Reality check for those interested in ophtho

[Andrew_Doan]

Exactly, and now that Oklahoma has established a precedent... Do you have data showing PRK performed by ODs to be worse than MDs?

You are correct that OK has established a precedent. This is why it's essential we fight every new optometry surgical bill; however, the fight is going to require work and lots of money.

In regards to surgical outcome data, not many people are electing to do PRK because LASIK is the preferred refractive surgical procedure. I don't think there are enough cases in OK to compare optometry PRK vs ophthalmology PRK. However, it's going to be difficut to convince policy makers and insurance companies to allow optometrists to venture into retinal lasers or intraocular sugeries based on the experience of PRK alone.

Cynthia Bradford, MD (one of the leaders in the fight against optometric surgery in OK) is speaking tomorrow at the AAO MId-year forum. I'll update this forum about the situation in OK.

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[juddson]

Cynthia Bradford, MD (one of the leaders in the fight against optometric surgery in OK) is speaking tomorrow at the AAO MId-year forum. I'll update this forum about the situation in OK.

I am looking forward to hearing about what she has to say.

judd

 

[TomOD]

Sorry, I couldn't stay quiet any longer

I think the big question is what is defined as surgery. The idiotic VA bill is a selfish attempt to not only stop qualifed OD's from performing simple laser procedures, but to also stop ALL VA OD's (and hopefully ALL OD's) from perform "surgeries" such as punctal occlusions, epilations, FB removals.

THIS non-sense was snuck into the bill by insecure, politically-motivated and undoubtedly, clinically inferior MD's in an attempt to protect turf.
http://www.poaeyes.org/HR_3473_Myths.doc

The facts are the facts. OD's "minor surgical procedures" are no more likely to produce bad outcomes as anyone elses. You just can't argue with FACTS. OD's here in North Carolina and most other places have been doing these minor procedures, such as FB removal, plugs, epilations ect..) for 20 years with outstanding outcomes. This is a fact and it is indisputible.

Unfortunately, a few maverick Ophthalmologists feel threatened and feel they must do "whatever is necessary" to protect their turf. Even going so far as making up a poster with the Marines raising the flag on Iwo Jima and implying it was unpatriotic for an OD to be treating veterans.

If Organized Ophthalmology would just tell the truth...........that it is 100% about ego and their income, I'd have more emphathy. But to hide behind the "patient protection" blanket, when there is absolutely no solid evidence beyond speculation and hope, is simply wrong. You'd have no problem proving that ODs doing such procedures is taking money out of Ophthalmologists pockets. That's easy to prove. But trying to prove we are blinding and killing people.........well, your going to run into a dead end there. Just ain't happening.

In summary, there is nothing to worry about. No OD is interested in doing cataract surgery, invasive retinal surgery or anything of the like. OD's need Ophthalmologists. I work exquisitively well with sub-specialist Ophthalmologists. I'm not sure why any Ophthalmologist would even WANT to waste their time doing minor chalazion removals, epilating lashes or instilling punctal plugs or even lasering a fibrotic posterior capsule. Me, or any other properly-trained OD, (and not all of them are) doing a minor surgical procedure should not worry any of you any more than your local dentist doing a minor surgical procedure.

 

[Gleevec]

If ODs want to do surgery, then they should go through the same residency process as MDs. What are ODs going to do when their laser procedure goes awry (possible retinal detachment or whatnot)? If ODs had residency training, they could handle any complications themselves.

If ODs want to do surgery, they need to have the same residency training as MDs. Otherwise, you might as well have dentists doing maxillary surgery or chiropractors doing spinal surgery. If they want to supplement their degree with surgicial training via a residency, then more power to them.

Right now, it really sounds like ODs want something (surgical rights) for nothing (no residency training). And of course this hurts the patients, because ODs aren't equipped for the pathological complications that may arise from procedures even involving lasers. At least if ODs did residency they would be better equipped to handle a variety of pathologies, and try to improve patient care.

So if ODs want surgical priviledges, let them earn it by going to residency and learning the same way everyone else had to. Right now it sounds like ODs are basically grubbing for money from lucrative laser procedures while not having done an ounce of extra surgical or pathological training in order to earn those rights.

 

[ckyuen]

Before this whole OD and MD thing gets out of hand here lets just stop this discussion. It is never productive, and all that comes out of it is animosity. For all those in medical school interested in Ophthalmology do a rotation in it so you can get an accurate representation of what is involved. All to often in medicine every field feels compelled to tell everyone their specialty is the greatest. Truth is what may be great for one person can be horrible for another, and if we didn't have different interest, well that would just throw off the whole supply and demand curve. I think a lot of people who bash other fields are one jealous or two insecure or unhappy with their choice so to make themselves feel better they attack others. It's a very common defense mechanism. So please everyone to each their own.

 

[Tony.]

I'm not sure who said OD's want something for nothing but,

I'll finish Optometry school in 2008 and Im sure that by then I'll be smart enough to understand that I'll need to do some kind of residency program if I want to be involved with any form of laser procedure.....

this MD vs. OD has already been beat down to death.......
but its still funny reading what people have to say about it....i guess nothing surprises me anymore...

 

[TomOD]

If ODs want to do surgery, then they should go through the same residency process as MDs. What are ODs going to do when their laser procedure goes awry (possible retinal detachment or whatnot)? If ODs had residency training, they could handle any complications themselves.

Sorry Gleevec,

The "you don't know anything because you didn't (pick one), go to my school, my training program, didn't read my books, didn't have my instructors, didn't have my genetically-gifted parents........etc... just doesn't hold any water. Remember, THE FACTS ARE THE FACTS. Unless you can prove it, it is simply an opinion. It's especially silly to hear this from a first year medical student who doesn't know an iris from a cataract.

It's the very definition of arrogance and perhaps, some would say, ignorance.

I'm not going to beat this dead horse again. I'll just exit with the latest news from the OK legislature today, where another ill-advised attempt to artifically reduce ODs long-established practice procedures by organized Ophthalmology has failed because it was rediculous. They were not trying to prevent ODs from performing MORE procedures, but were trying to turn back the clock 20 years............for what reason????? It's ashame we have to waste so much time bickering. If we all just took care of our own backyards, things would be fine.

"It has been a monumental couple of days in the Oklahoma legislature. We were able to pass the bill through the House and Senate this morning. This is unprecedented in the Oklahoma legislature.

House Vote: 84 yea 8 nea

Senate Vote: 40 yea 6 nea

The Governor has agreed to sign the bill and the Oklahoma Board of Examiners will write a board administrative rule to exclude the surgery procedures Optometrists are not certified to perform. The new law will allow Oklahoma optometrists to maintain the procedures they have performed for over 22 years. The law neither expands nor reduces the scope of practice for the Oklahoma Optometrists."

 

[Gleevec]

Haha, this is fantastic. Speaking of arrogance, have you encountered the word "hypocrite." You must feel all cool now that you have your OD degree. And wow, youre even cooler now you have basically insulted my intelligence. Real mature there TomOD, I guess some people never mature with age. And no, I dont know a lot of that stuff yet, but I will. And Ill actually have residency training to boot. So seriously, STFU. Its pathetic that your only response to my argument is a bit of knowledge that is irrelevant to this discussion and that I will learn soon enough anyway.

