Plight of Optometry in Ontario, Canada!

[UWSO2003]

Hi All,

Reading through some of the older posts and what not, I think it's very fortunate that the profession has such strong influences in the US. Here in Ontario, the OMA (Ontario Medical Association .. which my girlfriend is a member of) is a very strong political body.

As such, the scope of practice of Optometry in Ontario is decades behind that of the states, and other provinces as well.

Currently, the only DPA OD's can use is Tropicamide, proparacain, and benoxinate ... if memory serves me.

What about TPA's?? Fuggetaboutit! OD's in Ontario can not prescribe any Topicals/orals/injectables etc. Managing glaucoma? You wish!

The laws about FB removal are a little wishy-washy. But most OD's feel that anything more that using the "spongy spear" will fall outside the scope of practice. It's funny because my girlfriend after her first year of med school was removing FB's with a needle in the OR.

There are hopes that OD's will get TPA's sometime next year ... but I've been hearing the same song and dance since I was in first year. The college thinks that TPA's are more likely to come in about 5 years.

We haven't even touched upon the issue of dispensing. Here in Ontario OD's are limited to a "cost plus" system. Under this law we must dispense everything "at cost" (frames, lenese, CL, etc) but we charge a fixed "dispensing fee/professsional fee" to the bill. Trying to explain this to the patients is a real PITA, because most are used to the retail system.

Have pity all!

---

Members don't see this ad.

 

[TomOD]

All I can say Freddy is......wow!

No, I can say a little more than that.....I can't image practicing optometry without DPA and TPA priviledges. In my state we are authorized to rx virtual ANY meds including glaucoma, steroids, antibiotics, antifungals, anitviral......topical and oral.

It, as you know, is 100% political and comes from a handful of insecure and frighted ophthalmologist (and a few pediatricans they can recruit). Even though OD's in some states here in the US (like NC) have had TPA's since 1977 ( that's 24 years), there are still a few backward states that will not let OD's have oral rights or glaucoma......Even though it has been shown that OD's over these 24 year have absolutely no greater malpractice claims and have been treating their patients with great success.

It's a game. You guys will get what you deserve sooner or later. This is why you should all participate in organized optometry.

 

[UWSO2003]

Hi Tom,

Thanks for the reply. Let's hope that things change here in Ontario. It seems like Optometry has always been fighting a losing battle here. We've "the infamous we" been pushing for the deregulation of fees ... and lost (because of government funded health care, we get paid $39 CND per eye exam. In other provinces where it's degregulated OD's are getting ~60-80CND per exam .. which is still a bargan). OD's even agreed to a cut back in fees in the late 80's early 90's ....

That's why I was asking on "the other board" regarding recommendations for good sites in the US. I want to be able to see all that I can. My girlfriend is doing an elective in Ophalmology and in her first week she's seen more interesting pathology than I have! It freaks me out!

 

[drbizzaro]

Hi Tom,

Thanks for the reply. Let's hope that things change here in Ontario. It seems like Optometry has always been fighting a losing battle here. We've "the infamous we" been pushing for the deregulation of fees ... and lost (because of government funded health care, we get paid $39 CND per eye exam. In other provinces where it's degregulated OD's are getting ~60-80CND per exam .. which is still a bargan). OD's even agreed to a cut back in fees in the late 80's early 90's ....

That's why I was asking on "the other board" regarding recommendations for good sites in the US. I want to be able to see all that I can. My girlfriend is doing an elective in Ophalmology and in her first week she's seen more interesting pathology than I have! It freaks me out!

i heard that canadians no longer have health coverage of eye exams, is that true?

 

[ProZackMI]

Hi All,

Reading through some of the older posts and what not, I think it's very fortunate that the profession has such strong influences in the US. Here in Ontario, the OMA (Ontario Medical Association .. which my girlfriend is a member of) is a very strong political body.

As such, the scope of practice of Optometry in Ontario is decades behind that of the states, and other provinces as well.

Currently, the only DPA OD's can use is Tropicamide, proparacain, and benoxinate ... if memory serves me.

