clinical medicine. Sure we may seem proud, but who wouldnt after the study and training we go through? Okay, so we may not be able to do needle sticks and place IVs as good as nurses, but who cares. I have run into scores of former nurses and other midlevel providers who went through med school and residency and mentioned that they never expected how much a difference medical school and residency would make in their approach to a medical problem. Before they simply used cookie cutter memorizing formats...medical schools get people to think and analyze. When you are a midlevel provider...you dont know what you dont know. You may think you know everything, but it isnt until you do medicine that you realize what being a real clinical physician is all about. My friend, as an OD, you would feel the same if you became an Eye Physician and Surgeon.

Its a sacrifice that begins with hard work excelling in school and never accepting mediocre results. We by nature have a disproportionate number of Type A's and obsessive compulsive people. And we should, we only accept the best. And ultimately, no one can manage medical problems better than we can. Yet the inferiority complex and often arrogance of midlevel providers is astounding. After rounds once, I nodded my head in shocking amazement when I saw a CTS-CRNP nurse vigorously debating her absolutely stupid and wrong patient management decision choice with a fourth year medical student at my school in regards to CHF. The head of cardiothoroacic surgery was also leaving from rounds at the same time. So the NP was acting up because she though she was right and was making a show hoping she would win brownie points from staff and was getting flustered trying to explain her stupid understanding of pathophysiology with the student. She was wrong, proved wrong by a surgery intern, yet she still tried until a CTS fellow politely explained. I wish you all had the chance to look at her face...I bet she secretly wished she could drop the CTS (cardiothoracic surgery initial) from her CTS-CRNP and hide somewhere in the nursing quarters. How did she get the guts to act so stupid in front of the whole team of surgeons? I will never know.

It comes down to this, if one wants to know medicine...then prove it and join the club. If one cant do it through hardwork and a demonstration of ones abilities, thats fine...become an optometrist, audiologist, CRNP or whatever. But dont go to your doc school and just attend lectures on eyes and basic pathology and pharm and then call yourself a clinical eye physician to the public and consider yourself an equal to an ophthalmologist.

People cant have it both ways like the CRNP tried. Adding CTS to her name didnt do anything to her knowledge base...at the end of the day...she was still a nurse. She couldnt even hold her ground with a 4th year medical student despite her 10 yrs of clinical experience working in a CTICU. I have seen this repeated over and over again in the hospital. Some of it doesnt harm patient healthcare, but some of it potentially can.

The rigors and challenges of medical school naturally selects for people who desire to excel. We cant expect anything less when it comes to health.

I understand your point but you cannot compare a nurse to an OD---an OD is a doctor who went thru 8 yrs of education including undergrad and achieved a doctoral degree....I chose optometry because I want to be a primary care eye physician instead of choosing the DO route. My little brother begged me to apply for DO school instead---it just doesnt have the same appeal to be as a "focused" program like Optometry....There are very good primary eye disease residency programs for Optometrists. The Optometric Physician I work with did one with an Eye institute and is very skilled! Optometry school is very tough and not to be taken lightly

 

[rubensan]

I understand your point but you cannot compare a nurse to an OD---an OD is a doctor who went thru 8 yrs of education including undergrad and achieved a doctoral degree....

Dear futuredoctorOD,

So if I follow you correctly, ODs ARE comparable to MDs? but ODs are in a loftier category that CRNAs and CRNPs just because OD has the word "doctor" in the degree? I am not trying to be confrontational, I am just pointing out that you are using the same argument against them that many MDs on this forum are using against ODs...an argument, that at times has been more tactfully articulated than others, but has nonetheless put many ODs on the defensive concerning the scope and breadth of their education. To play Devil's advocate for a moment, CRNAs, CRNPs and Midwives all have "limited scope" (as you like to call it) training beyond standard nursing school. But if I am understanding you correctly, you agree that at the end of the day, lines do have to be drawn somewhere, correct?

Ruben

 

[MPS]

Yeah, a lot of 5 y/o's wear their glasses 24/7.

And you think optometrists are ignorant?

 

[Mirror Form]

And you think optometrists are ignorant?

When did I say optometrists are ignorant? Also, I'm not an ophthalmologist since I'm still in medical school. But getting back to the point, are you talking about using glasses to treat/prevent amblyopia? Or are you talking about otherwise normal kids developing amblyopia from some grossly wrong glasses prescription?