Frankly, all I said is that if ODs want the same priviledges as MDs, they should work for them. Im sorry you feel as if you deserve a handout, but in this country, if you want something, you have to work for it. I see you feel you should get something for nothing, and its frightening that you want to perform surgeries you are not trained for. Why stop at eye surgeries? Why dont ODs do ENT as well? Please, cut the crap. ODs just want the cash, even if it means sacrificing patient care. And thats pretty pathetic. I hope I dont have to deal with greedy optometrists like yourself TomOD, because what you're doing is just plain wrong-- I just hope patients dont pay for your fields greediness.

I admit, you guys get more refractive training than most opthalmologists will ever get, so I have no qualms about optometrists doing what they are trained for. But seriously, if you want to do surgery TRAIN FOR IT. The fact that you havent answered this part of the argument (and instead went immediately went ad hominem) shows that you really have no answer to the fact that ODs want these procedures just for the money, yet dont want to get the training that would increase the quality of patient care.

You must be real proud of yourself TomOD, wanting to do surgeries you're not trained for just to make some extra money while risking patients. Yeah, thats real cool.

I except another asinine response from you that completely ignores my arguments once more and attacks my age instead of the substance of my argument. Then again, it seems that your main argument is "Im an OD and I deserve to have more money without more training, even if it compromises patient care." I have a feeling that doesnt fly with most people.

I seriously hope that if I enter the field that I dont have to work with arrogant people like yourself TomDO that really only care about how many cars they can afford rather than how their training will affect patient care.

 

[TomOD]

If ODs want to do surgery, then they should go through the same residency process as MDs. What are ODs going to do when their laser procedure goes awry (possible retinal detachment or whatnot)? If ODs had residency training, they could handle any complications themselves.

Fair enough. I wasn't insulting your age. I don't have a clue how old you are. I was simply pointing out that it appears that your speaking, not from experience or knowledge of the subject, but from preconceived notions or from what someone told you. In fact, there appears to be very few practicing OD's or Ophthalmologist on this forum. What I usually read are posts from students and residents who, with all due respect, don't have a clue what the real world of eye care is all about.

Speaking of "paying your dues", I spent 4 years as a combat infantryman in the Marine Corp. Should THAT training be required to be an eye doctor? Of course not. That's rediculous, right?

If this is your question--what would I do if I caused a retinal detachment or "whatnot"? I'd do the exact same thing I do now when someone walks into my office off the street with a retinal detachment. I'd call the fellowship trained retinal Ophthalmologist, have a little small talk with him, ask him about his kids and tell him I have someone he needs to see. He'd say, "no problem, hope to see you at dinner next month, and send him on over". The end. He is not threated by me. I'm not his competition. It's amazing how friendly people can be when money is not involved.

No one is looking for a short-cut. But we also realize when someone is overtrained simpy in the name of history or ego. I'm all for adding and/or extending Optometric residencies to further training (already done in some cases).

But your entitled to your opinion........as I am mine. It's a great country. Good luck to you. Maybe your opinions will change in time.

I'm done here. Nothing else to say.

 

[Andrew_Doan]

What I usually read are posts from students and residents who, with all due respect, don't have a clue what the real world of eye care is all about.

No one is looking for a short-cut. But we also realize when someone is overtrained simpy in the name of history or ego.

I will give a longer response after I return from the AAO mid-year forum in DC.

First off, I strongly believe that surgery should be performed by surgeons. Medical students, residents, physicians, and the public should be educated about optometry's preparation and effort to prepare for optometric surgery. The bill in OK is disguised as a way of preservation for optometry; however, it gives more power to the board of optometry to dictate what ODs can and cannot do surgically in the future. So now we have non-surgeons deciding the fate of surgical patients. Wonderful. *sigh*. Most of my patients don't want ODs doing surgical procedures on their eyes, and the ones who don't care don't realize the difference between ODs and OMDs. I think it is important to educate the public about the differences in OD vs OMD training.

Second, all the residents and fellows who post on this board have real experiences with optometry. We receive OD consults on a daily basis. Also, most of us posting are senior residents who have had extensive contact with local and staff ophthalmologists. Our views are valid and reflect the current opinion of many ophthalmologists. There are hundreds here in D.C. leading the fight to make sure optometry stays within their scope of practice. I think it is great that young physicians and ophthalmologists are voicing their views because it will be this generation that can make a difference for future physicians.

Third, the VA vet bill will have no impact on private practice ODs. The VA bill has no influence on State Laws. As it stands, 49 states have made it illegal for some of the procedures performed by ODs at the VA. The VA bill will directly affect the less than 0.5% of ODs who currently work at the VA.

In regards to over-training, this is from an individual who is undertrained in comparison to all ophthalmologists. We are at a time when society is pushing for more proof of competency, not less. Ophthalmology is being pushed to increase their training of residents and recertification of their physicians for the sake of increasing the quality of patient care. However, it seems to me that optometry is encouraging increased surgical privileges without the proper surgical training. Thus, when it comes to the surgical management of patients, more, NOT less, training is a good thing!

 

[Yogi Bear]

I will give a longer response after I return from the AAO mid-year forum in DC.

First off, I strongly believe that surgery should be performed by surgeons. Medical students, residents, physicians, and the public should be educated about optometry's preparation and effort to prepare for optometric surgery. The bill in OK is disguised as a way of preservation for optometry; however, it gives more power to the board of optometry to dictate what ODs can and cannot do surgically in the future. So now we have non-surgeons deciding the fate of surgical patients. Wonderful. *sigh*. Most of my patients don't want ODs doing surgical procedures on their eyes, and the ones who don't care don't realize the difference between ODs and OMDs. I think it is important to educate the public about the differences in OD vs OMD training.

Second, all the residents and fellows who post on this board have real experiences with optometry. We receive OD consults on a daily basis. Also, most of us posting are senior residents who have had extensive contact with local and staff ophthalmologists. Our views are valid and reflect the current opinion of many ophthalmologists. There are hundreds here in D.C. leading the fight to make sure optometry stays within their scope of practice. I think it is great that young physicians and ophthalmologists are voicing their views because it will be this generation that can make a difference for future physicians.

Third, the VA vet bill will have no impact on private practice ODs. The VA bill has no influence on State Laws. As it stands, 49 states have made it illegal for some of the procedures performed by ODs at the VA. The VA bill will directly affect the less than 0.5% of ODs who currently work at the VA.

In regards to over-training, this is from an individual who is undertrained in comparison to all ophthalmologists. We are at a time when society is pushing for more proof of competency, not less. Ophthalmology is being pushed to increase their training of residents and recertification of their physicians for the sake of increasing the quality of patient care. However, it seems to me that optometry is encouraging increased surgical privileges without the proper surgical training. Thus, when it comes to the surgical management of patients, more, NOT less, training is a good thing!

hey,

if the corneal flap falls off when u're doing lasik, is it easy to put it back on?

 

[karlak]

I agree with whomever said that the average person has no idea of the difference between an OD and an MD. To Joe Schmo...they're both "eye doctors." As somebody who worked for a contact lens manufacturer, we used to refer to the whole spectrum as "Eye Care Professionals/ECPs"... thus further blurring the lines. There is a difference in the training. Having said that, I've had personal experience with some fabulous ODs who were far better than some MDs I've seen. But it all depends on what the patient's needs are. Being an Ophthalmologist is a lot more difficult than asking if the guy can see the "Big E."

