Proposed law for optometric surgery.

[Just Applied]

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Is the AAO doing anything about this?

http://forums.studentdoctor.net/showthread.php?p=11552766#post11552766

 

[anatomyaddict]

god...we are so screwed.

 

[Mirror Form]

There is already at least one state where optoms can operate. how many are actually doing it?

Just because they have the legal right, that doesn't make it economically feasible.

 

[Meibomian SxN]

There is already at least one state where optoms can operate. how many are actually doing it?

Just because they have the legal right, that doesn't make it economically feasible.

2 states now and counting: Oklahoma and Kentucky.

 

[Mirror Form]

2 states now and counting: Oklahoma and Kentucky.

In KY optometrists cannot do any significant operations. Regardless, how many optometrists in KY do lasers? What percentage of optometrists in Oklahoma operate?

 

[Slide]

Not sure if the AAO is doing anything quite yet, but it seems the Kentucky incident has woken up organizations across the country about this push. With the public backlash against this law as well in Kentucky and the increased donations to SCOPE/state ophthalmology organizations, these upcoming bills will be much harder to pass under the radar(unless of course, the state legislatures have already been bought out already).

 

[JaggerPlate]

I'm sure they will pass no problem. It's a hard code to crack, but once you figure out the correct balance of money + slimy politicians + a lack of any semblance of ethics ... you're golden.

 

[VA Hopeful Dr]

I'm sure they will pass no problem. It's a hard code to crack, but once you figure out the correct balance of money + slimy politicians + a lack of any semblance of ethics ... you're golden.

As I previously said, I very much doubt that the SC one will pass. The Nebraska and Texas ones are both very expansive, and those tend to be much more difficult to pass.

 

[Visionary]

2 states now and counting: Oklahoma and Kentucky.

The KY law has not yet been fully implemented, and it will likely be pruned prior to going live. OK is the only state where optometrists can perform surgical procedures, though the breadth of scope has been restricted significantly since the original passage of the law.

Honestly, considering the number of attempts, the success rate of optometric surgical scope bill passage is very low. The KY fiasco should actually make things more difficult for optometry. Ophthalmology will be sniffing out the sneak attacks in the future. When ophthalmology has an opportunity to be involved in the conversation, they win the vast majority of the time.

 

[JaggerPlate]

As I previously said, I very much doubt that the SC one will pass. The Nebraska and Texas ones are both very expansive, and those tend to be much more difficult to pass.

I hope like hell they don't pass; I'm a broke student and i'll donate money to help them not pass ... But just based off recent history with various groups trying this pathetic bull****, I have little faith they will fail.

 

[VA Hopeful Dr]

I hope like hell they don't pass; I'm a broke student and i'll donate money to help them not pass ... But just based off recent history with various groups trying this pathetic bull****, I have little faith they will fail.

OK, so in this past legislative year there was 1 large gain by optometry. In my state alone, we fought off 2 bills that were very similar. So at best, we're talking a 50/50 shot of this stuff getting passed. But I'm sure there were many other states where the OD bills stalled. Historically, and even recently, optometry has to submit a similar bill multiple times before it comes even close to passing.

Not saying we shouldn't keep an eye out for these things, but I think you're being a tad chicken-littley about this.

 

[JaggerPlate]

OK, so in this past legislative year there was 1 large gain by optometry. In my state alone, we fought off 2 bills that were very similar. So at best, we're talking a 50/50 shot of this stuff getting passed. But I'm sure there were many other states where the OD bills stalled. Historically, and even recently, optometry has to submit a similar bill multiple times before it comes even close to passing.

Not saying we shouldn't keep an eye out for these things, but I think you're being a tad chicken-littley about this.

I 100 percent hope I am wrong and you're right. Guess that's all I can say.

 

[ReelinGator]

It is great to hear all the bantering about how those "slimy" ODs passed a bill under the radar.

I hope someone on this thread is a medical student at the UF to verify what I am about to tell you to show just how upstanding organized medicine is.

Dr. Alan Mendelsohn is an OMD from Hollywood Fl that in 2001 tried and fortunately failed at passing a post-op bill that would have kept ODs from managing their patients following surgery, and was instrumental in keeping ODs from prescribing orals with his deep involvement as the PAC leader of the Florida Medical Association and Florida Society of Ophthalmology.

Now, this same man is serving a 4 year sentence in jail for fraud with an involvement in a ponzi scheme that took money from individuals and bribed sate leaders to vote medicine's way on many issues (list is to long to name but you get the point, and I admit not all of it was against optometry). This money was also spent to by his mistress a house and car.

