Proposed Optometry Bills for Scope of Practice Expansion

[Meibomian SxN]

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Meibomian Sx....your responses glaringly show your knowledge.You are what a general surgeon I trained with would call "Wrong and Strong". You are not only ignorant..you like screaming it to the world on studentdoctor.net..

You really represent your field well
Keep posting...it only proves my point...🙂

to top it off....I love how you blame the patient and son as its their fault

laughing my ass off

Riiight.....I'm glad I keep you amused. But I'm more curious where you all get these egos from? Is it pre-med or post-med or the fact that you scored high on your USMLE?

General surgeon you trained with? Smh, I'll still chuckle at that as I drive home today....

 

[Visionary]

So NOW you're saying that someone with NVI can't have NVG? Boy, I'd LOVE to rip you up in a grand rounds seminar....And YES, we had those in the OD curriculum as well as on rotations and residency!

I just hope you don't have the same train of thought when you're operating on that delicate pink tissue in the eye; pretty scary to think about 😱

Geez, son. Did you get into some bad weed or something? Are you having a stroke? I feel like I'm arguing with someone in a different language. Please go back and reread what I've posted. You clearly do not even understand what I'm saying. Wow.

 

[Visionary]

agreed, but as you said (and I have read numerous reports of) these retinacams are being put into PCPs, endo, etc for "screening photos", they keep the tech fee and the images are sent over the web to some ophtho to read the image, who in turn collects the balance of the fee. It IS bad care, but that doesn't seem to stop ophtho from doing it. Pts have NO IDEA that they aren't getting a proper eval, and will never seek out an eye doctor. I wonder who carries the liability burden on those cases.

You'll get no argument from me on that. The only place I've really seen this implemented is in the VA system, likely as a cost-cutting measure. Definitely not good patient care.

 

[thiaeyemd]

Netmag i see what you are saying but I think that when people say ignorant things and are very self righteous in their ignorance the wolves descend. It happens in the hospital with physicians who are at the same level. When someone (be it dermatologist, ophthalmologist or internist or whatever) says something that is factually incorrect and then tries to bully their way to have people agree or tries to get loud, people just rip them apart. I think that in this post, there were responses that to be honest are just medically incorrect and stupid and the same poster is also making claims about their knowledge and everyone else's lack of it..In this case the poster is an optometrist and the responders are MDs because they are more familiar with that topic probably....On a site like this, its basically an injured fish in a sea of sharks...dinnertime...

 

[thiaeyemd]

Meibomian Sx.....My ego, presence or lack thereof has nothing to do with your idiotic statements..thank you very much...Nice try but no one's buying it. If someone runs into the town square and screams the sky is green, people laugh at him because he is an idiot not because they have big egos. If you want to blame all of us laughing at you because we have huge MD egos so be it...A fool can live in his fantasy...

Part of my fellowship involved operating with a general surgeon who handled mandibular and maxillary trauma at the local hospital. Not sure why you think that is wierd or funny...

Also...to follow in terms of your complete lack of knowledge of treating a retrobulbar hemorrhage, most people who type something quickly by accident and then get corrected usually don't respond with "lesson learned". Going forward....I recommend you call your attending from "residency" and ask him "Quick random question, is it a good idea to do a laser PI on a patient who has neovascularization of the iris?" You might learn something.....again.

 

[mclem222]

damn..Meibs got served....

 

[eyeballmadness]

Meibomian Sx probably thinks its the patients and families fault for this too...


Veteran blinded by VA optometrists gets $250,000
November 11th, 2010, 1:34 pm · 25 Comments · posted by BRIAN JOSEPH, Sacramento Correspondent

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Update: Palo Alto Online is reporting Friday morning that a second veteran received a $400,000 settlement from the federal VA.
More than a year ago, the Watchdog told you about eight veterans who suffered preventable vision loss at the hands of California optometrists and how that illustrates the potential danger of a proposed state regulation allowing optometrists to treat glaucoma patients.
Last week, the federal government — which employed the optometrists at a VA hospital in northern California — agreed to pay $250,000 to settle a lawsuit by one of the veterans allegedly blinded by the optometrists' poor care.
The very next day, the state Department of Consumer Affairs passed the proposed regulations onto the final review before implementation.
Yikes.
For those of you who haven't been following our coverage of the issue, here's a brief summary:
California optometrists (that is, the professionals you go to for eye exams and glasses) have been lobbying the California State Legislature for years for the right to independently treat glaucoma patients.
California ophthalmologists (that is, medical doctors who specialize in the eye) have fought tooth and nail against granting their rivals any such authority. It's viewed as a turf battle in Sacramento, although the ophthalmologists insist they're concerned about patient safety.
Whatever the case, the whole thing was supposed to be resolved by 2008′s Senate Bill 1406 by Orange County State Sen. Lou Correa, D-Santa Ana. Correa's bill attempted to balance the optometrists' desires with ophthalmologists' concerns by establishing a committee of three optometrists and three ophthalmologists to hammer out compromise regulations. The process, however, didn't work out quite like the senator had planned: The optometrists and ophthalmologists couldn't agree on what to do. So the state hired a consultant to finish up the regulations.
The only problem was the consultant was an optometrist.
California ophthalmologists (the MDs) claim that the regulations — drawn up by a person with an obvious conflict of interest — are much too weak and allow optometrists (the glasses guys) to become glaucoma-certified without ever treating a glaucoma patient.
To illustrate their concerns, the ophthalmologists have pointed to the case of the eight veterans. Last year, administrators at the federal Department of Veterans Affairs Hospital in Palo Alto admitted that hospital optometrists treated the eight veterans for glaucoma but were not supervised by ophthalmologists as required by procedure. The hospital was later forced to notify the eight veterans suffered preventable vision loss at the hands of those optometrists.
In March, David E. Woodward Sr. a medical negligence case filed in U.S. District Court in the Northern District of California. Woodward claims in his suit that he received treatment from optometrists at the Palo Alto VA and was informed by the VA in July 2009 that the optometrists had misdiagnosed his glaucoma, which has caused him to lose vision.
Last week, the federal government settled the suit with Woodward by agreeing to pay him and his wife $250,000. As part of the agreement, however, the feds did not admit liability or fault.