Regarding pay... if compensation is your motivation, then choose a different field. Heck, you should have gotten an MBA or JD instead. Schooling is shorter/cheaper...and you can make just as much. Leave the residencies to those who truly want to be ophthalmologists... heck let the poor foreign med school grad have it... the poor guy who may have already completed a residency abroad but needs a US residency to get licensed. I've met quite a few of them who are already excellent ophthalmologists, but are stuck working as near-slave like pre-resident fellows....hoping and praying to match so that they can do what they love.

The increase in interest in ophthalmology is great... although it has its negatives as well. Some people who truly love the field are unable to match due to the highly competitive match process. As we all know, the guy who scored 98% on his boards may look good on paper... but may suck as a physician. Radiology has seen this phenomenon as well. And even though people think radiologists have a great lifestyle... reality is quite different. Trust me, I know first hand.

 

[Gleevec]

We are at a time when society is pushing for more proof of competency, not less. Ophthalmology is being pushed to increase their training of residents and recertification of their physicians for the sake of increasing the quality of patient care. However, it seems to me that optometry is encouraging increased surgical privileges without the proper surgical training. Thus, when it comes to the surgical management of patients, more, NOT less, training is a good thing!

TomOD, this is exactly what I said but you dismissed simply because of my age. Its funny how someone can make the exact same argument with the same logic, yet you have no response. I guess though you really had to grasp for straws in attacking my argument to the extent of going ad hominem, but Im interested to see how you will reply to my argument stated almost EXACTLY THE SAME by someone else.

Have fun.

 

[Gleevec]

Here's a question:

Let's say an OD performs a LASIK procedure in the future (lets say in OK, where there arent that many ophthos) and retinal detachment occurs. Who is going to fix it? There arent that many ophthos in OK to begin with and they are spread out (the whole basis of the OD legislation), so what is a patient to do in that case? Wait for an appointment at an ophtho possibly hundreds of miles of way who is booked up for days and who had not encountered the patient previously?

At least if an ophtho was performing the LASIK procedure, if something goes wrong, he is there to fix it. But what will ODs do when things go wrong, especially in places like OK where the very lack of ophthos is the stated logic (the underlying force for ODs being $$$) to the public, would prevent rapid treatment of complications from surgery?

 

[GlaucomaMD]

Gleevac,

I don't believe ODs should be doing LASIK, but
yours is a poor argument...

An ophthalmologist who did the LASIK would not be "fixing" the RD anyway. The vitreoretinal surgeon would. Very few LASIK ophthalmologist would repair RD (I guess very few may do laser barricade on their own - I doubt it though).

 

[Gleevec]

Gleevac,

I don't believe ODs should be doing LASIK, but
yours is a poor argument...

An ophthalmologist who did the LASIK would not be "fixing" the RD anyway. The vitreoretinal surgeon would. Very few LASIK ophthalmologist would repair RD (I guess very few may do laser barricade on their own - I doubt it though).

That's interesting, because that was one of the things my LASIK surgeon for the summer said was good about going to him for. Then again, he might be referring to the fact that he was part of a surgical group. Ill ask again when I go to have it done this summer.

 

[exmike]

Gleevac,

I don't believe ODs should be doing LASIK, but
yours is a poor argument...

An ophthalmologist who did the LASIK would not be "fixing" the RD anyway. The vitreoretinal surgeon would. Very few LASIK ophthalmologist would repair RD (I guess very few may do laser barricade on their own - I doubt it though).

What if that ophthalmologist did a retinal fellowship? Do retinal fellows not do LASKIK because retinal procedures are more lucrative or something? Could retinal fellow do both or do they usually stick to retinal procedures after they finish their fellowship.

 

[Andrew_Doan]

Sorry, I couldn't stay quiet any longer

I think the big question is what is defined as surgery. The idiotic VA bill is a selfish attempt to not only stop qualifed OD's from performing simple laser procedures, but to also stop ALL VA OD's (and hopefully ALL OD's) from perform "surgeries" such as punctal occlusions, epilations, FB removals.

I'll post more on this later, but want to address the above specifically. Know your info before posting. The VA bill does not exclude what you can do now. This bill affects only ODs performing surgery (laser and cutting) at the VA and affects less than 0.5% of all practicing ODs!

http://www.theorator.com/bills108/hr3473.html


Section 1707 of title 38, United States Code, is amended by adding at the end the following new subsection:

`(c)(1) Eye surgery at a Department facility or under contract with the Department may be performed only by an individual who is either a licensed medical doctor or a licensed doctor of osteopathy.

`(2) For purposes of this subsection, the term `eye surgery' means any procedure involving the eye or the adnexa in which human tissue is cut, burned, frozen, vaporized, ablated, probed, or otherwise altered or penetrated by incision, injection, laser, ultrasound, ionizing radiation, or by other means, in order to treat eye disease, alter or correct refractive error, or alter or enhance cosmetic appearance. Such term does not include removal of superficial ocular foreign bodies or the prescription and fitting of contact lenses for the purpose of altering refractive error.'.

 

[TomOD]

Section 1707 of title 38, United States Code, is amended by adding at the end the following new subsection:

`(c)(1) Eye surgery at a Department facility or under contract with the Department may be performed only by an individual who is either a licensed medical doctor or a licensed doctor of osteopathy.

`(2) For purposes of this subsection, the term `eye surgery' means any procedure involving the eye or the adnexa in which human tissue is cut, burned, frozen, vaporized, ablated, probed, or otherwise altered or penetrated by incision, injection, laser, ultrasound, ionizing radiation, or by other means, in order to treat eye disease, alter or correct refractive error, or alter or enhance cosmetic appearance. Such term does not include removal of superficial ocular foreign bodies or the prescription and fitting of contact lenses for the purpose of altering refractive error.'. [/i]

It's all in the interpretation. "Removal of superficial ocular foreign bodies" does not mean instilling punctal plugs, D&I of the lacrimal sac, anterior stromal puncture, etc. There WILL be someone insisting that these fall under surgery and that I am, after 6 years and many procedures, no longer qualifed to do them. Sad as it is, there will be those that sit in their empty exam chairs with no patients because they have the personality of tree and decide that Dr. OD can't do anything. This is why is must be spelled out and every 'i' dotted and every "t" crossed.

Is a fluorescein angiography an injection "used to treat eye disease" or is it used as a diagnostic aid?

To you and me and hopefully to everyone else reading it seems black and white, but I've seen enough to know that there will be alot of reading between the lines.

But the REAL question is: Who in the heck in the AAO in telling an independent profession AND the federal government what to do?

I doubt that the Academy of Ophthalmology would tolerate it if the Academy of Optometry "decided" that Ophthalmologists can no longer.......lets say....instill punctal plugs. We just decided that you were not qualified. NO particular reason. No evidence of bad outcomes. Doesn't matter if you had done it for 25 years. You were not qualified and we are going to tell the U.S. government that no Ophthalmologist can do another punctal plug insertion. Silly isn't it?

This is what Optometry faces every year. The new move by organized Ophthalmology is going to the state attorney generals and sweet-talking them into handing down a "decision" suddenly limiting the scope of practice of ODs. This is what happen in OK. ONE lone-wolf Ophthalmologist, in her self-rightous crusade to save human-kinds eyesight, managed to get the OK attorny general to issue an ill-advised statement. Fortunately, the OK legislature saw through the games and put a stop to it. Silly, silly turf-war bickering.