This man's son also is attending medical school at UF after never taking the MCAT and raised a huge s**t fit that was so bad that the dean of the college got fired. Obviously you can understand what kind of person we are dealing with here.

Again I know...its those dirty, not smart enough to go to med school ODs that are the problem.

A few things that we should be honest about: An OD through their concentrated curriculum and additional training is qualified to perform PI, SLT, ALT, and Yag lasers. In addition, they also have more than enough training to be doing steroid inj into the lids. When ODs first got the right to use diagnostic drugs people were going to be falling over in the streets, then topical therapeutics...which definitely was going to kill and blind patients....then comes orals blah blah blah........and then we come to lasers and injections.

The reality of it is, ODs have successfully expanded their scope of practice and have proven to be very competent in doing so.

I DO NOT believe that ODs should ever be performing complicated invasive procedures such as the cataract surg, intraocular inj, and so on. I feel your concern with a bill like KY so being so vague, and agree that bills should be more specific. I also am confident in the State board of optometry in KY will regulate what is allowed in a reasonable manner. (no OD will be doing Avastin injections and eyelid lifts)

I feel like the true problem is that many OMDs are wondering what is in it for me to go to school this long if ODs can do these things. Again, the demand for an OMD is not going to be affected by these few changes, that not to mention have low reimbursement rates.

The only question I have left is, who gave the MDs the right to be the final say on what is right vs wrong over all medical fields? I guess the members of the State Boards of Optometry are either untrustworthy or incompetent.

 

[90 diopter]

Are glaucoma lasers and Yags part of standard curriculum in optometry school? Our university had several optometry students alongside the ophthalmology residents, and I don't recall ever seeing any of them behind the laser. Just asking because I don't know.

What do optometrists typically do if these procedures go horribly wrong? I haven't had any personal experience from this scenario because I live in a state that doesn't allow optometric surgery, but if an optom messes up a surgery, where does the patient get sent?

 

[MR1]

A few things that we should be honest about: An OD through their concentrated curriculum and additional training is qualified to perform PI, SLT, ALT, and Yag lasers. In addition, they also have more than enough training to be doing steroid inj into the lids.

Please enlighten me here. Explain why you are qualified to do these. How many have you done on real patients. Have you ever seen a complication of one. Also, why would you do a steroid injection into the lid? This seems like asking to be able to do a sub-conj injection. It just doesn't make sense, there is almost no reason you ever would do this by itself.

 

[east]

Treatment of chalazia with corticosteroid injections.

Authors

King RA, Ellis PP Source

Ophthalmic Surg 1986 Jun; 17(6) :351-3.Abstract

Of 34 chalazia injected with triamcinolone acetate, 29 resolved after one or two injections. Larger lesions frequently required a second injection. During a six-month follow-up period, there were five recurrences; all occurred in lesions originally measuring larger than 36 sq mm. The response to intralesional corticosteroid injection was similar in all age groups and in lesions of short and long duration. Intralesional injection of triamcinolone acetate offers an acceptable alternative or adjunct to incision and curettage in the management of chalazia.

 

[east]

- "You cease being a real doctor. I actually think of this as a positive, but I've heard this complaint from some of my co-trainees in the past. After your intern year, you gradually forget everything else about the human body except for the details you need to know that are directly related to the eye. Because the eye is so specialized, I often consider "eye-dentist" a more accurate term for what I do. My general medical knowledge is gone. Again, I see this as a positive thing; I really have no interest in managing anything other than eye diseases and send everything else back to primary care."

Saw this on another very recent thread in this forum....any other ophthalmologist care to comment on this statement. How would one reconcile this statement with the multitude of threads that use the argument that ODs should not be allowed to do much of anything medically in eye care due to their gross lack of general medical knowledge which can only be gained in medical school. Eye knowledge and systemic knowledge related to the eye is just so sub par in the views of many on this thread as to be laughable.

Not trying to start a fight, not interested in surgery, love my job with my current scope...just curious, cause I know that this post (by probably a great ophthalmologist) states the current situation of many ( and I do know many great ophthalmologists on a personal and professional level).

Cheers

 

[MstaKing10]

When ODs first got the right to use diagnostic drugs people were going to be falling over in the streets, then topical therapeutics...which definitely was going to kill and blind patients....then comes orals blah blah blah........and then we come to lasers and injections.

I DO NOT believe that ODs should ever be performing complicated invasive procedures such as the cataract surg, intraocular inj, and so on..