What about TPA's?? Fuggetaboutit! OD's in Ontario can not prescribe any Topicals/orals/injectables etc. Managing glaucoma? You wish!

The laws about FB removal are a little wishy-washy. But most OD's feel that anything more that using the "spongy spear" will fall outside the scope of practice. It's funny because my girlfriend after her first year of med school was removing FB's with a needle in the OR.

There are hopes that OD's will get TPA's sometime next year ... but I've been hearing the same song and dance since I was in first year. The college thinks that TPA's are more likely to come in about 5 years.

We haven't even touched upon the issue of dispensing. Here in Ontario OD's are limited to a "cost plus" system. Under this law we must dispense everything "at cost" (frames, lenese, CL, etc) but we charge a fixed "dispensing fee/professsional fee" to the bill. Trying to explain this to the patients is a real PITA, because most are used to the retail system.

Have pity all!

I guess I'm just shocked that OD's can do all these things in the US. I confess my ingorance, but ODs can prescribe therapeutic medications in the US? I understand diagnostic, but therapeutics? Damn...that scares me. I have no idea how much pharmacology ODs receive in the US or Canada, but RxPs? Jeez...and I thought PhD/PsyD psychologists getting RxPs was scary.

When I see my optometrists, it's to receive a brief, cursory eye exam and to get new contact lenses/glasses...period. She does not diagnose anything, nor does she do anything that is remotely medical. I'm young and in good health, but still...if I had any problems, I would see an ophthalmologist, nor an optometrist. Maybe I'm confused, but what kinds of things do ODs treat now? Are you guys seeking to expand you scope of practice in the US and Canada?

 

[KHE]

I guess I'm just shocked that OD's can do all these things in the US. I confess my ingorance, but ODs can prescribe therapeutic medications in the US? I understand diagnostic, but therapeutics? Damn...that scares me. I have no idea how much pharmacology ODs receive in the US or Canada, but RxPs? Jeez...and I thought PhD/PsyD psychologists getting RxPs was scary.

When I see my optometrists, it's to receive a brief, cursory eye exam and to get new contact lenses/glasses...period. She does not diagnose anything, nor does she do anything that is remotely medical. I'm young and in good health, but still...if I had any problems, I would see an ophthalmologist, nor an optometrist. Maybe I'm confused, but what kinds of things do ODs treat now? Are you guys seeking to expand you scope of practice in the US and Canada?

Oh boy. Here it comes again....

 

[Ryan_eyeball]

I guess I'm just shocked that OD's can do all these things in the US. I confess my ingorance, but ODs can prescribe therapeutic medications in the US? I understand diagnostic, but therapeutics? Damn...that scares me. I have no idea how much pharmacology ODs receive in the US or Canada, but RxPs? Jeez...and I thought PhD/PsyD psychologists getting RxPs was scary.

When I see my optometrists, it's to receive a brief, cursory eye exam and to get new contact lenses/glasses...period. She does not diagnose anything, nor does she do anything that is remotely medical. I'm young and in good health, but still...if I had any problems, I would see an ophthalmologist, nor an optometrist. Maybe I'm confused, but what kinds of things do ODs treat now? Are you guys seeking to expand you scope of practice in the US and Canada?

In most states in the US an OD, can prescribe topical eyedrops, oral medications, and use diagnostic medications. I'm even aware that we are allowed to prescribe narcotics, although I doubt I ever would. An OD must complete three or four years of undergraduate studies (most OD's have received a Bachelor's), then complete 4 years of OD school. There are three portions to a national board examination, plus any type of seperate state board examinations. OD's are also able to apply for a one year residency in a special modality of their choice: Pathology, CL's, BV, pediatrics. VA residents are now required to pass another national test designed specifically for VA OD's.

If an OD and an MD both received pharmacology classes from a similiar professor (i know in St. Louis the professor teaches at SLU med/pharm, and Umsl Optometry) or used the same books to study, does it make much of a difference? If both doctors Rx Patanol, and suggest Artificial tears for an Allergic conjuctivits, I think both have done the same service to the patient.