Typed but not read (gonna take my kids to Chunky-Cheese)

 

[Eyesore]

It's all in the interpretation. "Removal of superficial ocular foreign bodies" does not mean instilling punctal plugs, D&I of the lacrimal sac, anterior stromal puncture, etc. There WILL be someone insisting that these fall under surgery and that I am, after 6 years and many procedures, no longer qualifed to do them.

Geez, Optometrists do those things? What's next? tap and injects? Pterygium removal with conj allograft? lateral canthotomy and cantholysis?

 

[Tony.]

you know, Tom OD...speaking about punctal plugs...
I dont mean to open up a whole other can of worms but......
do you think putting in "punctal plugs" and "age" are related? ( in terms of efficiency)

my sister insists on seeing ophthalmologists for everything! even simple annual eye exams...
when she went to her ophthalmologist last year to get punctal plugs, I remember seeing her opthalmologists hands shake !!
can you imagine? the MD was trying to put in punctal plugs and she was doing it on a trial and error basis.....!! My sister was a little nervous but the procedure went ok.........( no infections etc. 100% ok)

Anyway, to contrast, when I interned at an optometrists office last summer, he put in punctal plugs all the time.....this OD is young, energetic, etc.....his hands Never shook!

do you think all those EXTRA years in med school, the MD's are at a disadvantage? I mean, ( in terms of putting in punctal plugs ) wouldnt you wanna see an OD anyway for that?

 

[GlaucomaMD]

What if that ophthalmologist did a retinal fellowship? Do retinal fellows not do LASKIK because retinal procedures are more lucrative or something? Could retinal fellow do both or do they usually stick to retinal procedures after they finish their fellowship.

First of all, an ophthalmologist who is fellowship-trained in retina AND who is practicing retina WOULD NOT be doing LASIK - NOT unless he wants to start burning his referral bridge!

I'm quite sure the doc you talked to were talking about his GROUP.

 

[Andrew_Doan]

This is what Optometry faces every year. The new move by organized Ophthalmology is going to the state attorney generals and sweet-talking them into handing down a "decision" suddenly limiting the scope of practice of ODs. This is what happen in OK. ONE lone-wolf Ophthalmologist, in her self-rightous crusade to save human-kinds eyesight, managed to get the OK attorny general to issue an ill-advised statement.

Get your head out of the sand TomOD! Without Optometry's efforts and lobbying with politicians, optometry would not be able to do drops, prescribe medications, and now oral medications. First off, you're NOT a physician. However, I'm not arguing to take back what you have now. I'm drawing the line, with ALL my colleagues about what makes a surgeon!

You accuse the AAO of sweet talking the politicians? Well, for the record, Optometry schools have courses in lobbying and have their students contact congress to "further their profession". Did you also know that each congress member in OK knows 4 optometrist, received laser pointers from optometry, and a check before the 1998 OK laser bill??? The house members were playing with the laser pointers during session in 1998 before the OD bill pass. Don't accuse the AAO of sweet talking when your profession has sweet talked the politicians to allow optometry to be "medical optometrists": first dilation, second eye drops, and finally oral medications.

Furthermore, outcomes are not a good measure of optometry's success. Clearly, your field is going to boast about the unpublished 12,000 laser procedures in OK without complications, but you and I know that this is a lie. Where are the 100-200 retinal detachments that occur statistically with the yag capsulotomies? Face it, your field is going to lie and only report the "success", but optometry is not going to admit the bad outcomes. Also, people don't generally sue.

With the VA bill, you will still have patients. You can continue to do what you do now minus the procedures. In regards to anterior puncture, NO you should not do this. In regards to irrigation of the lacrimal system, NO you should not do this either because this is done as a diagnostic procedure to determine if surgery is needed. We don't trust an irrigation procedure from outside caregivers, so this has to be repeated anyhow. Refer them to a surgeon who can diagnose the problem and do the surgical procedure. Your doing a lacrimal irrigation only increases the cost for the patients.

Why are ODs (non-surgeons), allowed to make their own surgical boards to dictate what procedures can and cannot be done?! This is why the AAO, AMA, and ophthalmologists are drawing the line. It's NOT just one lone MD in OK TomOD. No my friend, it is the majority of ophthalmologists in the US. Did you not read Dr. Lindstrom's statement in this thread?
http://forums.studentdoctor.net/showthread.php?t=117800

This is the view of all the members at the mid-year forum who are department chairs, program directors, private MDs, military physicians, and academic physicians from every state in the US. We usually do not see consensus amongst ophthalmologists, but this is one issue that I can assure you will unite ALL ophthalmologists. Optometry needs to realize its limitation and learn that surgery is completely off limits. It's not a hard concept. Accept it now and the truth will be less harsh.

Truthfully, I don't think optometrists have the experience and judgement to manage ocular problems surgically because you don't have the adequate experience to know when it's beyond your capability. A little knowledge is dangerous. For instance, I will end with this recent example. An optometrist recently referred directly to the glaucoma service a monocular patient who has lost vision with a pressure of 71 mmHg for an "emergency laser peripheral iridotomy". The OD was thinking that this was angle closure, however, when I saw the patient, he had no pain and no shallow chamber. I looked in and the anterior chamber was formed. I gonio the patient and his angles were open to the ciliary body band in both eyes. Undilated exam had the subtle findings of pseudoexfoliation: http://webeye.ophth.uiowa.edu/eyeforum/case8.htm

If the OD had laser privileges, then a laser PI would have been done on the patient in the left eye, and then the right eye in this monocular patient. People may say, what's the big deal? Well, the unecessary laser treatment in the good eye may have resulted in a retinal detachment in the only good eye. This may have resulted in the patient having horrible vision or being completely blind. This is why it's important for the public and ophthalmologists to draw the line between those who are surgeons with years and years of experience and those who are non-surgeons.

 

[ckyuen]

Andrew don't forget about the big one also, the possibility of SO in a monocular patient who gets a laser procedure. I'm sure you have many of those stories to relate because we all do. On a routine basis I have Optoms referals for some miscellaneous reason, glaucoma, hemifield loss where they have completely missed mac off retinal detachments and documented normal dilated fundoscopic exams. At least they told the patient you need evaluation by an ophthalmologist for glaucoma or neurologic disorder so we can make to proper diagnosis. It's hard to bite your tongue but you do, b/c it benefits no one. Also it's not uncommon to miss the diagnosis of acanthamoeba, however once it is made do not put the patient on steroids as a optom who refered to us did two weeks ago. Also if optometrists insurance companies knew they were performing all of these procedures their malpractice would sky rocket. As it stands they currently receive such immunity b/c they do what ever they feel they are qualified to do and when something goes wrong punt to the real doctor. And guess what? When the malpractice attorney comes around he goes for the real doctor first unfortunately not the incompetent monkey who messed up in the first place.

 

[xmattODx]

Hello all,
I've been reading the recent rash of threads regarding optometric scope of practice and have really enjoyed the thoughts expressed by all of you. My point of writing this post is not to further inflame the OD, OMD relationship but to give another perspective. I am not at all impressed with the leadership of my profession (Optometry - as I'm sure you all gathered). I do NOT want surgery, I do NOT want oral meds. I want to be an optometrist. I respect and appreciate what the forefathers of optometry did to obtain diagnostics for me but I don't want anything else. I have people who are far better trained than I to whom I can refer my patients. I am sure that my patients would much rather be seen by an Ophthalmologist who has far more experience than I. I know I would go to an OMD for any surgical procedure. While I don't want to practice medicine, I do want to practice optometry. That, my friends, is becoming more and more difficult with the influx of commericial opticals, and managed care driving the price of an eye exam to the point where I must rely on the sale of optical goods to survive. This is the main reason, IMHO, that optometry is seeking to futher its scope of practice. We are barely hanging on with the limited scope we have now. A larger scope means more income potential.