Perhaps you think that way now, but consider this:

Among many of the other concerns that have been stated on this thread and countless others, this is one of my primary concerns. That is, OD's getting the right to prescribe topical drugs...then oral drugs...now minimally invasive procedures...you get the progression here. Next will undoubtedly be more invasive procedures such as cataracts, injections etc. It's shortsided to think only of what they are asking for now, but consider what they could be asking for 5...10...15 years down the road.

 

[east]

Perhaps you think that way now, but consider this:

Among many of the other concerns that have been stated on this thread and countless others, this is one of my primary concerns. That is, OD's getting the right to prescribe topical drugs...then oral drugs...now minimally invasive procedures...you get the progression here. Next will undoubtedly be more invasive procedures such as cataracts, injections etc. It's shortsided to think only of what they are asking for now, but consider what they could be asking for 5...10...15 years down the road.

Speaking of short sighted....The AOA continues to promote the oversupply of ODs thus over saturating the eye care provider market, and leading to inevitable over-reach for scope expansion of optometry. These kids out of school need to pay their student loans (which are now not commensurate with their starting income) and they will increasingly continue to poach procedures and therefore income from Ophthalmology. Right or Wrong, sleazy methods or legitimate arguments, it doesn't matter. More ODs equals more need to scope expand, and also more ODs to donate and fund PACs in order to expand a legislated profession. This is a threat to all of us OD and MD alike.

 

[TheLesPaul]

- "You cease being a real doctor. I actually think of this as a positive, but I've heard this complaint from some of my co-trainees in the past. After your intern year, you gradually forget everything else about the human body except for the details you need to know that are directly related to the eye. Because the eye is so specialized, I often consider "eye-dentist" a more accurate term for what I do. My general medical knowledge is gone. Again, I see this as a positive thing; I really have no interest in managing anything other than eye diseases and send everything else back to primary care."

Saw this on another very recent thread in this forum....any other ophthalmologist care to comment on this statement. How would one reconcile this statement with the multitude of threads that use the argument that ODs should not be allowed to do much of anything medically in eye care due to their gross lack of general medical knowledge which can only be gained in medical school. Eye knowledge and systemic knowledge related to the eye is just so sub par in the views of many on this thread as to be laughable.

Not trying to start a fight, not interested in surgery, love my job with my current scope...just curious, cause I know that this post (by probably a great ophthalmologist) states the current situation of many ( and I do know many great ophthalmologists on a personal and professional level).

Cheers

I hate to use "n=1" as an argument for that, but that really is an isolated opinion. There are plenty of ophthalmologists at the university I attend that care about a great deal of organs besides the eye, and frequently have made systemic diagnoses. There are two areas where this can pop up that I can think of off the top of my head:

1) consults -- to provide a proper consult for another service (e.g., Internal Med), one would have to know their structure, protocol, and what's important/feasible in a way that's not possible if one only has knowledge of the eye. All physicians have rotated through an IM clerkship, and (should) have a knowledge of how to provide an effective consult -- nothing is more frustrating than a consult that shows clearly no knowledge of the patient's other problems.

2) operative risk -- both in terms of anesthesia, and for a feel for when operation is worthwhile, vs when a patient's comorbidities make it silly to take his cataracts out.

It's a lot of small things, but small things done right = good patient care. Not that ODs can't do it necessarily, but the formal training is not there.

 

[Mirror Form]

Speaking of short sighted....The AOA continues to promote the oversupply of ODs thus over saturating the eye care provider market, and leading to inevitable over-reach for scope expansion of optometry. These kids out of school need to pay their student loans (which are now not commensurate with their starting income) and they will increasingly continue to poach procedures and therefore income from Ophthalmology. Right or Wrong, sleazy methods or legitimate arguments, it doesn't matter. More ODs equals more need to scope expand, and also more ODs to donate and fund PACs in order to expand a legislated profession. This is a threat to all of us OD and MD alike.

Except that at this point expansion of scope isn't going to help OD's. For one thing, ophthalmology is just as saturated. Second, no procedures are profitable anymore compared to seeing patients in clinic unless you're doing a lot of that procedure.

Remember that ophthalmologists have the legal right to do any procedure. How many non retina specialists are doing focal laser and intravitreal injections? Most general ophthalmologists are well trained for both, and both have great reimbursement. Yet not that many comprehensive ophthalmologists do them because the overhead is too high unless you have a large patient load that needs them.

 

[200UL]

I hate to use "n=1" as an argument for that, but that really is an isolated opinion. There are plenty of ophthalmologists at the university I attend that care about a great deal of organs besides the eye, and frequently have made systemic diagnoses. There are two areas where this can pop up that I can think of off the top of my head:

1) consults -- to provide a proper consult for another service (e.g., Internal Med), one would have to know their structure, protocol, and what's important/feasible in a way that's not possible if one only has knowledge of the eye. All physicians have rotated through an IM clerkship, and (should) have a knowledge of how to provide an effective consult -- nothing is more frustrating than a consult that shows clearly no knowledge of the patient's other problems.