I think its even more scarey on your thoughts. If you had any problems you would see an OMD first, some insurances will not pay for OMD visit without an initial visit by an OD. Many ocular conditions present with no symptoms initially and only manifest themselves when certain amounts of damage have occured (esp. in the case of glaucoma). I think its vital that you find an optometrist that you do have confidence in to diagnose any ocular conditions, but know when to refer such as an RD, ocular tumors, etc when necessary. Whenever you get a CL exam or spectacle prescription an OD, should check with a Slit lamp the anterior health of the eye, and using either a 90D lens, or an Ophthalmoscope to check the posterior health of the eye. An advised dilation every year is recommended to check the periphery of the eye for tears, and detachments (some people are advised this with certain predisposing factors). I think OD's have the most potential to make an impact in the care of glaucoma patients.

There are a need for both OD's and OMD's in the US. Some OMD, practices focus heavily on the prescribing of glasses and CL's. I doubt OMD's receive any formal training in medical school about learning how to prescribe glasses or CL's. They often hire technicians to do this, and working in a retail commericial chain as an optician we would like to deny Rx's from OMD offices. Why, because often time they are off. Some patients have told me they just Rx'd whatever an Autorefracter read. Certainly, not every OMD office is like this, some are very good at what they do. And there are also some OD's out there that are not that good at Rx'ing.

I just believe we should do more of what we are trained to do (Rx glasses, CL's, diagnose/treat ocular conditions we are trained to treat). Also, I think OMD's should stick to what they are trained best for diagnose/treat and preform surgery.

Oklahoma have been the only state that has expanded their scope of practice to use of Lasers to perform Trab surgeries for glaucoma and Yag Capsulotomies for a post op Cat. Is there a big threat for patients receiving these from OD's. I don't believe so, I've even done a YAG at a OMD's office. Most OMD's will argue that only surgeons should be performing these, and not OD's. It isn't particulary a difficult procedure to perform, but its not what I want to do. But of course, they don't want OD's doing these procedures because of loss of financial payments (but they aren't trained to prescribe glasses but they don't mind selling them???). Again I think both should stick to what they do best. If I wanted to do surgery of the eye, I would have went to medical school.

Just my 2 cents.

 

[Ben Chudner]

I guess I'm just shocked that OD's can do all these things in the US. I confess my ingorance, but ODs can prescribe therapeutic medications in the US? I understand diagnostic, but therapeutics? Damn...that scares me. I have no idea how much pharmacology ODs receive in the US or Canada, but RxPs? Jeez...and I thought PhD/PsyD psychologists getting RxPs was scary.

When I see my optometrists, it's to receive a brief, cursory eye exam and to get new contact lenses/glasses...period. She does not diagnose anything, nor does she do anything that is remotely medical. I'm young and in good health, but still...if I had any problems, I would see an ophthalmologist, nor an optometrist. Maybe I'm confused, but what kinds of things do ODs treat now? Are you guys seeking to expand you scope of practice in the US and Canada?

There are a ton of posts on this subject both on this forum and the ophthalmology forum. Rather than us rehashing this discussion, I would recommend you read those.

 

[Ben Chudner]

Oh boy. Here it comes again....

 

[rpames]

Although I agree with Ben about not discussing this here, I just want to make one comment.

At the Illinois College of Optometry, we receive more hours of pharmacology than any medical, dental, or podiatry school in the state. The only healthcare provider who receives more pharmacology than us are the pharmacists.

 

[ProZackMI]

Although I agree with Ben about not discussing this here, I just want to make one comment.

At the Illinois College of Optometry, we receive more hours of pharmacology than any medical, dental, or podiatry school in the state. The only healthcare provider who receives more pharmacology than us are the pharmacists.

I find that VERY hard to believe. You receive more pharmacology than medical students? I doubt that. If that's true, then Illinois must have piss poor medical schools. Back this up with facts. Why would an optometrist receive more pharmacology education than a physician? That is simply absurd. Quit trying to inflate your profession. ODs are not physicians.