Optometry is currently a divided profession. Many, many ODs are not seeking these rights - but what I feel is a small minority are with great gusto.

I hope to have an even better relationship with ophthalmology when the dust settles, where I can do what I do well and you can do the surgery.

Thanks for your time,
and all you ODs out there feel free to flame away.

 

[ophtho1122]

Oklahoma House, Senate pass bill that if fully enacted, would convert optometrists to ophthalmologists with full surgical privileges
The bill would allow Oklahoma ODs to perform non-laser eye surgeries. It was offered as an amendment to the state?s 1998 law that authorized optometrists to perform some anterior segment procedures and PRK. Please contribute to the Surgical Scope Fund today so we can immediately put your contribution to work for the future of ophthalmology. Contact Bob Palmer at [email protected], or 202.737.6662.

 

[Eyesore]

I simply put action over words. If anyone would like to see a well-equiped Optometry practice and an Optometrist that practices on the cutting edge, has a large, well cared-for glaucoma and ocular disease population, uses Ophthalmologist as referral sources only for surgery (patients are promptly returned back to me for follow-up and all future care) and makes 80% of his income (well above the above salary) from services and not materials, and who treats ANY eye disorder that does not require major surgery..........please feel free to come pay me a visit.

A private request will get you the address and a good time to visit. I'll even take you out to lunch.

Otherwise, it's all puffs and sticking your chest out.

I will put my experience and skill managing non-surgical eye conditions up against anyone on this list. Really, I enjoy visitors. NC has great weather this time of year.

Anyone?

Tom,

You claim to have an optometry practice with a lot of "medical management" of eye diseases. From reading your posts, it seems as though you feel you are equal to many ophthalmologists with regards to medical management.

It is easy to get on these message boards and say things like, "I diagnosed this blah, blah, blah that was missed by blah, blah, blah...." However, the proof is in the pudding. You graduated in 2000. So you have vastly more years spent in "eyes" than any of the residents on this board. Yet, your performance on these case presentations that Andrew puts out have not been that great. I realize that this is just a small sample size, but if that is any indication of the caliber of work you come up with, then I am not impressed.

My intention in posting this was not to attack you personally. I just feel that even though you (as a self-proclaimed practitioner of "how optometry is supposed to be practiced") truly believe that your clinical skills are excellent, when it comes to medical ophthalmology, it may not even be up to par compared to a good 2nd year resident.

 

[TomOD]

http://forums.studentdoctor.net/showthread.php?t=117800
Truthfully, I don't think optometrists have the experience and judgement to manage ocular problems surgically because you don't have the adequate experience to know when it's beyond your capability. A little knowledge is dangerous. For instance, I will end with this recent example. An optometrist recently referred directly to the glaucoma service a monocular patient who has lost vision with a pressure of 71 mmHg for an "emergency laser peripheral iridotomy". The OD was thinking that this was angle closure, however, when I saw the patient, he had no pain and no shallow chamber. I looked in and the anterior chamber was formed. I gonio the patient and his angles were open to the ciliary body band in both eyes. Undilated exam had the subtle findings of pseudoexfoliation: http://webeye.ophth.uiowa.edu/eyeforum/case8.htm
.

Andrew, we are in agreement I think for the most part. I don't want, and I don't this ODs should be doing intraocular surgery. I guess our disagrement is what type of procedures ODs should do.

The case you present above is a poor validation of your reasoning. Poor doctors exist all over. At a teaching institution or elsewhere, your going to see cases referred to you by ODs that can't or won't treat various conditions for whatever reason. You will not see and will not know about the many others patients that are successfully treated "in-house" at the ODs office.

I have one for you from yesterday. I had a 22 y.o. lady come in to my office (shocking as it may be) for a second opinion after seeing the Ophthalmologist that did her Lasik surgery 1 1/2 years ago. Her complaint was a 2 month onset of decreased vision in each eye. He gave her Lotamax q1h and scheduled her for an MRI in 2 weeks???

She clearly had epiretinal membranes confirmed by looking with a 90D and HRT scans but was correctable to 20/25 in each eye. She is -3.00 -1.00 x 170 in one eye and -1.50 in the other. My feeling is that this surgeon rushed to Lasik on a young 20 year old that wasn't stable. Now she is more myopic and is going for an unnecessary and expensive (in my opinion) neuroimaging. Much too premature for imaging I think.

I've got probably as many flubbed up Ophthalmologists cases (not to mention Internists, Pediatricans, PA's and NP's....but no one is working to prevent them from treating eye problems) as you do bad OD cases. I had a lady being treated with 2 glaucoma meds (wasting $110/month on a fixed income) that had quadranoptic defects from a CVA..........MISSED by 2 Ophthalmologists. They never did an automated visual field! Pressures are fine taking into account thickened corneas via pachmetry.

I don't judge all Ophthalmologist based on these 2 guys. I KNOW most are very well trained and very capable. I'd like for you all not to treat all OD's as if we are all the same. Unfortunately, at this time in history, there is a wide variety of ODs with various skill levels and interests.

I just had a guy with a splinter deep into his cornea that had it yanked, pulled, rubbed and sprayed at by a family MD and a few PA's before they sent him down to me.

Hey, I know there is alot of politics on both sides and frankly, to me, it's kinda sickening.

My only question is why don't Ophthalmologist "mind their own backyard" and work to become the best practitioners they can and not worry about ODs? You say people don't sue that much. I'm not sure what planet your on but I can't turn my t.v. on without seeing some attorney soliciting medical cases. Your just wrong that people will not sue in bad cases. They will and they do. They will sue an OD just as quickly.......no make that quicker....than an Ophthalmologist.

But seriously, while we are on the topic. I know this is like discussing politics or religion. We are never going to change each others minds here on the internet. I'll leave you with this. What really irks me is the notion that an OD or any professional for that matter, would do ANYTHING to intentionally hurt anyone. I'll go even further than than. I look both ways before I back my car out out of the driveway. I don't drink and drive. I would NEVER, EVER do any procedure on any patient if I even thought they'd have a bad outcome. I'm not crazy. I have a conscience. I don't want to be responsible for blinding or even killing anyone. I just won't do anything that I feel is over my head. For that reason I keep a dry erase board in my private office. I currently have 17 patients that I have referred out to various eye sub-specialists . I see 3 going to a glaucoma MD (for PI or filtering sx), 8 going out to a cataract MD, 1 to an neuroMD (I want his opinion on a 3rd nerve palsy), 1 to a corneal MD (for a pteryium removal), 2 to an oculoplastic MD (one for suspect basal cell and one for ectropion sx) . I have 1 sched. to see a neurologist for suspect pseudotumor (after the MRI I ordered turned out to be negative). I have 1 scheduled to see a cardiologist (for OIS). And there is another going to see an Internist for suspected diabetes (he does not currently have a PCP).

I DO NOT WANT AND DO NOT THINK OD'S SHOULD DO: cataract surgery, invasive retinal surgery, major lid surgery, filtering glaucoma surgery or anything that penetrates the globe. I'm busy enough with what I do now. I just don't want to have to defend myself every few years when some MD decides they think I should not be doing what I've been doing successfully for years. I am not priviledged with any information and am not sure what the hell they are doing in Oklahoma other then trying to get autonomy.