If it's the latter, I've never heard of it. Although I've only done a few month long ophtho rotations, so there are a lot of things I haven't heard of. But I'm skeptical about how likely that would be. If it's the former, then your comments don't make any sense. Obviously any child found to be at risk for amblyopia would be referred for specialized care.

 

[Loncifer]

I think that educating patients is the right way to go. I have no idea how rigorous the OD education is, nor do I really care. They are not medical doctors and are not trained for surgerical intervention. Since the public has trouble discerning the difference sometimes, it is our duty to show them the difference. The same goes for CRNA's, Psychologists, and other mid-levels looking to expand due to our own apathy and lack of patient knowledge. I was not aware of the numerous expansion of scope issues until midway through medical school. Nowadays, I try to make it a point to educate anyone I encounter during my clinical rotations whenever relevant. I know many of my classmates (especially those going into anesthesia and psych) are doing the same. For example, I can barely go a day or two without encountering a diabetic patient. During my H&P, I always ask them if they see an eye doctor yearly. I then ask if they see an ophthalmologist or optometrist, and if they don't know the difference, I use the opportunity to explain the difference in an objective manner. I know that if i (or more importantly...a family member) needed surgery, I'd go to (or recommend) an ophthalmologist who had an anesthesiologist (not a crna). I think the general public deserves to know enough about the difference between the different degrees in order to make a wise and educated decision.

By the way, I do not believe in slinging mud or calling OD's names. I just believe in being honest...something that OD's should have no problem with at all.

Buck,
You say, in opening, that you have no idea how rigorous OD education is, nor do you care. You then later state that you explain to patients the difference between an OD and OMD in "an objective manner". Don't you feel there is a problem in reconciling these two statements?
Respectfully,
Loncifer

 

[Buck Strong]

Buck,
You say, in opening, that you have no idea how rigorous OD education is, nor do you care. You then later state that you explain to patients the difference between an OD and OMD in "an objective manner". Don't you feel there is a problem in reconciling these two statements?
Respectfully,
Loncifer

Hmmmm...I don't know how rigorous PT or chiro school is, but if I have LOL who fell in the bathroom and fractured her hip, I'd probably objectively recommend that she go see an MD/DO orthopod. Unless you know of any midwest states short on orthopaedic surgeons that are allowing chiropractors and physical therapists to perform surgery.
Respectfully,
Mr. Strong

P.S. To pre-emptively reply to (insert OD poster name here) probable reply about diabetic retinopathy patients not necessarily needing eye surgery right now, while fractured hip lady probably does...If I had a patient with a frozen shoulder vs. rotator cuff tear, I'd probably still send them to an orthopod, even though they might not need surgery right now. I hope you can understand where I'm coming from.

 

[aphistis]

And you think optometrists are ignorant?

No, but they evidently have trouble detecting sarcasm.

 

[JennyW]

Yeah, a lot of 5 y/o's wear their glasses 24/7.

Most 5 year olds who are wearing glasses should be wearing them during all waking hours.

And amblyopia can be induced with as little as 1 diopter of anisometropia.

Jenny

 

[Mirror Form]

Most 5 year olds who are wearing glasses should be wearing them during all waking hours.

And amblyopia can be induced with as little as 1 diopter of anisometropia.

Jenny

As I said before, if they were in danger of amblyopia they'd be referred to specialized care. If a 5 y/o wasn't in danger of amblyopia, why would they need to wear their glasses during all waking hours? Maybe this is something I haven't learned yet, but I can't think of any other reason.

 

[Andrew_Doan]

As I said before, if they were in danger of amblyopia they'd be referred to specialized care. If a 5 y/o wasn't in danger of amblyopia, why would they need to wear their glasses during all waking hours? Maybe this is something I haven't learned yet, but I can't think of any other reason.

Some kids have accommodative esotropia when they are hyperopes. Wearing glasses reduces their accommodationand prevents their eyes from turning in.

 

[smiegal]

Nothing upsets me more than a bunch of FP residents that hate their job and did FP as a stepping stone to something more competitive like ophthalmology.

Why are you so bothered by FP residents going into Ophthalmology?

 

[JennyW]

As I said before, if they were in danger of amblyopia they'd be referred to specialized care. If a 5 y/o wasn't in danger of amblyopia, why would they need to wear their glasses during all waking hours? Maybe this is something I haven't learned yet, but I can't think of any other reason.