 

[Ben Chudner]

I find that VERY hard to believe. You receive more pharmacology than medical students? I doubt that. If that's true, then Illinois must have piss poor medical schools. Back this up with facts. Why would an optometrist receive more pharmacology education than a physician? That is simply absurd. Quit trying to inflate your profession. ODs are not physicians.

There is no reason to be insulting in responding to rpames. Simply stating that you would like to see facts to back up his claims would be sufficient. Inflammatory comments like "quit trying to inflate your profession" and "OD's are not physicians" will only lead to same threads we have had in the past which do not benefit anyone on the forum.

 

[KHE]

There is no reason to be insulting in responding to rpames. Simply stating that you would like to see facts to back up his claims would be sufficient. Inflammatory comments like "quit trying to inflate your profession" and "OD's are not physicians" will only lead to same threads we have had in the past which do not benefit anyone on the forum.

Perhaps one of the moderators of this group should post a thread that explains in detail what optometrists can do, and what their training is like WITHOUT using comparisions to fields such as dentistry or podiatry.

Perhaps that would help explain what it is that optometrists do to all the people out there who are so obviously ignorant of it. And I don't mean any disrespect by that. 99% of the people are ignorant through no real fault of their own.

 

[ProZackMI]

There is no reason to be insulting in responding to rpames. Simply stating that you would like to see facts to back up his claims would be sufficient. Inflammatory comments like "quit trying to inflate your profession" and "OD's are not physicians" will only lead to same threads we have had in the past which do not benefit anyone on the forum.

I apologize if I offended anyone, but it could be that you're being overly sensitive. As a physician, I find it very difficult to believe that any optometry school in any state would require more hours of pharm than a medical school. If he presents a statement as fact, it is not insulting to ask for supportive evidence.

Again, I apologize. I sincerely did not mean to be insulting, but I was shocked by his statement.

 

[ProZackMI]

Perhaps one of the moderators of this group should post a thread that explains in detail what optometrists can do, and what their training is like WITHOUT using comparisions to fields such as dentistry or podiatry.

Perhaps that would help explain what it is that optometrists do to all the people out there who are so obviously ignorant of it. And I don't mean any disrespect by that. 99% of the people are ignorant through no real fault of their own.

I admit to being ignorant. I never realized ODs had RxPs and always thought of their training as being more...well, frankly, technical with some biomedical science intermixed. I really would like to know more. I am sorry.

 

[rpames]

I find that VERY hard to believe. You receive more pharmacology than medical students? I doubt that. If that's true, then Illinois must have piss poor medical schools. Back this up with facts. Why would an optometrist receive more pharmacology education than a physician? That is simply absurd. Quit trying to inflate your profession. ODs are not physicians.

Facts:
ICO: General Pharm I 4 credits
General Pharm II 4 credits
Ocular Pharm 4 credits
TOTAL..............12 credit hours


I can not find exact figures any where, but the medical schools I found who list there classes, list 2 semesters of pharmacology. Unless their classes are 6 credits each, they do not add up 12. The fact that I stated was told to me by two different ICO faculty. One is also a researcher at Rush Universty...a very good medical school. The other was our pharmacology prof. He is a PhD, not an OD. He is also very active in getting ODs the right to Rx oral meds in Illinois. I'm certain he has done his homework.

I just want to say that I am not trying to start some stupid fight, I hate that kind of thread. I'm just stating facts. You said you did not know the kind of pharm education ODs get, so I'm telling. And just a side note, since you don't know the kind of education we receive, how can you be so negative toward us? If you read about the curriculum and still don't think we are real doctors, that is one thing, but hating us just because, is another.

And about IL having "piss poor" medical schools...I think those at Northwestern would have to disagree.

 

[KHE]

I admit to being ignorant. I never realized ODs had RxPs and always thought of their training as being more...well, frankly, technical with some biomedical science intermixed. I really would like to know more. I am sorry.

Here is a link to the American Academy of Optometry's definition:

http://www.aoanet.org/x792.xml

Here is a link to the American Academy of Ophthalmology's website:

http://www.aao.org/about/team.cfm

Obviously, both of these organizations mission is to advance their profession, so you have to take it with a grain of salt.