I see alot of sick patients and I work with a variety of experts. They help me and I help them.

What I DON'T do (and it irks me to see less trained OD do this) is send patients unnecessarily to general or comprehensive Ophthalmologists. But if those ODs are idiots and don't know what they are doing either because they are lazy, didn't pay attention in school, didn't apply themselves, or figure all they want to do is sell glasses, then they need to send them out.

I do not refer out for subconjunctival hems, blepharitis, glaucoma (which I can treat as well or better than any MD unless surgery become necessary because there is no magic to it), corneal FBs/dystrophy/degeneration. I don't refer out anything unless it requires surgery or I am stumped and need a second opinion.

Anterior stromal puncture is WELL within my training, licensure and skill level. I do it when necessary and have never had any bad outcomes. In fact, they have all been extraordinary so far. My office is better equiped than most OD and many MD's offices because I pride myself in my work and I reinvest in my practice.

I will admit that ODs have alot of work to do to come on a level playing field with each other. There are still many that function primarily as refractionists. Fortunately, many of them are retiring. I also have no problem and think that ODs should probably undergo a year or 2 of residency training to perform any more advanced ocular procedures than we currently do.

I have always been very open. My practice located in NC is open to anyone that would like to visit ( via private email). Just don't come to kick my ass I host Optometry externs and teach to Physician Assistant students.

Anyway, these posts are getting longer and longer. I'm gonna have to end it here. We will have to agree to disagree and I guess leave it at that. I'm tired. Replies are welcome but I won't be typing any more. There are flowers to smell and kids to play with.

P.S. To any aspiring Ophthalmologists and residents here, give serious thought to coming and practicing in central NC. We are in need of good retinal surgeons, oculoplastic MD's, glaucoma MD's and neuro-Ophthalmologists. I'll be one of your best referral sources

 

[Eyesore]

I do not refer out for subconjunctival hems, blepharitis, glaucoma (which I can treat as well or better than any MD unless surgery become necessary because there is no magic to it), corneal FBs/dystrophy/degeneration. I don't refer out anything unless it requires surgery or I am stumped and need a second opinion.

That's a scary statement to make, my friend. As an ophthalmologist, I would never make a statement like that. You just minimized most of what glaucoma specialists do for a living. Most of their cases are not surgical. Sure, I feel comfortable managing routine glaucoma cases. I even feel comfortable doing trabeculectomies, lasers, etc. However, I would still never presume that I can manage non-surgical glaucoma cases equally or better than anyone. Unless you do gonioscopy on every new patient you see, then your exams are incomplete. How many patients have you diagnosed with chronic narrow angle glaucoma? Did you know that this is one of the most frequent new diagnosis when a new glaucoma specialist moves into town? This is because many practitioners, ophthalmologists included, just write POAG and prescribe gtts without doing gonioscopy. But I'm sure you have never done this, because you are just as good and thorough as any glaucoma specialist. How many patients have you diagnosed with plateau iris? Oh, I guess you wouldn't be able to completely diagnose this because you would have to do an LPI in order to make this diagnosis. Do you offer many of your glaucoma patients on gtts the option of SLT? As you know, some patients prefer this over daily gtts.
Anyway, nobody wants to get in a pissing contest. I just think that making a statement like "I can manage non-surgical glaucoma as well or better than anyone else" is ludicrous. This is precisely where the old adage "a little knowledge is dangerous" fits in.

 

[Andrew_Doan]

Hello all,
I've been reading the recent rash of threads regarding optometric scope of practice and have really enjoyed the thoughts expressed by all of you. My point of writing this post is not to further inflame the OD, OMD relationship but to give another perspective. I am not at all impressed with the leadership of my profession (Optometry - as I'm sure you all gathered). I do NOT want surgery, I do NOT want oral meds. I want to be an optometrist. I respect and appreciate what the forefathers of optometry did to obtain diagnostics for me but I don't want anything else. I have people who are far better trained than I to whom I can refer my patients. I am sure that my patients would much rather be seen by an Ophthalmologist who has far more experience than I. I know I would go to an OMD for any surgical procedure. While I don't want to practice medicine, I do want to practice optometry. That, my friends, is becoming more and more difficult with the influx of commericial opticals, and managed care driving the price of an eye exam to the point where I must rely on the sale of optical goods to survive. This is the main reason, IMHO, that optometry is seeking to futher its scope of practice. We are barely hanging on with the limited scope we have now. A larger scope means more income potential.

Optometry is currently a divided profession. Many, many ODs are not seeking these rights - but what I feel is a small minority are with great gusto.

I hope to have an even better relationship with ophthalmology when the dust settles, where I can do what I do well and you can do the surgery.

Thanks for your time,
and all you ODs out there feel free to flame away.

Thank you for your post. I agree. Optometry and ophthalmology can work together to provide high quality eye care for society. We both play important roles. There will be greater needs for both our services in the future with greater numbers of glaucoma, cataracts, AMD, and diabetic retinopathy. However, we need to clearly draw the line between surgeons and non-surgeons.

 

[Yogi Bear]

anyways, does anyone have a link to the histroy of optometry vs. the history of opthalmology and how those two fields relate to each other.

let's bring up the topic of oral surgeons. one of my classmates in an elective is doing the dds/md oral surgery program for 6-7 years. he already has his dds but needs to do something like 2 years of med + 2 years general surgery + 2 years of oral/maxillofacial surgery to be able to become a licensed dds/md. so that's like 6 years above dental school. Once he's done, he could actually apply to fellowships that'd allow him to do plastic surgery. (on the other hand, some oral surgery/maxillofacial surgery programs are only 4 years and don't confer the md. so it's like 4 years after dds (i don't think they can do md fellowships) vs. 6-7 years after dds to do the same thing (can do md fellowships). only difference? the "MD" next to ur name.

if optometrists want to be eye surgeons, I wouldn't mind if they were to receive a similar education as the oral surgeons. i.e. 4 more years after od to do ophthalmology (no chance of md fellowships so they'd just be a comprehensive pratictioner) or 6 years after od to get the od/md title as well as the chance to do MD fellowships. take note that the dds/md people still need to take the usmle i, ii, iii, etc (i think). if so, the OD who want to do eye surgery should also be required to do the same. thus, if the ODs want to be treated equally, they should at least receive an equal amount of training and qualifications.

 

[Andrew_Doan]

That's a scary statement to make, my friend. As an ophthalmologist, I would never make a statement like that. You just minimized most of what glaucoma specialists do for a living. Most of their cases are not surgical. Sure, I feel comfortable managing routine glaucoma cases. I even feel comfortable doing trabeculectomies, lasers, etc. However, I would still never presume that I can manage non-surgical glaucoma cases equally or better than anyone. Unless you do gonioscopy on every new patient you see, then your exams are incomplete. How many patients have you diagnosed with chronic narrow angle glaucoma? Did you know that this is one of the most frequent new diagnosis when a new glaucoma specialist moves into town? This is because many practitioners, ophthalmologists included, just write POAG and prescribe gtts without doing gonioscopy. But I'm sure you have never done this, because you are just as good and thorough as any glaucoma specialist. How many patients have you diagnosed with plateau iris? Oh, I guess you wouldn't be able to completely diagnose this because you would have to do an LPI in order to make this diagnosis. Do you offer many of your glaucoma patients on gtts the option of SLT? As you know, some patients prefer this over daily gtts.
Anyway, nobody wants to get in a pissing contest. I just think that making a statement like "I can manage non-surgical glaucoma as well or better than anyone else" is ludicrous. This is precisely where the old adage "a little knowledge is dangerous" fits in.