Stiger
Meanwhile, Brian Stiger, the director of the state Department of Consumer Affairs, had the opportunity to review the regulations one last time. Stiger, a reformer appointed by Gov. Arnold Schwarzenegger who has cleaned house in several of the state's boards and commissions, had initially indicated he wanted to scrap the regulations and start over, but later said they were OK and approved them.
The state Office of Administrative Law, however, had problems with the regulations in their original form. OAL as it's known had the exact same problem with the regulations as the ophthalmologists: Optometrists can meet the requirement for treating patients without actually, well, treating patients.
Instead of demanding that the loophole be removed from the regulations, OAL offered a, um, different solution: Changing the definition of treatment so it doesn't actually mean interacting with, or managing the symptoms of, patients. In other words, OAL told the California State Board of Optometry to change the definition of treatment so it doesn't actually mean treatment, which is exactly what the board did.
California ophthalmologists had hoped that Stiger might block the regulations this go around because OAL directly acknowledged the lack of treatment, but no dice. Last week, OAL reported that glaucoma regulations were now under review, meaning Stiger had signed off on them.
OAL could, in theory, still block the regulations, but considering the board followed OAL's directions that's not very likely. It looks as though California will soon allow optometrists to independently treat glaucoma, even though California optometrists have gotten in trouble for doing just that.

 

[Eyes Only]

Visionary...

Where did you hear about a new school in Louisville?

Just curious.

 

[MullerCell]

On what planet is a PI appropriate treatment of NVG? It isn't even a consideration. A PI relieves pupillary block, this isn't the mechanism of angle closure in NVG. In NVG, the angle is sealed shut with neovascularization. How does a hole in iris help in that situation? If the angle hasn't completely closed, Avastin and prompt PRP can help regress the NV and you can treat with topicals to try to bring down the IOP, but in advanced cases with a closed angle these patients typically require a prompt tube shunt for IOP control.

 

[Meibomian SxN]

On what planet is a PI appropriate treatment of NVG? It isn't even a consideration. A PI relieves pupillary block, this isn't the mechanism of angle closure in NVG. In NVG, the angle is sealed shut with neovascularization. How does a hole in iris help in that situation? If the angle hasn't completely closed, Avastin and prompt PRP can help regress the NV and you can treat with topicals to try to bring down the IOP, but in advanced cases with a closed angle these patients typically require a prompt tube shunt for IOP control.

So again (because it seems you phaco-chop monkeys just don't get anything but what's in the mirror in front of you)......How do you know if it wasn't pupil blocKed??? Every procedure you just mentioned is nothing "gold standard." Different approaches to every case. Did you not learn that in your 13,000 hrs of foundation?

Again, I thank whoever is up above us that I don't have to refer my surgical Px's to the weird bunch I encounter on here.

 

[Meibomian SxN]

Meibomian Sx probably thinks its the patients and families fault for this too...


Veteran blinded by VA optometrists gets $250,000
November 11th, 2010, 1:34 pm · 25 Comments · posted by BRIAN JOSEPH, Sacramento Correspondent
..

There's negligent docs in every specialty.....

http://www.memphisdailynews.com/editorial/Article.aspx?id=48004

Dr. Seth Yoser fainted Thursday, immediately after U.S. District Judge S. Thomas Anderson sentenced him to 42 months for mail fraud, wire fraud and selling drugs without a license.

Yoser, an ophthalmologist who specialized in the treatment of wet macular degeneration, pleaded guilty last summer to 35 counts of federal fraud charges for stealing an expensive medicine from his practice, double-billing Medicare for the medicine and then selling it back to ophthalmology practices, including the clinic where he was a partner, the Eye Specialty Group in East Memphis. (See "Good Deed Punished" in the Feb. 10 issue of The Daily News, www.memphisdailynews.com).

The judge cleared the courtroom and called in a nurse after the doctor fainted at noon. Yoser's condition was not known by press time Thursday.

or

http://www.verdictsearch.com/index.jsp?do=news&rep=recent&art=090111_hs

$7,500,000 Plaintiff lost eye while awaiting corneal transplant, claimed ophthalmologists needlessly delayed procedure. Defense contended plaintiff waited too long before seeking help. Parks v. Perl
Essex Co., N.J.; Super. Ct.; No. ESX-L-6718-07 (2/11/11)

$1,700,000 Cataract patient's new lens shifted after surgery and caused damage that destroyed eye. She claimed surgeon didn't promptly address the problem. Defense contended patient avoided treatment. Brown v. Ezekwo
Bronx Co., N.Y.; Sup. Ct.; No. 6242/06 (10/18/10)

$740,000 Plaintiff lost almost all of one eye's vision after cataract surgery, claimed surgeon didn't stop long enough after eye's intraocular pressure rose during the procedure. Logmao v. Zabin
Westchester Co., N.Y.; Sup. Ct.; No. 3600/06 (11/8/10)

$684,000 Plaintiff lost eye days after cataract surgery, claimed ophthalmologist left town and didn't provide referral for follow-up treatment. Doctor argued she saw patient twice before leaving. Rieker v. Kristal
La Salle Co., Ill.; Cir. Ct.; No. 08-L-90 (5/27/11)

$550,000 Plaintiff alleged LASIK surgery exacerbated problem with inner layer of one of his corneas, worsening his vision. Defense contended LASIK surgery doesn't affect inner layer of cornea. Dorffer v. Roholt Vision Institute
Summit Co., Ohio; Ct. C.P.; No. 2008 10 7477 (11/24/10)

$400,000 Air Force vet claimed VA hospital didn't address his glaucoma, despite rendering other eye care. He lost one eye's sight and some of other eye's sight. Defense didn't challenge liability. Kennedy v. United States of America Unfiled matter, California (12/1/10)

$2,284 Man who underwent replacement of intraocular lens, to correct astigmatism, claimed doctor improperly positioned new lens, causing months of pain and necessitating surgery. Seal v. Chin
San Francisco Co., Calif.; Super. Ct.; No. CGC-10-499681 (6/1/11)

 

[mclem222]

Different approaches to every case? Neovascular glaucoma, Neovascularization of the iris...when is that ever an indication for a Yag PI? Dude you f1*(*u(*(*ed up.. Just move on....Stop arguing about something that is blatantly wrong...I am an OD and you are beginning to piss me off.