2) operative risk -- both in terms of anesthesia, and for a feel for when operation is worthwhile, vs when a patient's comorbidities make it silly to take his cataracts out.

It's a lot of small things, but small things done right = good patient care. Not that ODs can't do it necessarily, but the formal training is not there.

This post actually has some merit. The optometric surgeons of kentucky get away with their "witch-craft" because they are practicing out of site from real physicians. They are off performing the SLT lasers (a great procedure to shoot for as the indications are vague and no-one could ever judge their poor technique - they simply need to tell 90 year old granny and her nephew things went perfectly and do it with a smile. When the pressure fails to come down from 30 and granny goes blind, everyone can act surprised, but at least ben gaddie received $400 out of the deal and the state optometry board had no complaints.).

However, I would pay money to watch these guys communicate with the local trauma team about a patient's NLP vision after traumatic optic neuropathy or the local internist in a case of hypertensive retinopathy.

In other words, there are differences between optometrists and ophthalmologists that go way beyond surgical training. Communicating with other medical professionals is one of them.

While we all miss things, I will never forget the request for an MRI on a glasses prescription (that is right, a glasses prescription) from a local optometrist when I was a medical student. It read "vision loss right eye, please obtain and MRI." The local radiology group obtained it (because what hospital would not want to obtain the $2000 test to help the bottom line). The unfortunate thing for the local optometrist is that this same MRI test and radiology read let to the diagnoses of "pseudophakia" and "retinal detachment." Who knew you could order a MRI in this country on a glasses prescription pad? And is it standard of care among the more medically oriented optometrists to diagnose macula-off RDs with it? I wonder if this guy even dilates his flashes and floaters patients anymore? - just get an MRI by pulling out the trusty glasses prescription pad.

 

[JaggerPlate]

It is great to hear all the bantering about how those "slimy" ODs passed a bill under the radar.

I hope someone on this thread is a medical student at the UF to verify what I am about to tell you to show just how upstanding organized medicine is.

Dr. Alan Mendelsohn is an OMD from Hollywood Fl that in 2001 tried and fortunately failed at passing a post-op bill that would have kept ODs from managing their patients following surgery, and was instrumental in keeping ODs from prescribing orals with his deep involvement as the PAC leader of the Florida Medical Association and Florida Society of Ophthalmology.

Now, this same man is serving a 4 year sentence in jail for fraud with an involvement in a ponzi scheme that took money from individuals and bribed sate leaders to vote medicine's way on many issues (list is to long to name but you get the point, and I admit not all of it was against optometry). This money was also spent to by his mistress a house and car.

This man's son also is attending medical school at UF after never taking the MCAT and raised a huge s**t fit that was so bad that the dean of the college got fired. Obviously you can understand what kind of person we are dealing with here.

Again I know...its those dirty, not smart enough to go to med school ODs that are the problem.

Progression of logic:

MD tries to pass an anti-OD bill -> MD is convicted for fraud for an unrelated offense -> MD's son used Daddy's connections to get into medical school -> MDs are corrupt -> ergo, any attempt to cease the new OD expansion bills is simply another example of MD corruption.

Hmmm ... is there a title for that type of argument??

I also am confident in the State board of optometry in KY will regulate what is allowed in a reasonable manner. (no OD will be doing Avastin injections and eyelid lifts)

LOL

Again, the demand for an OMD is not going to be affected by these few changes, that not to mention have low reimbursement rates.

Actually, that's exactly how demand and reimbursement distribution fall. However, I haven't heard a single "OMD" complain once about reimbursements falling; I have heard various, various physicians concerned about patient safety.

The only question I have left is, who gave the MDs the right to be the final say on what is right vs wrong over all medical fields? I guess the members of the State Boards of Optometry are either untrustworthy or incompetent.

Let me paraphrase:

"Who gave Doctors of Medicine the right to manage and regulate the field of medicine???"

UGH.

 

[90 diopter]

I'd like to clarify my point- I was the person who posted in another message thread the bit about "ceasing to be a real doctor" once becoming an ophthalmologist. This comment was brought up a few posts up, and I'd like to elaborate.