Accommodation in children is very variable. You're assuming that the machine is going to be that accurate on children who can accommodate massive amounts, especially in an instrument.

If you have a child looking into an autorefractor who gives you a reading of -1.00 in one eye and a -2.00 in the other when in actuality they are a -1.00 OU, you can induce amblyopia by prescribing those glasses.

Jenny

 

[smiegal]

Aphistis,

What's your take on the similarities & differences between the OMFS DDS track and a hypothetical OD route for surgical training?


VA hopeful Dr,

Maybe we should set up a randomized, controlled trial for outcomes of OD vs. MD eye surgery. Would you like to volunteer yourself & some family members for the OD wing?

Seriously, though, what kind of evidence would you be looking for?

 

[VA Hopeful Dr]

Aphistis,

What's your take on the similarities & differences between the OMFS DDS track and a hypothetical OD route for surgical training?


VA hopeful Dr,

Maybe we should set up a randomized, controlled trial for outcomes of OD vs. MD eye surgery. Would you like to volunteer yourself & some family members for the OD wing?

Seriously, though, what kind of evidence would you be looking for?

Evidence, let's see....

1) ODs in Oklahoma have been doing lasers for about 10 years now. I'd love to see some outcomes from all that. Now, as both Dr. Doan and mdkurt have said, it should be up to the ODs to provide that data; however, if, during a YAG, the OD manning the laser screws up and cracks the IOL, an ophthalmologist would be the one called to fix that. How many cases like this have Oklahoma MDs seen? If there had been many of those OD-induced screw ups, the AAO would have published it in every journal/publication/billboard they could afford. Mdkurt was right, he can't just waltz in and start looking over OD charts concerning lasered patients. But any dire consequences would require involving an MD, so why not just ask the Oklahoma MDs for their records?

2) Here's a clinical trial we can set up that would prove one way or the other AND insure patient safety. Two words - ophthalmologist supervision. Let the OD do the surgery, but the MD is right there watching and ready to take over should anything go wrong/look like its about to go wrong.

Here's a neat idea though: it is my understanding that many insurance plans (private mostly) don't reimburse ODs equal to MDs for the exact same procedures. Why not get the AAO to suggest the following to the AOA (optometric association), "Hey, if y'all will quit all this surgical lobbying, we will work with you for equal reimbursement." If, as many of you have suggested, ODs are merely in this scope-expansion business for the money, then offer an alternative means from them to increase their business that doesn't involve surgery.

Just another suggestion to get us to quit all this silly bickering.

 

[rubensan]

Here's a clinical trial we can set up that would prove one way or the other AND insure patient safety. Two words - ophthalmologist supervision. Let the OD do the surgery, but the MD is right there watching and ready to take over should anything go wrong/look like its about to go wrong.

A lot of surgery attendings (ENT, gsurg, OB/GYN, ophtho, etc) will say that you could, in theory, train a "monkey" to operate. The art of being a physician AND surgeon is not only the skill of the surgical procedure itself, but also knowing when to operate and how to manage the COMPLICATIONS of surgery. I don't believe that anyone (MD or OD) should be able to take a pt to the OR if they are unprepared to manage the complications or bad outcomes. Your plan of MD supervision during ophthalmic surgery already exists, it's called ophthalmology residency! It's not in the patients' best interest nor is it fair to the OMDs for ODs to say "we'll operate but if anything goes wrong we'll just refer to the ophthalmologist."

Here's a neat idea though: it is my understanding that many insurance plans (private mostly) don't reimburse ODs equal to MDs for the exact same procedures. Why not get the AAO to suggest the following to the AOA (optometric association), "Hey, if y'all will quit all this surgical lobbying, we will work with you for equal reimbursement." If, as many of you have suggested, ODs are merely in this scope-expansion business for the money, then offer an alternative means from them to increase their business that doesn't involve surgery..

I do like this idea. You're right! There is no reason why ODs should not be compensated as much as MDs for similar services, but surgery by surgeons!

 

[aphistis]

Aphistis,

What's your take on the similarities & differences between the OMFS DDS track and a hypothetical OD route for surgical training?


VA hopeful Dr,

Maybe we should set up a randomized, controlled trial for outcomes of OD vs. MD eye surgery. Would you like to volunteer yourself & some family members for the OD wing?