In the optometry groups definition, it makes reference to certain surgical procedures, but the states in which ODs perform these are very very rare.

In the ophthalmology definition, they try to put down the training of ODs with the implication that many ODs don't have undergraduate degrees though the number of schools who allow a 3/4 program is small and the number of ODs who graduate with an undergraduate degree is over 98%. (Not that an undergraduate degree matters much anyway because I can't say I spent much time studying the eye during my undergraduate career.)

This debate has raged on ad nauseum on both sides. There are tons of internet resources for you to browse. Feel free to do so if you truly desire to learn about the field of optometry and what it is that optometrists do. Rest assured though, it's more than

"brief, cursory eye exam and to get new contact lenses/glasses...period"

as you stated in an earlier post.

 

[KHE]

Facts:
ICO: General Pharm I 4 credits
General Pharm II 4 credits
Ocular Pharm 4 credits
TOTAL..............12 credit hours


I can not find exact figures any where, but the medical schools I found who list there classes, list 2 semesters of pharmacology. Unless their classes are 6 credits each, they do not add up 12. The fact that I stated was told to me by two different ICO faculty. One is also a researcher at Rush Universty...a very good medical school. The other was our pharmacology prof. He is a PhD, not an OD. He is also very active in getting ODs the right to Rx oral meds in Illinois. I'm certain he has done his homework.

I just want to say that I am not trying to start some stupid fight, I hate that kind of thread. I'm just stating facts. You said you did not know the kind of pharm education ODs get, so I'm telling. And just a side note, since you don't know the kind of education we receive, how can you be so negative toward us? If you read about the curriculum and still don't think we are real doctors, that is one thing, but hating us just because, is another.

And about IL having "piss poor" medical schools...I think those at Northwestern would have to disagree.

I would suggest that counting the 4 hours of ocular pharmacology hardly constitues "more hours of pharmacology" than medical students because while technically, it may be true that ODs at ICO spend more hours, I'm not sure you can equate the depth of the material covered. The tacit implication of your claim is that OD students have or receive as much if not more pharmacology knowledge than medical students and I think you're on pretty shakey ground with that assertion.

 

[Ben Chudner]

I apologize if I offended anyone, but it could be that you're being overly sensitive. As a physician, I find it very difficult to believe that any optometry school in any state would require more hours of pharm than a medical school. If he presents a statement as fact, it is not insulting to ask for supportive evidence.

Again, I apologize. I sincerely did not mean to be insulting, but I was shocked by his statement.

Normally, I would let this go since you did apologize, but you were insulting. It is not overly sensitive to take offense to statements like "quit trying to inflate your profession" and "OD's are not physicians". You are correct in that asking for supportive evidence is not insulting and that is why I stated that if you just asked for that it would be sufficient.

I think a lot of the OD's on this forum felt this issue was argued to death a couple of months ago. Rather than being overly sensitive, I think I am overly tired of these attacks. I no longer feel the need to justify the level to which I practice optometry to people who have no understanding of my profession, and I do not believe it is my responsibility to educate you. I can appreciate that you want to learn more about what we can do, but I believe you will only try to use it against us, just as several other MD's have done in the past.

For the record, it is a matter of law that I am recognized as an Optometric Physician in Washington State.

 

[TommyGuns]

i heard that canadians no longer have health coverage of eye exams, is that true?

Ya, it's true as of November 2004 for people between the ages of 20 - 64. But of course, anyone who has diabetes, glaucoma, etc. are still covered.

 

[drbizzaro]

Ya, it's true as of November 2004 for people between the ages of 20 - 64. But of course, anyone who has diabetes, glaucoma, etc. are still covered.

doesnt that mean less patients?