 

[Visionary]

Visionary...

Where did you hear about a new school in Louisville?

Just curious.

No secret that I practice in Kentucky. Heard it at the recent KMA meeting. Unsubstantiated at this point, though.

 

[Meibomian SxN]

Different approaches to every case? Neovascular glaucoma, Neovascularization of the iris...when is that ever an indication for a Yag PI? Dude you f1*(*u(*(*ed up.. Just move on....Stop arguing about something that is blatantly wrong...I am an OD and you are beginning to piss me off.

And yes, there's ALWAYS a lackey out there to comment (speaking of YOU).....

Blatantly wrong? You act as if the 2 disease conditions act independent of each other?!? Thanks for souring my coffee with your turncoat rant! You, I nor 'thiaeyemd' were not there to assess the case; which was a poor, vague example case to show that ODs are incompetent I might mention....

All I know is ODs have access to certain laser privileges now and more states will follow. Live with it and don't be a tool for the egotists!

 

[mclem222]

Meibs...sure two diseases can occur at the same time...anything in this world is "technically" possible however are you aware that neovascularization of the iris is a direct CONTRAINDICATION to do a YAG PI? I love optometry but don't accuse me of being a turncoat because a jackass like you likes to represent our field by yelling out nonsense to a room full of ophthalmologists, optometrists, students and god knows who else. Great...I hope you are happy that your posts will be cut and pasted and used the next time we push for anything and the OMDs want to show that we don't know what the f()_(*( we are talking about...I am glad we are going to be doing lasers soon in a bunch of states but I really hope that you are not the one who decides to do it...idiot...

 

[Meibomian SxN]

Meibs...sure two diseases can occur at the same time...anything in this world is "technically" possible however are you aware that neovascularization of the iris is a direct CONTRAINDICATION to do a YAG PI? I love optometry but don't accuse me of being a turncoat because a jackass like you likes to represent our field by yelling out nonsense to a room full of ophthalmologists, optometrists, students and god knows who else. Great...I hope you are happy that your posts will be cut and pasted and used the next time we push for anything and the OMDs want to show that we don't know what the f()_(*( we are talking about...I am glad we are going to be doing lasers soon in a bunch of states but I really hope that you are not the one who decides to do it...idiot...

And a closed angle is an INDICATION for a PI, dunce! Everything is not text book, or maybe with you it is! What was the entering IOP? How closed was the angle? Was the Px seen at 4pm (which means retina is closing up shop for the day, therefore NO CONSULT)? No matter what this OD did, NOTHING would be a satisfactory outcome in the MDs view except referring.

Instead of licking the egotist boots, how about standing up for and WITH your fellow OD who made the clinical judgement that the PI WAS indicated??? One thing I commend MDs for is there willingness to stick by and stand up for each other. Shame our profession doesn't have the same camaraderie; as seen with the AOAs trends.....

Go back to scribing & retting for your MD boss, sounds pretty much where you ought to be.....

 

[MR1]

And a closed angle is an INDICATION for a PI, dunce! Everything is not text book, or maybe with you it is! What was the entering IOP? How closed was the angle? Was the Px seen at 4pm (which means retina is closing up shop for the day, therefore NO CONSULT)? No matter what this OD did, NOTHING would be a satisfactory outcome in the MDs view except referring.

Instead of licking the egotist boots, how about standing up for and WITH your fellow OD who made the clinical judgement that the PI WAS indicated??? One thing I commend MDs for is there willingness to stick by and stand up for each other. Shame our profession doesn't have the same camaraderie; as seen with the AOAs trends.....

Go back to scribing & retting for your MD boss, sounds pretty much where you ought to be.....

NO pupillary block is the indication for a PI. A closed angle can be closed by many things but ONLY pupillary block will be fixed with a PI. If there is NVG and no pupillary block (99% of the cases of NVG), then a PI is ridiculosis. That is the reason everyone is attacking you. Also by chance if there is pupillary block and NVI\NVG, the a YAG PI is asking for problems, you need to do a straight argon or combo PI.

Again, not knowing what you don't know.

 

[JaggerPlate]

NO pupillary block is the indication for a PI. A closed angle can be closed by many things but ONLY pupillary block will be fixed with a PI. If there is NVG and no pupillary block (99% of the cases of NVG), then a PI is ridiculosis. That is the reason everyone is attacking you. Also by chance if there is pupillary block and NVI\NVG, the a YAG PI is asking for problems, you need to do a straight argon or combo PI.

Again, not knowing what you don't know.

LOL. I've lost count at the number of times he's been proven blatantly wrong and still tries to back peddle and rally more sailors for his sinking ship.

 

[Meibomian SxN]

NO pupillary block is the indication for a PI. A closed angle can be closed by many things but ONLY pupillary block will be fixed with a PI. If there is NVG and no pupillary block (99% of the cases of NVG), then a PI is ridiculosis. That is the reason everyone is attacking you. Also by chance if there is pupillary block and NVI\NVG, the a YAG PI is asking for problems, you need to do a straight argon or combo PI.

Again, not knowing what you don't know.

Ok, so add pupillary block to the list. Did you see the Px? Do you have the Px's complete history? I thought so.....😴

Its pointless. Fact is the man made the clinical decision to do a PI. Next I'm guessing you'll tell me the scotoma his fault also? Smh....

Again, I'm lucky to not have to refer to surgeons like you.

LOL. I've lost count at the number of times he's been proven blatantly wrong and still tries to back peddle and rally more sailors for his sinking ship.