Seriously, though, what kind of evidence would you be looking for?

The only similarity I can think of is that in both cases, a post-doc surgical residency would be completed. The differences, however, are significant:

1) In every OD surgical track I've seen proposed here, OMD's would serve as the attendings to supervise the training. OMS residents are overseen by (duh) OMS attendings, but if you check the faculty listings of different programs, you'll typically see noticeably more single-degree surgeons than dual-degree. In studying OMS, picking up the MD along the way obviously provides a broader appreciation of the different disciplines involved in patient care, but it's by no means necessary to become an excellent surgeon. Oral & maxillofacial surgery is a completely self-sufficient specialty.

2) OMS fills a unique niche within the healthcare professions that isn't included in any other specialty. The field shares a lot of anatomic overlap with MD specialties like ENT & PRS, but highlighting the differences is as simple as asking an ENT resident what s/he knows about occlusion, or an OMS resident how many cochlear implants s/he has placed. As a specialty of dentistry, OMS includes a great deal of attention to issues that receive little to no emphasis in the complementary medical fields. As such, OMS can make persuasive arguments regarding the necessity of their profession. Offering a similarly compelling argument to justify the existence of these proposed optometrist surgeon programs is the challenge currently facing optometry as a profession, and based on the information presented here at SDN, I don't think it's come anywhere close to meeting that standard. I haven't seen any proposed procedure these OD surgeons would perform that isn't already accounted for by ophthalmology.

 

[toofache32]

The only similarity I can think of is that in both cases, a post-doc surgical residency would be completed. The differences, however, are significant:

1) In every OD surgical track I've seen proposed here, OMD's would serve as the attendings to supervise the training. OMS residents are overseen by (duh) OMS attendings, but if you check the faculty listings of different programs, you'll typically see noticeably more single-degree surgeons than dual-degree. In studying OMS, picking up the MD along the way obviously provides a broader appreciation of the different disciplines involved in patient care, but it's by no means necessary to become an excellent surgeon. Oral & maxillofacial surgery is a completely self-sufficient specialty.

2) OMS fills a unique niche within the healthcare professions that isn't included in any other specialty. The field shares a lot of anatomic overlap with MD specialties like ENT & PRS, but highlighting the differences is as simple as asking an ENT resident what s/he knows about occlusion, or an OMS resident how many cochlear implants s/he has placed. As a specialty of dentistry, OMS includes a great deal of attention to issues that receive little to no emphasis in the complementary medical fields. As such, OMS can make persuasive arguments regarding the necessity of their profession. Offering a similarly compelling argument to justify the existence of these proposed optometrist surgeon programs is the challenge currently facing optometry as a profession, and based on the information presented here at SDN, I don't think it's come anywhere close to meeting that standard. I haven't seen any proposed procedure these OD surgeons would perform that isn't already accounted for by ophthalmology.

What he said.

What am I doing here?

 

[futuredoctorOD]

What he said.

What am I doing here?

I say this in "good faith"--every doc on here OD or OMD/ ODO ---I have the utmost respect for your hard work and accomplishments---I aspire to be one of you in 5 years. That said, I feel that any degrading comments directed at Optometrists is completely uncalled for and ridiculous really. I for one have not seen one poster on here degrade an Opthalmologist--Opthalmology on the basis of what it is...I have seen people on here degrade optometry (Vanelo, Brendang, etc....)----the opinions from these folks hold no merit becuase of the unprofessional and degratory nature they exhibit regarding to optometric physicians. Both fields are respectable and very difficult to achieve--this is a fact....I propose that:

1. Creat a surgery residency for OD's like Dr. Doan suggested (maybe a couple tweaks here and there)---so there is an understanding between the two professions or we can look forward to enjoying years of legal "fun" as we did for the 25 yrs of prescription rights battles in 50 states---1972 to present---that was a joy wasn't it?

2. Expand the Optometric formulary to include oral meds in every state instead of just 41, and make it comprehensive to treat most eye diseases within the scope of a primary care eye doctor....Ohio is good example for a decent formulary but needs to expand each year and currently IS expanding. Face reality---optometrists are primary care eye doctors and if Opthalmology is respects this than STOP fighting with them over glaucoma medicines in New York, etc-----this is stupid and a waste of money.