 

[drbizzaro]

When I see my optometrists, it's to receive a brief, cursory eye exam and to get new contact lenses/glasses...period. She does not diagnose anything, nor does she do anything that is remotely medical. I'm young and in good health, but still...if I had any problems, I would see an ophthalmologist,

i know you appologized, but i just have to say - that comment has got to be one of the worst i've ever heard... it's worse than people who say optometrists should be called opticians....

i think tv is a really bad influence on the general public... as well as the medical public too

 

[cansnowflake]

The optometrist that I work for told me that the deregulation of OHIP (Ontario Health Plan) has been a positive thing, because now she is able to upgrade her equipment and get cool things (like a retina camera) and is able to charge for using them as diagnostic tools, while OHIP had a limit as to what you can charge for exams etc.

Has anyone else in Canada experienced something similar to this? or has the loss of health coverage been negative to practices?

 

[OntOD]

Ya, it's true as of November 2004 for people between the ages of 20 - 64. But of course, anyone who has diabetes, glaucoma, etc. are still covered.

Ontario, where I practice in, was actually one of the last provinces to deinsure ocular-visual assessments (from MDs or ODs). Ontario. Alberta, BC, Quebec, and other provinces delisted eyecare long before November 2004. I'm not sure if any other provinces still insure regular optometric visits.

Here in Ontario, while our patient volume slowed down initially, most of us are happier now with the delisting because the provincial insurance plan (OHIP) only paid us $39.15 for a full exam (unchanged since 1989), and now ODs are charging upto $110 locally for exams (but some charge as little as $50). We're still seeing less patients but our revenue hasn't decreased substantially (and for many, it has even increased) so our workload has become a little easier.

Going back to TPAs, the Health Professions Regulatory Council (HPRAC) has finally resumed its study on expanding our scope of practice to prescribe medications. This time it looks like it'll pass because family medicine and ophthalmological organizations are finally agreeing to "limited" extension of TPA use to ODs. We may not get autonomy on glaucoma meds, but we're very likely to get anti-infectives, anti-allergics, and NSAIDs/steroids. Here's a link to the currrent study:

http://www.hprac.org/english/pageDisplay.asp?webDocID=5177#Optometry

 

[ucbsowarrior]

Ontario, where I practice in, was actually one of the last provinces to deinsure ocular-visual assessments (from MDs or ODs). Ontario. Alberta, BC, Quebec, and other provinces delisted eyecare long before November 2004. I'm not sure if any other provinces still insure regular optometric visits.

Here in Ontario, while our patient volume slowed down initially, most of us are happier now with the delisting because the provincial insurance plan (OHIP) only paid us $39.15 for a full exam (unchanged since 1989), and now ODs are charging upto $110 locally for exams (but some charge as little as $50). We're still seeing less patients but our revenue hasn't decreased substantially (and for many, it has even increased) so our workload has become a little easier.

Going back to TPAs, the Health Professions Regulatory Council (HPRAC) has finally resumed its study on expanding our scope of practice to prescribe medications. This time it looks like it'll pass because family medicine and ophthalmological organizations are finally agreeing to "limited" extension of TPA use to ODs. We may not get autonomy on glaucoma meds, but we're very likely to get anti-infectives, anti-allergics, and NSAIDs/steroids. Here's a link to the currrent study:

http://www.hprac.org/english/pageDisplay.asp?webDocID=5177#Optometry

The oma sure doesn't seem like it's on board with their june 2005 stance. I think TPA's in Ont. are close, but may still be about a year or two away. do i think it's all political and pathetic...i sure do. but it doesn't really matter what i think or anyone else...it's a political battle btw the md's and od's.... and the md's usually have more power in ontario. the only advantage the ont. ods' have this time is that many other provinces have tpas and this can be used as a point of agrument for extrapolation in favor of ont od's.

the key is getting any type of tpa legislation thru the door in ontario...and expanding the tpa scope for od's as time progress.

keep your fingers crossed.
ucbsowarrior

 

[SomeGuy]

Here's a submission from the Council of Opticians of Ontario to the Health Professionals Regulatory Advisory Council, specifically, the part of refractometry:
http://www.hprac.org/downloads/may05/Opticians/COO_Final_HPRAC_Referral_Submission_April29_2005.pdf