My point was not that medical training served no purpose; to the contrary, it plays an essential role in what I do on a daily basis. But all that training is centered around the eye. A patient with an acutely perforated colon is not going to present to my office complaining of abdominal pain. I have no idea how to manage such a patient (though I did have this knowledge many years ago), because that is not something I will ever see or be expected to manage as an ophthalmologist. On the other hand, there are many many MANY general medical problems that can present with ocular signs and symptoms. These I do see on a regular basis, and when I do, I know where to refer the patient so he gets the proper work-up and treatment. I have lost track of how many brain tumors, completely obstructed carotid arteries, and rare autoimmune disorders I have indirectly diagnosed in my relatively new career.

It is okay to lack the knowledge to diagnose and treat something that is outside your scope of practice. But it is essential to know when something is not quite right with the patient, and to know exactly where to refer the patient to for a proper work up. I believe this knowledge is where the 4 years of medical school and general internship make a world of difference between me and my local optometrist (who is completely awesome).

FYI, my original message was directed toward a third year medical student possibly interested in ophtho. I stand by my prior comment- ophthalmologists do not do what most laymen typically consider a "doctor" does during the day. Someone with a strong family practice mentality would probably not enjoy what I do, and vice versa. 🙂

 

[Fishsticks]

Forgive my ignorance, if this has been discussed elsewhere.

Has there ever been discussion of creating combined OD/MD programs for ODs or OD students that want to expand their scope to include surgical procedures? I know that for dental students who decide that they want to become oral surgeons, they can apply for program in which they earn and MD and get surgical training. I think the dental programs range from 4-6 years after dental school and include portions of medical school and residency combined into those years.

 

[east]

200UL your history of posting anecdotal evidence is truly remarkable. 2 posts up the n=1 argument is made by a fellow ophthalmologist, and you just bring it home with that great example (obviously the rule not the exception....read sarcasm for those who don't appreciate it. 200UL you get sarcasm, you are proficient at it.). Thanks, I learn a lot from your posting.

 

[soonmd1]

Forgive my ignorance, if this has been discussed elsewhere.

Has there ever been discussion of creating combined OD/MD programs for ODs or OD students that want to expand their scope to include surgical procedures? I know that for dental students who decide that they want to become oral surgeons, they can apply for program in which they earn and MD and get surgical training. I think the dental programs range from 4-6 years after dental school and include portions of medical school and residency combined into those years.

I understand why you would think this, but dental school i way more rooted in medicine than optometry. I have seen the dental curriculum my friends follow- physiology biochem pharm and anatomy might be slightly more watered down but they are still gettng a good basic science foundation, not to mention highly detailed head and neck knowledge. Therefor with the programs you are talking about for dentistry...the transition to the 2 year clinical medicine curriculum is much more natural- they have to take step 1 of boards to get there.

 

[east]

I understand why you would think this, but dental school i way more rooted in medicine than optometry. I have seen the dental curriculum my friends follow- physiology biochem pharm and anatomy might be slightly more watered down but they are still gettng a good basic science foundation, not to mention highly detailed head and neck knowledge. Therefor with the programs you are talking about for dentistry...the transition to the 2 year clinical medicine curriculum is much more natural- they have to take step 1 of boards to get there.

Just wondering if you have seen the optometry curriculum, or even better than to see it, matriculate through it? With your proclaimed knowledge of curriculi, can you explain why optometry students are not getting a "good basic science foundation".

 

[east]

Except that at this point expansion of scope isn't going to help OD's. For one thing, ophthalmology is just as saturated. Second, no procedures are profitable anymore compared to seeing patients in clinic unless you're doing a lot of that procedure.

Remember that ophthalmologists have the legal right to do any procedure. How many non retina specialists are doing focal laser and intravitreal injections? Most general ophthalmologists are well trained for both, and both have great reimbursement. Yet not that many comprehensive ophthalmologists do them because the overhead is too high unless you have a large patient load that needs them.

You're exactly right. Scope expansion will help few, thus the short sighted comment.
I'm just trying to get into the heads of decision makers in our profession and I think that this may be what they are thinking, and your right the thinking is flawed and when you go a little deeper like you just commented, it makes no sense other that to assume there is a great deal of money in it for leadership, and schools of optometry.

 

[JaggerPlate]

Just wondering if you have seen the optometry curriculum, or even better than to see it, matriculate through it? With your proclaimed knowledge of curriculi, can you explain why optometry students are not getting a "good basic science foundation".

Why don't you provide an objective, side-by-side comparison between medical and optometry curricula and let the community review the information?

Additionally, the MD provided to dental students is obtained through a grueling OMFS residency that many describe as one of the most intense, 6 year programs in medicine. If ODs were interested in completing a 6 year program after a full OD program and OD residency, I don't think many MDs would object.