3. Create more partnerships in hospitals between the two professions and WORK TOGETHER---as in optometric externships, residencies (there are VA hospital residencies cooperatives OD/OMD, and eye institutions, but not many if any private or state hospitals that I know of. (please correct me here if I am wrong.)

4. Be realistic.....Both professions are here and will be for a long time----be symbiotic not predatory or parasitic........

 

[toofache32]

...optometric physicians...

What does this mean?

 

[rubensan]

I for one have not seen one poster on here degrade an Opthalmologist--Opthalmology on the basis of what it is...

Sure, I agree, some comments were a little harsh. BUT you have to remember that the title of this forum is: Ophthalmology: Eye Physicians & Surgeons. You probably won't find many threads degrading ophthalmologist here! Though, I'm sure there are a few OD forums out there that do a good job of degrading ophthalmologists!

Face reality---optometrists are primary care eye doctors and if Opthalmology is respects this than STOP fighting with them over glaucoma medicines in New York, etc

Can you please clarify what this sentence means?

RUben

 

[bigfrank]

Die Thread, Die!!!

 

[Andrew_Doan]

2. Expand the Optometric formulary to include oral meds in every state instead of just 41, and make it comprehensive to treat most eye diseases within the scope of a primary care eye doctor....

To do this, you need a medical internship & residency (4 years post-graduate) with more experience with oral medications.

Your knowledge of oral medications and their use need to be more than just a pharmacy class and shadowing attending optometrists.

 

[EYESURG]

To do this, you need a medical internship & residency (4 years post-graduate) with more experience with oral medications.

Your knowledge of oral medications and their use need to be more than just a pharmacy class and shadowing attending optometrists.

Guys, please stop arguing with this "Future...etc." He just doesn't get it. Don't argue with a....

 

[futuredoctorOD]

To do this, you need a medical internship & residency (4 years post-graduate) with more experience with oral medications.

Your knowledge of oral medications and their use need to be more than just a pharmacy class and shadowing attending optometrists.

41 states already have oral medications as part of the scope.....Ohio for example allows for:

4725.01(C)

(C) "Therapeutic pharmaceutical agent" means a topical ocular pharmaceutical agent or any of the following drugs or dangerous drugs that is used for examination, investigation, diagnosis, or prevention of disease, injury, or other abnormal conditions of the visual system or for treatment or cure of disease, injury, or other abnormal condition of the anterior segment of the human eye and is an anti-microbial, anti-allergy, anti-glaucoma, topical anti-inflammatory, or cycloplegic agent, or an analgesic:

(1) A topical ophthalmic preparation;

(2) Oral dosage of any of the following drugs:

(a) Acetazolamide;

(b) Astemizole;

(c) Dichlorphenamide;

(d) Diphenhydramine;

(e) Glycerin in a fifty per cent solution;

(f) Isosorbide in a forty-five per cent solution;

(g) Methazolamide;

(h) Analgesics that may be legally sold without prescription;

(I) Terfenadine;

(j) Ampicillin in a two hundred fifty milligram or five hundred milligram dosage;

(k) Cefaclor in a two hundred fifty milligram or five hundred milligram dosage;

(l) Cephalexin in a two hundred fifty milligram or five hundred milligram dosage;

(m) Dicloxacillin in a two hundred fifty milligram or five hundred milligram dosage;

Doxycycline in a fifty milligram or one hundred milligram dosage;

(o) Erythromycin in a two hundred fifty milligram, three hundred and thirty-three milligram, or five hundred
milligram dosage;

(p) Penicillin VK in a two hundred fifty milligram or five hundred milligram dosage;

(q) Tetracycline in a two hundred fifty milligram or five hundred milligram dosage.

(3) Any other oral dosage of a drug or dangerous drug that is listed by rule adopted by the State Board of Optometry under section 4725.09 of the Revised Code.

4725-16-02 Additional oral therapeutic pharmaceutical agents

In accordance with Chapter 119. of the Revised Code, in consultation with the State Board of Pharmacy, and under the authority of section 4725.09 of the Revised Code, the oral drug dosage formulary is being expanded. Oral dosages of drugs or dangerous drugs that are therapeutic pharmaceutical agents under division (C)(2) of section 4725.01 of the Revised Code are added to the existing oral dosage formulary listed within that section.