Awesome post! This is why optometrists cannot replace general ophthalmologists. In addition to the above, general ophthalmologists are better trained and can offer definitive surgical management, which is not currently available to optometry. I've seen too many fields constrict to a 30 degree central field with medical therapy before patients are referred for trabeculectomy. As long as ophthalmology continues to fight organized optometry, we can assure a high level of care for our patients.

Autonomy is fine, but when the field of optometry is not surgically trained, then they have no business deciding whether or not optometrists can deliver surgical care. This is why ophthalmology can no longer manage, as TomOD states, "their own backyard". Optometry's only hope of expanding their scope of practice is with: money, lobbying, and sweet talking the politicians. The expansion of optometry's scope of practice has nothing to do with the public's nor politician's faith in the training of optometrists. For example, the recent OK bill was attached to a pharmacy bill at the last minute. I've learned many things on Capital Hill, and one thing I've learned is that the public and educated politicians have no idea in regards to the differences in the training of optometrists vs ophthalmologists. When educated, no body wants non-surgeons to shoot lasers or cut on their eyes.

I just don't want to have to defend myself every few years when some MD decides they think I should not be doing what I've been doing successfully for years.

Actually, MD's rarely take anything away from optometry. It's more often that OD's have gained more privileges through legislation. The time for this to continue has to come to an end.

It is clear that optometry cannot manage its own scope of practice, and the line stops at surgical intervention (intraocular, laser, and minor surgeries). If you want to do procedures, then go to medical school. However, it's harder to get into medical school and ophthalmology residency compared to the ~1200 applicants for the slightly more than 1200 optometry positions available in 2000.

 

[Andrew_Doan]

if optometrists want to be eye surgeons, I wouldn't mind if they were to receive a similar education as the oral surgeons.

This has been discussed before, so I'll be brief. Optometry started out with only refractions. With lobbying efforts, their scope of practice expanded more and more: dilation, prescriptions, and then oral medications in some states.

Ophthalmology is a sub-specialty of surgery and medicine for over 200 hundred years. Dentistry is also a surgical specialty.

We have a mechanism to produce high quality surgeons, it's called medical school and residency. Optometrists don't have the medical background to complete an ophthalmology residency that is medically and surgically intensive. Thus, this is why numerous ODs have gone back to medical school and then completed a residency.

 

[Yogi Bear]

This has been discussed before, so I'll be brief. Optometry started out with only refractions. With lobbying efforts, their scope of practice expanded more and more: dilation, prescriptions, and then oral medications in some states.

Ophthalmology is a sub-specialty of surgery and medicine for over 200 hundred years. Dentistry is also a surgical specialty.

We have a mechanism to produce high quality surgeons, it's called medical school and residency. Optometrists don't have the medical background to complete an opthalmology residency that is medically and surgically intensive. Thus, this is why numerous ODs have gone back to medical school and then completed a residency.

whoops....yeah.....i guess the key point is that dds is "doctor of dental surgery"...hehehe....and even w/ having been trained as surgeons, they'd still need to do at least 4 years of additional training to operate on the jaws.

 

[Yogi Bear]

http://www.pof.org/../../refract.htm (intersting article about opticians/optometrists/ophtalmologists)

 

[Gleevec]

Thus, this is why numerous ODs have gone back to medical school and then completed a residency.

I am in favor of that, or even just specialized residency training for ODs. But I am quite disturbed that some ODs want to perform procedures they did not have formal training for, and it scares me that people like TomOD are so willing to perform surgeries when they havent had that training. The problem is that some people claim to have knowledge and skills they do not have, and patients buy into this, resulting in a diminished standard of care.

 

[TomOD]

That's a scary statement to make, my friend. As an ophthalmologist, I would never make a statement like that. You just minimized most of what glaucoma specialists do for a living. Most of their cases are not surgical. Sure, I feel comfortable managing routine glaucoma cases. I even feel comfortable doing trabeculectomies, lasers, etc. However, I would still never presume that I can manage non-surgical glaucoma cases equally or better than anyone. Unless you do gonioscopy on every new patient you see, then your exams are incomplete. How many patients have you diagnosed with chronic narrow angle glaucoma? Did you know that this is one of the most frequent new diagnosis when a new glaucoma specialist moves into town?

Ah.......man you guys dragged me back in. I'm curious why you feel that you can't manage non-complicated glaucoma patients as well as a glaucoma specialist. If we (ODs and OMDs), in my area, sent every glaucoma patient to the one glaucoma MD in the area, every one of those patients would have to wait 2 years to be seen.

Tell me what it is that you feel you can not do as well (non-surgical I'm talking). The ONLY tool we have at this time to manage glaucoma is lowering the intraocular pressure. You monitor pressures, you monitor fields, you perform scanning laser routinely to look for change. The biggest challage is getting people to use their drops. The ones that don't or can't or don't respond get an appt with the glaucoma MD.

We've (society, that is) got much to learn about this disease. But unless you just have little interest, I feel that you or I can learn as much as anyone about glaucoma.

For the record, I do goinioscopy on every glaucoma patient or suspect and go one step further. I photo the angles with a slit lamp camera to study the angles closer if need be. I do goino on diabetics too. Yep, I've diagnosed patients with narrow angle glaucoma, found angle recessions, found hyphemas in the angle. Would you like for me to send you some of my photos? What's your point?

In these situation, most times, the patient will be sent to a board-certified, fellowship-trained glaucoma MD. He AND I will treat this patient. It's a good relationship and it benefits the patient. But for the "routine" 0.65/0.65 open-angle glaucoma patient, ocular hypotensive eye medications are the first-line treatment of choice at this time. Maybe SLT will prove to be superior to ALT and be repeatable. This maybe be a better option and may move to the front of the pack in the future.

What do you guys think we do in 4 (FOUR) years of Optometry school? Flip the phoropter dials the whole time. 4 years of detailed, specific and intense study of the vision, eyes and systemic conditions related to them. We learn, and perform procedures such as gonioscopy, corneal/conjunctival FB removals, scleral depression, epilations, visual field analysis, lacrimal dilation and irrigations, corneal debridement, subcutaneous, intramuscular, and subconjuntival injections. We have detailed training on ocular and systemic pharmacology. We learn in detail how diabetes, HTN, sickle cell, AIDS, Giant cell arteritis, MG, Sarcoidosis, Syphillis......and on and on........affects the eyes. I don't pretend to know as much as an MD working in these particular fields, but we learn what they mean as they relate to the eyes AND how to treat it or when to refer it (and to whom).

I agree with Andrew Doan that ODs need to see more patients. Some of us see many more than others during our training (depending on where they train).

AND we are tested with national board exams, written and practical. And, at least in my case, in an intensive state oral practical exam where I had to demonstrate such skills as goinoscopy, scleral depression, D&I of the puncta. We have only around a 70 % first time passing rate on our state boards.

I'm not pulling this stuff out of my butt. Check out the curriculums of OD schools (not ones from 1965). 4 years of eyes. All eyes, all the time.

 

[OphthoBean]

Delurking....Okay, so I am checking out the OD requirements as encouraged.