Not about "proving me wrong." It was a pathetic attempt to wrongfully throw another OD under the bus. I stand by his decision. Period.

 

[JaggerPlate]

Again, I'm lucky to not have to refer to surgeons like you.

After following the discussion, I think we can all thank God you have to refer to someone ... even if it isn't the foolish, money grubbing, OD hating ophthalmologists on this board.

Not about "proving me wrong."

and yet, that's what seems to have happened ... again, and again.

 

[MR1]

Ok, so add pupillary block to the list. Did you see the Px? Do you have the Px's complete history? I thought so.....😴

Its pointless. Fact is the man made the clinical decision to do a PI. Next I'm guessing you'll tell me the scotoma his fault also? Smh....

Again, I'm lucky to not have to refer to surgeons like you.


Not about "proving me wrong." It was a pathetic attempt to wrongfully throw another OD under the bus. I stand by his decision. Period.

This is just funny now. NO don't just add pupillary block to the list, it is the list. I didn't see the patient, I dont' have to know the history though. I dont' care. We were told someone did a PI on NVG. Unless there is pupillary block, that person made a bad decision. You can stand behind them all day long, that just makes you along with them WRONG.

When I make a bad decision I own up to it but I dont' expect anyone to stand behind me and say "well I stand by his wrong decision"

PS - You maybe referring to me and not know it by the way.

 

[JaggerPlate]

This is just funny now. NO don't just add pupillary block to the list, it is the list. I didn't see the patient, I dont' have to know the history though. I dont' care. We were told someone did a PI on NVG. Unless there is pupillary block, that person made a bad decision. You can stand behind them all day long, that just makes you along with them WRONG.

When I make a bad decision I own up to it but I dont' expect anyone to stand behind me and say "well I stand by his wrong decision"

PS - You maybe referring to me and not know it by the way.

I've lost count.

 

[Meibomian SxN]

This is just funny now. NO don't just add pupillary block to the list, it is the list. I didn't see the patient, I dont' have to know the history though. I dont' care. We were told someone did a PI on NVG. Unless there is pupillary block, that person made a bad decision. You can stand behind them all day long, that just makes you along with them WRONG.

When I make a bad decision I own up to it but I dont' expect anyone to stand behind me and say "well I stand by his wrong decision"

PS - You maybe referring to me and not know it by the way.

I've lost count.

Again for the 20th time, no one knows if the Px had pupillary block. I'm sure if what this OD did was incorrect treatment then the referring MD would have thrown him under the bus.

Nah, we refer to Mark Friedberg out in Red Bank, NJ for retina. Not the greatest bedside manners (seems rampant in your program judging by the posts) but he's "OD friendly", writes excellent f/u letters, not the least bit insecure of OD scope expansion and gives nice seasonal grafts of food.

Besides, I'm sure you don't top him as far as surgical superiority goes; wouldn't you agree? I only send to the best

 

[speyeder]

And yes, there's ALWAYS a lackey out there to comment (speaking of YOU).....

Blatantly wrong? You act as if the 2 disease conditions act independent of each other?!? Thanks for souring my coffee with your turncoat rant! You, I nor 'thiaeyemd' were not there to assess the case; which was a poor, vague example case to show that ODs are incompetent I might mention....

All I know is ODs have access to certain laser privileges now and more states will follow. Live with it and don't be a tool for the egotists!

Why is mclem222 a turncoat? Because he doesn't agree with you? Well guess what? No one with two brain cells does because you're blatantly wrong, again!

 

[speyeder]

And a closed angle is an INDICATION for a PI, dunce! Everything is not text book, or maybe with you it is! What was the entering IOP? How closed was the angle? Was the Px seen at 4pm (which means retina is closing up shop for the day, therefore NO CONSULT)? No matter what this OD did, NOTHING would be a satisfactory outcome in the MDs view except referring.

Instead of licking the egotist boots, how about standing up for and WITH your fellow OD who made the clinical judgement that the PI WAS indicated??? One thing I commend MDs for is there willingness to stick by and stand up for each other. Shame our profession doesn't have the same camaraderie; as seen with the AOAs trends.....

Go back to scribing & retting for your MD boss, sounds pretty much where you ought to be.....

We're all waiting for you to re-write the chapter on NVG in Shield's glaucoma.

 

[Meibomian SxN]

Why is mclem222 a turncoat? Because he doesn't agree with you? Well guess what? No one with two brain cells does because you're blatantly wrong, again!

Because of the tone & demeanor in which he "disagreed". I never cursed at anyone, even if I disagreed with their vain attempts to paint the Oklahoma OD as a incompetent Jedi Knight after posting a vague case example....

The end

 

[hello07]

I only have one question for Meibomian sxn: Do you suffer from inferiority or superiority complex? I'm not a CSW, psychiatrist or psychologist but you have some mental- issues. You are not a normal OD.

How many times were you rejected from Med School?

 

[Shnurek]

Lol I can be ******ed in my arguments because I am just a first year student but if you are an OD I'd be more humble in my arguments unless you are absolutely sure you are right.

 

[JaggerPlate]

I only have one question for Meibomian sxn: Do you suffer from inferiority or superiority complex? I'm not a CSW, psychiatrist or psychologist but you have some mental- issues. You are not a normal OD.

How many times were you rejected from Med School?

+ another one (and a comment from a sane, logical OD calling out the absurdity).

 

[Tippytoe]

I have no opinion on this case. I think we all know it's not good to laser through neovascular vessels.

What is sad is the one who brought up the "OD's are stupid because I saw this one case" story.

This case may or may not be true. And yes, ODs do sometimes do some dumb things. But the fact is, OMDs do very dumb things too. I can tell most of the posters on this forum are newbees based on their holier-than-though mindset.

Any OD that has been in practice more than a few years can recite story after story of ophthalmologist screw-ups (and the opposite case is true too). I've seen cases from OMDs such a missed retinal detachment, missed foreign bodies, totally screwed up refractions, and I can't tell you how many post-op ectasia corneas I've seen from goofed up Lasik surgeries on corneas that were much too thin to begin with.