(A) Oral dosages of the following drugs:

(1) Amoxicillin up to and including five hundred milligram dosage;

(2) Erythromycin up to and including five hundred milligram dosage;

(3) Ibuprofen up to and including eight hundred milligram dosage;

(4) Loratadine;

(5) Naproxen up to and including five hundred fifty milligram dosage;

(6) Terfenadine with Pseudoephedrine Hydrochloride.

(7) Fexofenadine Hydrochloride

(8) Fexofenadine/Pseudoephedrine

(9) Amoxicillin/Clavulante Potassium

(10) Loratadine and Pseudoephedrine Sulfate

(11) Azthromycin up to and Including 250 milligram dosage

(12) Cetirizine Hydrochloride

(13) Clarinex

(14) Zyrtec D

(15) Acyclovir (consistent with paragraph B)

(16) Valacyclovir (consistent with paragraph B)

(17) Famciclovir (consistent with paragraph B)
This is relatively broad when compared with states like Illinois where there is no oral prescriptions as of yet----but there will be soon. Are you saying that beyond these drugs they would need a medical internship or residency-------what do you mean? The OD's I work with prescribe everything on this list--the other day I got to see a patient with a herpetic (herpes zoster) infection and the OD write an oral antiviral...Another time a patient with Pseudotumor--an OD wrote oral predisone. What exactly are you saying?

 

[futuredoctorOD]

Guys, please stop arguing with this "Future...etc." He just doesn't get it. Don't argue with a....

Again you have to stoop to the lowest common denominator------with a degrading comment "Don't argue with a...." wonderful

 

[vanelo]

The OD's I work with prescribe everything on this list--the other day I got to see a patient with a herpetic (herpes zoster) infection and the OD write an oral antiviral...

Before you want to prescribe anything at all, you may want to consider a few grammar lessons.

 

[pushinepi2]

--------------------------------------------------------------------------
".........41 states already have oral medications as part of the scope.....Ohio for example allows for.....

4725.01(C)

(C) "Therapeutic pharmaceutical agent" means a topical ocular pharmaceutical agent or any of the following drugs or dangerous drugs that is used for examination, investigation, diagnosis, or prevention of disease, injury, or other abnormal conditions of the visual system or for treatment or cure of disease, injury, or other abnormal condition of the anterior segment of the human eye and is an anti-microbial, anti-allergy, anti-glaucoma, topical anti-inflammatory, or cycloplegic agent, or an analgesic:

(1) A topical ophthalmic preparation.... Astemizole....."
--------------------------------------------------------------------------

Astemizole? Astemizole? Wow. Haven't heard that one since the last patient dropped dead of Romano-Ward syndrome. This drug, as I recall, caused some nasty arrhythmias when combied with other CYP450 inducer/inhibitors. I believe anti-retrovirals were major co-offenders when prescribed in conjunction with this drug.

Besides providing people with an obsure bit of FDA history, the little hismanal/astemizole anectode underscores the importance of appropriate training. While its true that midlevel providers with far less pharmaco-physiologic background training than optometrists provide these medications, it is vitally important for healthcare practitioners to understand the possibly wide ranging systemic manifestations of topical or locally acting drugs. When it comes to the practice of medicine, the stakes are quite high. I think the heart of this conflict is laid bare when talking about prescriptive authority for undeniably systemic drugs. Clearly, optometrists already prescribe medications that have whole-person effects. Timolol is just one controversial example. Where does prescribing authority end, however? Since optometrists already prescribe beta blockers with systemic effects, should they be permitted to write them for hypertension?? If the response is "yes", then one presupposes that optometrists have a comprehensive understanding of hypertensive disease. Because uncontrolled HTN leads to disasterous ophthalmic complications, doesn't it make sense to permit ODs to write for antihypertensives? Do ODs get training in the benefits of selective vs nonselective beta blockers? Are ODs prepared to gauge the therapeutic effect of carvedilol as it relates to a piss-poor ejection fraction? What about ACEIs or ARBs in the patient with chronic renal insufficiency?