 

[east]

Why don't you provide an objective, side-by-side comparison between medical and optometry curricula and let the community review the information?

Additionally, the MD provided to dental students is obtained through a grueling OMFS residency that many describe as one of the most intense, 6 year programs in medicine. If ODs were interested in completing a 6 year program after a full OD program and OD residency, I don't think many MDs would object.

I hope that when I decide to get back to my real life I don't have over 8,000 posts on an anonymous internet site, but to indulge you... If you read the post I was responding to, it was concerning a comparison of dental and optometry pre-residency schooling. Since your leading question involves none of those things do you still want a side by side comparison?

 

[Visionary]

Just wondering if you have seen the optometry curriculum, or even better than to see it, matriculate through it? With your proclaimed knowledge of curriculi, can you explain why optometry students are not getting a "good basic science foundation".

I don't claim to know much about the optometry curriculum, but then I doubt you know much about our training. There have been a few posters on this site who have finished optometry school, then gone to medical school (vtrain comes to mind). All of them have stated that the training in medical school/internship/residency far surpasses any optometric training. They are better suited to speak on the subject than either of us.

It is well-known, however, that an ophthalmologist has more than 10 times the clinical training of an optometrist in terms of patient contact, much of which is surgical. The Kentucky Optometric Board has determined that a 32 hour course with a supervised surgical procedure on one human eye is sufficient to be certified to treat the public. The argument made is that ophthalmologists add new procedures to their practice through similar short courses. The difference is that ophthalmologists' training has a surgical foundation comprised of hundreds of varied surgical procedures, whereas optometrists' training clearly does not. If you don't have such a foundation to build on, I would argue that you cannot justify a short course for certification for any procedure.

 

[east]

I don't claim to know much about the optometry curriculum, but then I doubt you know much about our training. There have been a few posters on this site who have finished optometry school, then gone to medical school (vtrain comes to mind). All of them have stated that the training in medical school/internship/residency far surpasses any optometric training. They are better suited to speak on the subject than either of us.

It is well-known, however, that an ophthalmologist has more than 10 times the clinical training of an optometrist in terms of patient contact, much of which is surgical. The Kentucky Optometric Board has determined that a 32 hour course with a supervised surgical procedure on one human eye is sufficient to be certified to treat the public. The argument made is that ophthalmologists add new procedures to their practice through similar short courses. The difference is that ophthalmologists' training has a surgical foundation comprised of hundreds of varied surgical procedures, whereas optometrists' training clearly does not. If you don't have such a foundation to build on, I would argue that you cannot justify a short course for certification for any procedure.

visionary, with all due respect you need to go back and read the post to which I was referring. Your entire post here is referring to Medical education versus Optometric education. My response was to the comparison of pre-residency dental and optometric education. I agree entirely with medical/ophthalmological training being superior to optometry. That had nothing to do with my comment on dental education vs optometry education. Look you guys seem to have such an itchy trigger finger when it comes to training....Yes! you are better trained in most pathology and definately any surgery, this could explain the thousands of referrals, probably per day, that ODs make to MDs. We know this.... relax.

 

[Mirror Form]

Forgive my ignorance, if this has been discussed elsewhere.

Has there ever been discussion of creating combined OD/MD programs for ODs or OD students that want to expand their scope to include surgical procedures?

It has been discussed, and it will probably never happen. Since there is no shortage of ophthalmologists or medical students applying for ophthalmology, what would be the real reason for creating such a program? There would be no benefit to the public for creating and spending money on such a program. The only reason for creating such a program would be to save a small handful of OD students the effort of applying for and attending medical school.

 

[JaggerPlate]

I hope that when I decide to get back to my real life I don't have over 8,000 posts on an anonymous internet site, but to indulge you... If you read the post I was responding to, it was concerning a comparison of dental and optometry pre-residency schooling. Since your leading question involves none of those things do you still want a side by side comparison?

I noticed it was dental v. optometry (I was reading it on a mobile device during a break in "real life"), but since someone else mentioned the idea of a solid "basic science education" and the crux of the argument is optometry merging into a more traditional, medicine-esque field, I thought dismissing the anecdotal opinions with an objective comparison might be helpful.

However, a pithy comment and avoidance of the core issue essentially makes the point just as effectively. No side-by-side comparison needed; carry on.