During my time in a OMD referral center I was pained at all the simple cases ODs would refer in. So if anything, I'd say ODs are much, much more conservative and too quick to refer to subspecialists while many (not all) OMDs seem to feel like they are failures if they can't handle any and every thing that comes at them.

I could have been a smartass and 'showed off' to the OMDs. I could have tried to have the patient sue OMDs on a few occasions when there was blatant malpractice and they might have actually won. But I didn't.

See the ones of us that are mature realize that these things happen to the best of us. Maybe the OMD was very busy that day, didn't dilate on that 10 day cataract post-op, didn't see the inferior detachment microns from the macula. It's not an excuse really......but it does happen. Maybe the tech didn't document his visual field complaint? Maybe it wasn't detached 2 hours prior to seeing me when he saw the patient (yea right).

Eye care and the medical world is competitive enough without us fighting each other. Fortuantely it doesn't happen in our day to day life very much. It seem to only show in internet forums and in state legislatures with the militant ODs and OMDs fighting each other.

So just please don't bring up the "I saw an OD that screwed up" line. It's as old as the OMDs telling legislatures that we will blind people if we are allowed to use dilating drops, as was done in the 1970's 😀

 

[Visionary]

I have no opinion on this case. I think we all know it's not good to laser through neovascular vessels.

What is sad is the one who brought up the "OD's are stupid because I saw this one case" story.

This case may or may not be true. And yes, ODs do sometimes do some dumb things. But the fact is, OMDs do very dumb things too. I can tell most of the posters on this forum are newbees based on their holier-than-though mindset.

Any OD that has been in practice more than a few years can recite story after story of ophthalmologist screw-ups (and the opposite case is true too). I've seen cases from OMDs such a missed retinal detachment, missed foreign bodies, totally screwed up refractions, and I can't tell you how many post-op ectasia corneas I've seen from goofed up Lasik surgeries on corneas that were much too thin to begin with.

During my time in a OMD referral center I was pained at all the simple cases ODs would refer in. So if anything, I'd say ODs are much, much more conservative and too quick to refer to subspecialists while many (not all) OMDs seem to feel like they are failures if they can't handle any and every thing that comes at them.

I could have been a smartass and 'showed off' to the OMDs. I could have tried to have the patient sue OMDs on a few occasions when there was blatant malpractice and they might have actually won. But I didn't.

See the ones of us that are mature realize that these things happen to the best of us. Maybe the OMD was very busy that day, didn't dilate on that 10 day cataract post-op, didn't see the inferior detachment microns from the macula. It's not an excuse really......but it does happen. Maybe the tech didn't document his visual field complaint? Maybe it wasn't detached 2 hours prior to seeing me when he saw the patient (yea right).

Eye care and the medical world is competitive enough without us fighting each other. Fortuantely it doesn't happen in our day to day life very much. It seem to only show in internet forums and in state legislatures with the militant ODs and OMDs fighting each other.

So just please don't bring up the "I saw an OD that screwed up" line. It's as old as the OMDs telling legislatures that we will blind people if we are allowed to use dilating drops, as was done in the 1970's 😀

Fair enough. I take partial blame here, as I got the ball rolling by responding to Meibum, who is notoriously reactionary and inflammatory. Heck, I knew he would come back at me guns blazing, even though I was just trying to clarify the issue. Kinda fun, though.

As you stated, there are enough misdiagnoses, cases of mismanagement, and complications to go around. I doubt there is a practicing optometrist/ophthalmologist among the posters here who hasn't had at least one such case. I don't think any of the rational folks here really think optometrists are greedy, uncaring, negligent, buffoons.

As some of the other posters have mentioned here and on the ophthalmology board, the issue is the relative foundations of clinical/surgical training of ophthalmologists and optometrists. Trying to call these disparate training paths equivalent is nonsense, and the rational among you seem to agree. There is no way a 32 hour course with supervision on a single live case is adequate, when you lack a solid foundation in surgical procedures and management. Similarly, the idea that scope expansion is an appropriate way to compensate for optometrist oversupply is nonsense.

 

[Jason K]

Trying to call these disparate training paths equivalent is nonsense, and the rational among you seem to agree. There is no way a 32 hour course with supervision on a single live case is adequate, when you lack a solid foundation in surgical procedures and management. Similarly, the idea that scope expansion is an appropriate way to compensate for optometrist oversupply is nonsense.

Thanks to Tippytoe and Visionary for taking this thread back on task. I think it’s important to focus on the overall debate here. The question is, should ODs be adding laser procedures to our scope at this point in our profession’s development? I think the answer is “no.” It has nothing to do with whether or not we are capable of learning the knowledge necessary to carry out anterior seg laser procedures in office. We are capable of learning them, and some of us have. The question is, as a profession, are we currently graduating ODs with the knowledge and practical skills necessary to perform these procedures at the same level of competency as our more highly-trained surgical colleagues? I believe the answer is “No, we’re not. At least not now.” To ignore that reality is irresponsible and short-sighted. Right now, the ODs doing these procedures are mostly practitioners who have considerable experience diagnosing and managing glaucoma. It’s a relatively small group. Whoever this OD is that was apparently “shooting LPIs from the hip” is probably the exception rather than the rule....for now. The problem is, what’s going to happen when the average "joe blow" out of optometry school decides he’s going to haul off and do the “comprehensive 32-hour weekend laser-tag course.” Given the inconsistency of our OD programs today, it’s not at all uncommon to graduate ODs who are not competent in glaucoma diagnostics and management, but yet are qualified on paper to do so. I’m sorry to be realist here, but there are some programs graduating ODs who are glaucoma-certified who are simply not well-trained in glaucoma. Many are competent, and some are not. If this stuff takes off, are we going to be ok with the latter folks heading out into practice, getting behind the wheel of therapeutic laser, and firing away at whomever crosses their path after they complete a brief course and demonstrate “minimum” competence? Will that be good for our profession? Will that be good for patients? Personally, I think as far as OD training goes, we've got some work to do as far as standardizing and solidifying the foundational knowledge before we go adding lasers to our repertoire.