My point is simply this: look at the big picture. Optometrists already prescribe medications with systemic effects. They already diagnose and treat eye disease and manage their own patients. What is also clear is that their training is completely different than that of their ophthalmalogic counterparts. I find it difficult to believe that an ODs training, despite intensive courses in pathology, anatomy, and physiology, is in any way as comprehensive as an ophthalmologists. In terms of time investment, the recently graduated ophthalmologic physician has four to five more years of education in the diagnosis and treatment of ocular and systemic disease. I would hope that these differences are kept in mind when legislating over such hotly contested issues like scope of practice. As individuals with the most comprehensive training, the ophthalmologists should remain as the arbiters of presciptive and medical authority.

But don't worry too much about my opinion... I have no intention of going into ophthalmology!

-PuSh

 

[pushinepi2]

...The OD's I work with prescribe everything on this list....Another time a patient with Pseudotumor--an OD wrote oral predisone. What exactly are you saying?

What we're saying is this:

Neurologic Clinics
Volume 22 • Number 1 • February 2004
Copyright © 2004 W. B. Saunders Company

Pseudotumor cerebri

Deborah I. Friedman, MD *
UniSchool of Medicine and Dentistry
Rochester, NY, USA

--------------------------------------------------------------------------

"Corticosteroids rapidly decrease the ICP but are not suitable for chronic use. Their side effects of weight gain and fluid retention are undesirable and counterproductive. Moreover, patients may experience rebound intracranial hypertension as the medication is tapered [109] . Corticosteroids generally are reserved for the short-term, urgent treatment of patients who have visual loss or are used in conjunction with a surgical procedure [182] . Corticosteroids are recommended for use in conjunction with the surgical procedure (to “buy time” while awaiting surgery) not instead of surgery.."

Interesting discussion.

Push

 

[vanelo]

What we're saying is this:

Neurologic Clinics
Volume 22 • Number 1 • February 2004
Copyright © 2004 W. B. Saunders Company

Pseudotumor cerebri

Deborah I. Friedman, MD *
UniSchool of Medicine and Dentistry
Rochester, NY, USA

--------------------------------------------------------------------------

"Corticosteroids rapidly decrease the ICP but are not suitable for chronic use. Their side effects of weight gain and fluid retention are undesirable and counterproductive. Moreover, patients may experience rebound intracranial hypertension as the medication is tapered [109] . Corticosteroids generally are reserved for the short-term, urgent treatment of patients who have visual loss or are used in conjunction with a surgical procedure [182] . Corticosteroids are recommended for use in conjunction with the surgical procedure (to “buy time” while awaiting surgery) not instead of surgery.."

Interesting discussion.

Push

An OD, of course, would never know that. Their education doesn't require it.

 

[JennyW]

An OD, of course, would never know that. Their education doesn't require it.

If you think that ODs aren't trained in the treatment and referal protocols for pseudotumor cerbri as well as the ocular and systemic side effects of those treatments then you are wrong, wrong, wrong my friend.

Obviously, we have yet another MS4 or PGY1 who is simply repeating the mantra that they have been spoonfed for the past 4 years: That allopathic medical education is the only possible path to enlightenment.

*yawn*

Jenny

 

[pushinepi2]

If you think that ODs aren't trained in the treatment and referal protocols for pseudotumor cerbri as well as the ocular and systemic side effects of those treatments then you are wrong, wrong, wrong my friend.

Obviously, we have yet another MS4 or PGY1 who is simply repeating the mantra that they have been spoonfed for the past 4 years: That allopathic medical education is the only possible path to enlightenment.

*yawn*

Jenny

I'll one up your yawn with a *sigh*! The intent of my previous post was meant to shift the debate away from personal attacks and towards the heart of the scope of practice conflict. This debate, as you point out, is comprised of allopaths, osteopaths, ODs, and graduate physicians. It is important to talk about issues and not focus (pardon the visual pun) on optometric/ophthalmologic bias.

 

[EYESURG]

An OD, of course, would never know that. Their education doesn't require it.

BTW, I co-authored a major article about Pseudotumor cerebri or IIH. I'd like to see Mr "future..etc." guy attempt to write even one paragraph. I would not even accept his paragraph for edition.

 

[rubensan]

.

Obviously, we have yet another MS4 or PGY1 who is simply repeating the mantra that they have been spoonfed for the past 4 years: That allopathic medical education is the only possible path to enlightenment.

Jenny

Jenny, you seem like a reasonable person. I actually enjoy the humor and sarcasm in many of your posts. Against my better judgement, I am perpetuating this thread, but as an MS4, I don't believe that we are all spoonfed this mantra.

Ruben