 

[Shnurek]

As a first year I am taking Gross Anatomy, lab and lecture (we have to know everything superior of the diaphragm except for the arms and we have real cadavers) Integrated Optics, lab and lecture, Human Bioscience, lecture, Systemic Ocular Disease lab, Optometric Theory and Procedures, lab and lecture, Ocular Biochemistry and Physiology, lecture. As a side note, our entering class average GPA now is 3.57 and we take the same pharmacology course as medical students our second year (yet we still are too incompetent to prescribe orals in New York somehow, only 3/50 states that disallow us to do this)

 

[Slide]

As a first year I am taking Gross Anatomy, lab and lecture (we have to know everything superior of the diaphragm except for the arms and we have real cadavers) Integrated Optics, lab and lecture, Human Bioscience, lecture, Systemic Ocular Disease lab, Optometric Theory and Procedures, lab and lecture, Ocular Biochemistry and Physiology, lecture. As a side note, our entering class average GPA now is 3.57 and we take the same pharmacology course as medical students our second year (yet we still are too incompetent to prescribe orals in New York somehow, only 3/50 states that disallow us to do this)

Taking a pharmacology class does not mean you have the ability to prescribe orals willy nilly. Any M3 will tell you there is a good portion of stuff learned in M2 pharmacology that is never used or not used in the real world, and more that is not taught in pharmacology. Shadow a ward or clinic service for a while and you'll soon learn that what's in the classroom does not translate to what happens during clinical training.

Oral steroids are an example of this. You don't get taught the art of titrating steroids, managing a steroid taper, or all the possible things that can happen with steroids besides the sterotypical features (moon face, striae, weight gain, etc.) in class. When a patient rolls in with GCA and if you are going to be writing the steroids, if you are only watching his GCA alone, you better know what the hell you're doing when you give dosages as well as if you even consider tapering the patient off steroids (which itself can be debatable).

Or let's say you have a patient who needs Diamox for his acute elevation in IOP. In some patients, it's not an issue to give. However, if your patient has chronic renal failure, do you give it then? Is it worth the risk? Would another alternative be better or not? Should you bother renal with this consult, or take care of it yourself? Is the patient a candidate for Diamox because his mobility restricted and does not always have access to fluids? These are things you won't really learn in a pharmacology class. Things such as these takes clinical intuition and training. If you're going to ask a medical opinion with your fallback answer as "oh he's got high eye pressure" instead of a better, more thought-out answer, you're gonna get some flak from the medicine/nephrology consult.

Oral medications itself is not a vacuum. There are lots of things to consider when giving patients oral medications. The information you learn in class isn't always adequate, much less if it's in the basic science course. Yes, it's the foundation in which you build upon your clinical knowledge for prescribing orals, but it's not enough for clinical needs.

 

[Mirror Form]

(yet we still are too incompetent to prescribe orals in New York somehow, only 3/50 states that disallow us to do this)

Technically, medical school graduates aren't legally allowed to prescribe any medications. M.D.'s must do an additional year of internship before we'd be allowed to prescribe patanol outside of a training program.

 

[Meibomian SxN]

The difference is that ophthalmologists' training has a surgical foundation comprised of hundreds of varied surgical procedures, whereas optometrists' training clearly does not.

Are you serious??? Listen to yourself rant! Hundreds of surgical procedures? So I guess you can also perform craniotomies, stents and C-sections?

You scare me more than you think....

The optometry curriculum gives excellent foundation on performing many eye surgical procedures. So yes, a 32hr course is good enough.

You should seek help from your psychiatry colleagues, that ego is not good for you....

 

[Visionary]

Are you serious??? Listen to yourself rant! Hundreds of surgical procedures? So I guess you can also perform craniotomies, stents and C-sections?

You scare me more than you think....

The optometry curriculum gives excellent foundation on performing many eye surgical procedures. So yes, a 32hr course is good enough.

You should seek help from your psychiatry colleagues, that ego is not good for you....

I have assisted in C-sections, but not craniotomies or stents. Of course, I was speaking of more eye-specific surgical procedures.

Perhaps you can share with us your extensive supervised surgical training . . . on actual patients. 🙄

 

[KHE]

I have assisted in C-sections, but not craniotomies or stents. Of course, I was speaking of more eye-specific surgical procedures.

Perhaps you can share with us your extensive supervised surgical training . . . on actual patients. :rolleyes:

I saw someone get LASIK on Dr. Oz. That counts, right?

 

[Visionary]

I saw someone get LASIK on Dr. Oz. That counts, right?

Perfect! Come on down for the course! 😀

 

[Meibomian SxN]

I have assisted in C-sections, but not craniotomies or stents. Of course, I was speaking of more eye-specific surgical procedures.

Perhaps you can share with us your extensive supervised surgical training . . . on actual patients. 🙄

Sure thing. I have performed on several patients: SLT, ALT & MLT and a few LPIs (only because it wasn't too common).