We need to do it the right way if we’re going to do it at all and this is clearly not the right way. If we want to become surgeons, we need to add the training, not just the cool instruments. What we’re saying is “Hey, I have a doctorate and I want to be able to use that laser so give it to me...... now!” Once again, back to my teenager analogy. If we were talking about limiting laser use to ODs who have completed some sort of well-supervised training program involving a lot of repetition on actual human beings, then maybe it would make a little more sense. The way we're doing it is ridiculous. Yes, I realize that we're not talking about major invasive surgery here, but that's beside the point. The point is, it's the start of a different path and we're not at the place we need to be in order to start on that path. That the surgical procedures are not extraordinarily complex is irrelevant, in my opinion.

Some ODs seem to have a sort of “I could have gone to medical school” chip on their shoulder and think that what separates them from a talented eye surgeon is a 4 year medical degree. It’s not. What primarily separates us (surgically) from them is residency in ophthalmology involving thousands of supervised surgical procedures, not medical school. I don’t think you’d find many MDs on this site arguing that new MD grads leave school with anything more than a limited knowledge base when it comes to diagnostics and treatment of eye and vision disorders.

We need to add the experience and the repetition if we’re going to start on the surgical path as a profession. I think scope expansion is necessary and beneficial, but going about it in this manner is pathetic. It’s an incredibly impatient and misguided way for our profession to be behaving, but then, that seems to be the trend for us right now. Looking at the AOA/ABO nonsense that's going on, it's not hard to understand why this stuff is taking place.

 

[PBEA]

nice post but waaaaayyy too long, only thing I'd add is that if ODs want to do it the "right way" they still would need legal standing to do so. You can't just go and start a training program if it's illegal to do any of the procedures. Hence legislation.

 

[Meibomian SxN]

........We need to do it the right way if we're going to do it at all and this is clearly not the right way. If we want to become surgeons, we need to add the training, not just the cool instruments. What we're saying is "Hey, I have a doctorate and I want to be able to use that laser so give it to me...... now!" Once again, back to my teenager analogy. If we were talking about limiting laser use to ODs who have completed some sort of well-supervised training program involving a lot of repetition on actual human beings, then maybe it would make a little more sense. The way we're doing it is ridiculous. Yes, I realize that we're not talking about major invasive surgery here, but that's beside the point. The point is, it's the start of a different path and we're not at the place we need to be in order to start on that path. That the surgical procedures are not extraordinarily complex is irrelevant, in my opinion.

Some ODs seem to have a sort of "I could have gone to medical school" chip on their shoulder and think that what separates them from a talented eye surgeon is a 4 year medical degree. It's not. What primarily separates us (surgically) from them is residency in ophthalmology involving thousands of supervised surgical procedures, not medical school. I don't think you'd find many MDs on this site arguing that new MD grads leave school with anything more than a limited knowledge base when it comes to diagnostics and treatment of eye and vision disorders.

We need to add the experience and the repetition if we're going to start on the surgical path as a profession. I think scope expansion is necessary and beneficial, but going about it in this manner is pathetic. It's an incredibly impatient and misguided way for our profession to be behaving, but then, that seems to be the trend for us right now. Looking at the AOA/ABO nonsense that's going on, it's not hard to understand why this stuff is taking place.

As you and the other practicing ODs know, our leadership is not going in the direction that the majority of us want or have asked for. But the fact is our leadership is taking us ALL full steam ahead into the world of board certification, lasers and "lumps & bumps (the poor wording is not mines).

I personally would rather have seen better licensure mobility, all 50 states with oral & therapeutics and tackling insurance paneling. But that's not my reality.

And I know how difficult it is to score ANY scope expansion with ophthalmology, and so rather than have an attitude of "ahh, he just has a chip on his shoulder because he wasn't accepted into medical school", I embrace my colleagues victory and stand by their collective decision and know that they will develop a stronger clinical didactic program in their new, hard earned scope.

 

[Jason K]

As you and the other practicing ODs know, our leadership is not going in the direction that the majority of us want or have asked for. But the fact is our leadership is taking us ALL full steam ahead into the world of board certification, lasers and "lumps & bumps (the poor wording is not mines).

I personally would rather have seen better licensure mobility, all 50 states with oral & therapeutics and tackling insurance paneling. But that's not my reality.

And I know how difficult it is to score ANY scope expansion with ophthalmology, and so rather than have an attitude of "ahh, he just has a chip on his shoulder because he wasn't accepted into medical school", I embrace my colleagues victory and stand by their collective decision and know that they will develop a stronger clinical didactic program in their new, hard earned scope.

I agree that no one wants what the AOA/ABO is doing, but that doesn't make it acceptable to just jump on a sinking ship and follow their lead. We're trying to grow too fast for our britches, and that's not going to be good for anyone. It's not a good idea to add unsupported walls to a house and then say "No worries, I'll add the structural support to those walls later on." That's pretty much what we're doing right now with scope expansion and it's going to bite us in the ass at some point.

 

[KHE]

This thread was teetering on the brink anyways but now that someone has used the word "britches" it's hanging on by a thread.

 

[Jason K]

This thread was teetering on the brink anyways but now that someone has used the word "britches" it's hanging on by a thread.

Oh, c'mon, how may times in life do you actually get to use the word "britches" in a sentence?

 

[Tippytoe]

Yes, yes. We can agree. Organized optometry is completely putting their effort in the wrong places. Part of the reason I think future optometry is doomed.

In my state they fought to allow us to do FA (fluorescein angiography for iemily but I'm sure she already knew that and seeing how I'm not really an OD I had to google it). Is that not the DUMBEST thing to fight for? Of all the damn things to fight for! Right after OCTs came onto the scene. Really would I, in my primary care practice, need to do a FA even more than once a year if that? Totally stupid. We got the right to inject chalazions. That makes me a few bucks once or twice a month. Saves the patient a trip to another doc I guess. Suppose there is some good in that.