That's just with lasers. No, I am not an "expert" in the field, but I am definitely not a wet behind the ears new graduate (OD or MD) nor am I a 'spin and grin' OD.

I may be unhappy with my profession's political & career path, but I am good at what I do and would never jeopardize my patients well being. Good luck with your cesarians....

 

[JaggerPlate]

Sure thing. I have performed on several patients: SLT, ALT & MLT and a few LPIs (only because it wasn't too common).

That's just with lasers. No, I am not an "expert" in the field, but I am definitely not a wet behind the ears new graduate (OD or MD) nor am I a 'spin and grin' OD.

I may be unhappy with my profession's political & career path, but I am good at what I do and would never jeopardize my patients well being. Good luck with your cesarians....

A 32 hour course and assisting on 'several patients,' huh? Where do I sign my grandma up for surgery??

 

[speyeder]

So yes, a 32hr course is good enough.

You should hang that on your door. I'm sure patients will be lining up.

 

[Meibomian SxN]

You should hang that on your door. I'm sure patients will be lining up.

Have you performed the CXL procedure yet? On how many patients? What about the latest excimer lasers for refractive surgery? Have you used the new LenSx system yet? I wonder how and WHERE you'll learn how to.....

I guess you were already trained to do these procedures even before they originated? Wow, what a genius! I'll send my nana over to you first thing Monday morning for a demo...

 

[speyeder]

Have you performed the CXL procedure yet? On how many patients? What about the latest excimer lasers for refractive surgery? Have you used the new LenSx system yet? I wonder how and WHERE you'll learn how to.....

I guess you were already trained to do these procedures even before they originated? Wow, what a genius! I'll send my nana over to you first thing Monday morning for a demo...

Sorry I don't do refractive procedures. But if I did I would be eminently more qualified than you with your weekend training course.

 

[Just Applied]

I have read both threads in the opto forum and this one as well on the current subject and the profound lack of knowledge I see on the opto side is embarrassing to their profession. I am not trying to be offensive but it may come off like it and I do apologize. The example of NVI and NVG glaucoma is ridiculous. Obviously a PI would not help NVI in a pt with NVG (unless its pupillary block which is rare in NVI). This reminds me of an example the same poster posted a while ago about how he would refer a retrobulbar hematoma to a retina specialist. I see a very scary future for patients and this person keeps proving it over and over. I feel the only way people will realize what is happening is when they or someone they love literally goes blind. I know optos believe that there have never been any complications and all that but when they were given rights to Rx glaucoma drops, a whole slew of patients went blind in Oklahoma. It is just scary to imagine how many patients are going to be hurt by this. Reimbursement in medicine (no matter what field you are in) is going to decline... that will be a null point soon enough. I just feel like everyone is looking for a pot of gold that will not be there by the time they reach their goals. I have a good friend who is in PA school and the first thing they said in his school before they started was "You guys do 4 years of medical school in 2 years." They are fed this from the beginning. I actually tutor him and the amount of information they go through barely skims the surface of what MDs go through. I know this because, 3 years out of medical school I still remember all the basics and this is what he is tested on. But I digress, these grad school teach their students that they are have an amazing scope and could do whatever they want once they get out, but unfortunately thats not reality. Doing thing you are not TRAINED TO DO ON REAL PATIENTS is dangerous and people will get hurt. You are not going to be ready to handle the complications that can and will eventually happen...

 

[MstaKing10]

While most seem to be focusing on the technical aspects of performing these procedures, it is really not that part that scares me the most. Is it technically that challenging to perform a PI or do and ALT? The truth is they are not. Of course, I have the perspective of performing other more challenging procedures such as phaco, vitrectomy etc. so this is relative but still. The real challenge, the part that involves more knowledge, experience, training and skill than anything else is knowing who to perfom these procedures on, under what circumstances, and more importantly who to NOT perform certain procedures on.

It is the why, when and who that is much more important than the how...and no 32 hour course will teach you that.

 

[Visionary]

While most seem to be focusing on the technical aspects of performing these procedures, it is really not that part that scares me the most. Is it technically that challenging to perform a PI or do and ALT? The truth is they are not. Of course, I have the perspective of performing other more challenging procedures such as phaco, vitrectomy etc. so this is relative but still. The real challenge, the part that involves more knowledge, experience, training and skill than anything else is knowing who to perfom these procedures on, under what circumstances, and more importantly who to NOT perform certain procedures on.

It is the why, when and who that is much more important than the how...and no 32 hour course will teach you that.

True dat.