The point us sane and rational people know is that most likely any of us could learn to do about any procedure............but why? We have enough eye surgeons. ODs don't need to do surgery. Opticians don't need to refract because we have enough OMD and OD doing it already. (edit: of course there are some crazy MDs that try to claim plucking an eyelash or popping a pimple or flicking a piece of trash off the cornea is 'surgery' because it's listed that way in the CPT codes).

If we are scrambing to find more business via fighting for more procedures to do, that simply means there are too many of us. It doesn't mean we need to grease the hands of more politicans so we can do some other procedures.

BUT, and I think this is key, we don't know what the future holds and we don't necessarily want to be locked out when some genius invents a pill to prevent cataracts and a light pulse that completely cures myopia with no cutting. How about medicated contact lenses to cure diabetic retinopathy (it could happen)? Should ODs be allowed to fit those?

What many people have never thought about or realize is that medicine does not control optometry any more than they control dentistry or cosmetologists or auto mechanics. We are an independent and licensed profession responsible for policing ourselves via our state optometry boards who's primary responsiblity is protecting the public. Problem is, we are not doing a good job of it on the whole.

Besides, in the future, there will be no cutting with scapels like barbarians. Didn't anyone watch Star Trek? Bones would never think of cutting anyone open with a knife 🙂. I hate to think what docs in the next century will think of those crazies doing RK surgery, totally mangling healthy corneas.

Oh yea, I agree. Reciprocity is # 1 on my list. Allow me to move to another state without having to jump through all the stupid hoops we have to now (re-taking board exams for example) and I'll gladly give up the FAs......but this just shows how stupid optometry is from state to state.

And finally I do, truly believe, there is no need for the profession of optometry in general. We don't have 'tooth' MDs. No reason to have redundant 'O's in my mind. I think we should have a battle to the death. Maybe a big tug-o-war or demolition derby for ultimate supremacy of the eye. Nah.....I don't care that much.

Man, I'm getting as long winded as Jason now 😀 😛.

 

[Jason K]

Besides, in the future, there will be no cutting with scapels like barbarians. Didn't anyone watch Star Trek? Bones would never think of cutting anyone open with a knife 🙂. I hate to think what docs in the next century will think of those crazies doing RK surgery, totally mangling healthy corneas.

I'm actually trying to develop a special mount that would allow me to strap a couple of therapeutic lasers to my head. I work in commercial so I have to be fast. No sense wasting time with getting the patient into the slit lamp or worrying about accuracy. I've already put in a well-known request for a shark-mounted version, but that was for my last gig. Hey, maybe this scope expansion stuff will work out after all? 😀

muuuuah-ah-ah-ah-ah-ah-ah-ah-ah

MUUUU-AH-AH-AH-AH-AH-AH-AH

MUUUU-AH-AH-AH-AH-AH-AH-AH cough...cough...choke...cough....

 

[Shnurek]

I think the biggest problem in optometry is that many people go into it for the money and when they graduate they get a rude awakening. Then they end up going commercial and hate their jobs. Ever heard of HENRY's? High-Earner-Not-Rich-Yet. Why? ~150k student loans.

Honestly, if you practice more than 5 years and you still have loans to pay off you really are ******ed financially. I know Americans love to borrow lots of money and "worry about it later" -cough- our national debt -cough- but c'mon guys.

Don't be a slave to your student debt.... Goldman Sachs and other banks love cashing in on your ill financial management skills 🙂

eg. they borrow 150k to a student and then over the next 20 years the student ends up paying them back 450k. Great investment no? And it can't be nullified by declaring bankruptcy. That's 200% pure profit for filling out some paperwork 😛 Who gots the sweet job?

 

[Jason K]

I think the biggest problem in optometry is that many people go into it for the money and when they graduate they get a rude awakening.

Ugggghhh....so many things wrong with this statement. Firstly, no one in their right mind, as I've said before many times, goes into optometry with the idea of becoming wealthy. I can't think of one single person I know who pursued an OD with that as the end goal. It makes no sense. There are far more lucrative careers both in and out of healthcare.

Then they end up going commercial and hate their jobs. Ever heard of HENRY's? High-Earner-Not-Rich-Yet. Why? ~150k student loans.

HENRY's...? New OD grads.....seriously? If you think someone who graduates with an expensive degree, makes 75K, and can consider themselves a "high earner," then we have very different concepts of what high earnings are. New OD grads are LEWLACS; Low Earners Who Live As College Students. Gi'me a break, dude, high earners as new ODs?? You've got to be kidding me

Honestly, if you practice more than 5 years and you still have loans to pay off you really are ******ed financially. I know Americans love to borrow lots of money and "worry about it later" -cough- our national debt -cough- but c'mon guys.

I don't even know what to say here. Do you know the percentage of new OD grads these days who are able to pay their loans off in 5 years?? It's practically zero. If you barricade yourself in your parents house until your 32, eat nothing but ramen noodles three times per day, ride a bicycle for transportation, sell your plasma to a blood bank twice per month, work 6 days/wk, do absolutely nothing for entertainment, and you somehow manage to borrow only 50 or 60K, then maybe someone could pull it off in 5 years. That is, if you manage to find a job that pays you enough to do so. For everyone else who has to pay their own way, it's not going to happen.

Consider that there are ODs out there looking for work right now with 10 years of experience who are not finding it. Also, don't forget about interest my friend, it applies at lower loan levels as well. Much of your payment goes right to interest during the first 10 years or so of your loan. Unless you overpay considerably, you won't be making a big dent in your principal during the first 5 years.

You basically just called every OD who earned their degree in the last 10 years, "financially ******ed." I agree with you completely that an OD at 150k+ is a very poor investment, but please don't go around making the claim that people can just "pay off their loans in 5 years." That's a ridiculous claim for just about anyone in school these days. Dude, imemily's rubbing off on you.

 

[Eyes Only]

You basically just called every OD who earned their degree in the last 10 years, "financially ******ed." I agree with you completely that an OD at 150k+ is a very poor investment, but please don't go around making the claim that people can just "pay off their loans in 5 years." That's a ridiculous claim for just about anyone in school these days. Dude, imemily's rubbing off on you.

To amortize a $150,000 loan at 7% in 5 years would take a monthly payment of about $3,000.

Experts say that monthly student loan payments should not exceed 15% of monthly income.

This would require a monthly income of $20,000!!!

If you could make $100,000 you could comfortably afford a monthly payment of about $833 (10%) or you could sacrifice a little and pay $1,200 (15%). Which is why most recent grads refinance over longer periods.

I'm not down on optometry, I'm down on student debts that ruin your life.

 

[Shnurek]

Jason K I see you love generalizations and exaggerations. Keep doing your thing 👍

Also, with a pier diem rate of $350-$500 a day for optometrists, making a $3000 a month payment is not that difficult. You don't need to drive a BMW or a Mercedes. Don't be an idiot, pay off your loans first before living like anything above a student.

I'm not down on optometry, I'm down on student debts that ruin your life.

Totally agree.

Also, subsidized loans are disappearing starting next year. Looks like I'm f***ed too :O

 

[Jason K]

Also, with a pier diem rate of $350-$500 a day for optometrists, making a $3000 a month payment is not that difficult.

You’re dreaming if you think you’re going to come out of school making 500 per day. That’s the upper limit even for experienced ODs. New grads should expect to make a low of about 225 or 250 per day to a about 325 to 350 per day. That’s realistic. More than that is not. It may actually be lower when you get out due to the added hundreds of excess grads lining up to get pumped out into the system in a year or two.

Making a $3000 per month loan payment will require an income that is not practical for a new OD. A reasonable income for a new grad is around 75K, and that’s if you’re lucky enough to find FT work. Those numbers are actually a little high if you’re planning on working in private practice since owners know they can lowball new grads and they’ll still come running.

You don't need to drive a BMW or a Mercedes. Don't be an idiot, pay off your loans first before living like anything above a student.

You have this odd notion that new grads are out there buying Porsches and Hummers and living the high life, and that's why they're struggling. They’re not. They’re driving their parents’ beat up old Pontiac Grand Ams because they can’t afford a car payment and some are moving back in with mom and dad because they can’t afford rent.

You seem to think you have it all figured out, but you do not. I suggest you rerun your numbers, as should imemily and use realistic incomes this time. I don’t mean to be blunt here and I'm sorry if I sound harsh, but you guys are not working inside of reality. You’re working in a theoretical bubble that’s going to burst they day you step out of school into the real world.

 

[Shnurek]

You’re working in a theoretical bubble that’s going to burst they day you step out of school into the real world.

Same with you bro. We are both speculating. Who will be right? Most likely you because you have experience in the field but hey I want to work in the boonies so maybe I will get out unscathed.

 

[Jason K]

Same with you bro. We are both speculating. Who will be right? Most likely you because you have experience in the field but hey I want to work in the boonies so maybe I will get out unscathed.

True, I'm speculating on the severity of the down-turn that will take place due to the over-supply and other issues, but rest assured, it's going to get a lot worse. There's no speculating on that.

As far as moving out to the boonies, that may help you find a job, but it's not likely to increase your pay substantially. Move to a Mexican border town and you might see a pay bump, but other than that, you're going to get the same as the rest. Also know that the negative effects that are taking place in major cities will affect the profession nation wide, boonies and cities alike. The medical and vision insurance insanity that's going on is not limited to major cities either. You'll do yourself some favors by being willing to move out of town, but it's not going to render you immune to the changes that are taking place.

The reason I'm harping on this stuff is because this is exactly why the problem is perpetuating. Applicants use unrealistic numbers to "figure things out" and they're shocked when they get out into the real world. Believing that a 150K debt can be paid off by a new OD in 5 years is ridiculous. Even at 10 years it's ridiculous, but 5 is totally irrational. Sorry, but that's the truth of the matter.

 

[Tippytoe]

Let's see. Believe people who have DONE it. Or believe people that have never done it.

Hmmmm............that's a hard one, isn't it?🙄

 

[Eyes Only]

Anyone considering this profession should probably read this article from Review of Optometry:

http://www.revoptom.com/content/c/22520

 

[imemily]

Anyone considering this profession should probably read this article from Review of Optometry:

http://www.revoptom.com/content/c/22520

The cause of decline in income can be attributed to the stagnant economy as the article explicit mentions.

For example:

"The drop in income reflects a drop in sales."

"One solo practitioner says, “I made less in 2009 than I made in 2005 due to the downturn in the U.S. economy, and this year looks worse yet. I don’t see any daylight in the near future!”

“I lost business due to the recession, [and then] the landlord raised the rent, which required me to move,” she says. “This in turn caused many patients to decide not to travel longer to reach me.”

Moreover, the sample size of 1000 is way too small to be taken seriously.

If students are really considering Optometry the following link is more appropriate:

http://www.bls.gov/oes/current/oes291041.htm

Yest it is BLS, but it looks to be more accurate and realistic than the other link by REV of Optometry.

 

[Tippytoe]

The cause of decline in income can be attributed to the stagnant economy as the article explicit mentions.


Moreover, the sample size of 1000 is way too small to be taken seriously.

Ha, ha, ha, ha, ha, ha, ha, ha, ha, ha, ha................

5-10 practicing ODs posting here you don't believe. Now you say you don't believe ONE THOUSAND practicing ODs. How many would it take?

Maybe you could pack up the VW Beetle (complete with single flower up front) daddy gave you and travel the US to each ODs office to interview them and get back with us with your report?

Have you never taken statistics? How the heck do you think surveys are done? Every time you post we laugh at you more and more. Seriously- you post just to get a reaction, right? No way you can consistently be this naive.

I think my 10 year old knows more about the world than you do at this point.