So at my state school (MI) it IS a 4 year curriculum. You don't need a bachelor's degree. Less than 1/2 of their last class had a BA or BS. They spend 3 years taking classes and a year out in clinics seeing patients.

Compare this to most med students entering with a BA or BS, spending 2 years in class, 2 years examining pts as a student, one as an intern, then 3 more just on eye pts.

So 6-7 years out of high school with one full year of patient care versus 12 years out of hs with 6 full years of patient care...yeah, optometry in MI is almost exactly like ophthalmology! At the next MI ophtho society meeting I am gonna have to voice my tremendous support for OD sx. Not!

Next, I end up at optometry.org and am looking the"State Board Requirements" page which includes a table listing the varied requirements for licensure in 54 jurisdictions. I am happy to see that in MI, ODs must pass all 3 parts of their boards to be licensed. Now this is interesting...troubling...I don't know. In 4 jurisdictions, including North Carolina (don't the ODs there have a broad scope of practice?) they don't have to pass part 3 of their boards. Am I reading this wrong? Please tell me I am reading this wrong. I couldn't imagine sending physicians out to practice that couldn't pass their boards!

To make myself feel less scared, I click onto the exam content of part 3 to see if maybe that part doesn't really matter and isn't relevant to real OD practice. For me, it makes me feel more concerned because per the NBEO "Part III assesses a candidate's ability to examine actual patients, evaluate actual clinical data, and render patient care decisions, unlike the Basic Science and Clinical Science examinations, which assess cognitive skill (i.e., knowledge). "

So in FL, LA, NC, and VI (yeah, virgin islands) ODs do not necessarily have to be able to examine actual patients, etc.... Nice. Let's all please vote to allow ALL ODs to perform sx because they are ALL obviously extremely qualified to care for actual patients. Here is the plan. The ODs could set up a wet lab with pig eyes and perform cataract sx on 25 eyes. These labs would be in the 3 above states. If they do a good job 75% of the time as judged by ODs from the 3 states, they can earn themselves a certificate which would allow them to do sx in those 3 states. Since it apparently doesn't really matter if ODs can care for actual patients or render patient care decisions in those 3 states, these excellent pig eye surgeons will be fully allowed to perform sx on humans. Then, since 3 states allow OD sx, there will be pressure on the remaining states to permit OD sx.

Okay, I know, I got carried away there. Pregnancy hormones! But does it not concern anyone else that ODs can be licensed without passing all 3 parts of their boards?

 

[ophtho1122]

I would in no way support OD's performing surgical procedures even if they went through some sort of fellowship to get surgically trained. The system is in place for a reason. Not only does the current system protect patients from underqualified surgeons, but it also protects the profession from becoming flooded with more eye surgeons than are needed. Why do you think it is so hard for residency programs to add even one more resident position to their program? Imagine what the job market would be like if OD's were allowed to undergo formal training to perform surgery. This would be devastating for the field leading the high caliber residents that Ophthalmology usually attracts into other fields, leaving less desirable applicants to fill these positions.

 

[Yogi Bear]

Delurking....Okay, so I am checking out the OD requirements as encouraged.

So at my state school (MI) it IS a 4 year curriculum. You don't need a bachelor's degree. Less than 1/2 of their last class had a BA or BS. They spend 3 years taking classes and a year out in clinics seeing patients.

Compare this to most med students entering with a BA or BS, spending 2 years in class, 2 years examining pts as a student, one as an intern, then 3 more just on eye pts.

So 6-7 years out of high school with one full year of patient care versus 12 years out of hs with 6 full years of patient care...yeah, optometry in MI is almost exactly like ophthalmology! At the next MI ophtho society meeting I am gonna have to voice my tremendous support for OD sx. Not!

Next, I end up at optometry.org and am looking the"State Board Requirements" page which includes a table listing the varied requirements for licensure in 54 jurisdictions. I am happy to see that in MI, ODs must pass all 3 parts of their boards to be licensed. Now this is interesting...troubling...I don't know. In 4 jurisdictions, including North Carolina (don't the ODs there have a broad scope of practice?) they don't have to pass part 3 of their boards. Am I reading this wrong? Please tell me I am reading this wrong. I couldn't imagine sending physicians out to practice that couldn't pass their boards!

To make myself feel less scared, I click onto the exam content of part 3 to see if maybe that part doesn't really matter and isn't relevant to real OD practice. For me, it makes me feel more concerned because per the NBEO "Part III assesses a candidate's ability to examine actual patients, evaluate actual clinical data, and render patient care decisions, unlike the Basic Science and Clinical Science examinations, which assess cognitive skill (i.e., knowledge). "

So in FL, LA, NC, and VI (yeah, virgin islands) ODs do not necessarily have to be able to examine actual patients, etc.... Nice. Let's all please vote to allow ALL ODs to perform sx because they are ALL obviously extremely qualified to care for actual patients. Here is the plan. The ODs could set up a wet lab with pig eyes and perform cataract sx on 25 eyes. These labs would be in the 3 above states. If they do a good job 75% of the time as judged by ODs from the 3 states, they can earn themselves a certificate which would allow them to do sx in those 3 states. Since it apparently doesn't really matter if ODs can care for actual patients or render patient care decisions in those 3 states, these excellent pig eye surgeons will be fully allowed to perform sx on humans. Then, since 3 states allow OD sx, there will be pressure on the remaining states to permit OD sx.

Okay, I know, I got carried away there. Pregnancy hormones! But does it not concern anyone else that ODs can be licensed without passing all 3 parts of their boards?

i think opthalmologists and any doctor for the matter can pratice w/o passing the boards as long as they've gone through a residency program. they'd be "board eligible" rather than "board certified".

 

[Andrew_Doan]

i think opthalmologists and any doctor for the matter can pratice w/o passing the boards as long as they've gone through a residency program. they'd be "board eligible" rather than "board certified".

Incorrect. We must pass all steps of the USMLE I, II, AND III. In addition, we now have to be board certified in ophthalmology if we want hospital privileges or remain hired. Times are changing. Insurance carriers will demand board certification before insuring a physician. To be board certified, we have to pass a written and oral boards. ~65% of those taking the written boards will pass.

There is a huge push for MDs to increase documentation of competency. Thus, it is crazy that organized optometry is lobbying for surgical privileges without the training.

 

[Andrew_Doan]

Ah.......man you guys dragged me back in. I'm curious why you feel that you can't manage non-complicated glaucoma patients as well as a glaucoma specialist.

TomOD, you sound like you are taking very good care of your patients. I'm not criticizing you. I'm criticizing organized optometry for their push for surgical privileges.

You and I both agree on many levels.

I've worked with ODs who have done wonderful jobs managing uncomplicated glaucoma. Unfortunately, you are probably among the top 5-10% of all optometrists. As long as when you know when to refer for surgical treatment before too much field has been lost, there is no problem with you managing glaucoma. It's that I've seen too many fields with only 20-30 degrees central field being referred for glaucoma surgery. These patients should be referred much sooner. BTW, do you check diurnal curves in NTG patients?

Good luck and continue your high level of care for your patients.

 

[OphthoBean]

i think opthalmologists and any doctor for the matter can pratice w/o passing the boards as long as they've gone through a residency program. they'd be "board eligible" rather than "board certified".

Yeah, that is incorrect like Andrew said. Same process for DOs trained in AOA ophtho programs. Though I am fully licensed to practice medicine in 2 states, I am not yet board certified in ophtho.

To get your license to practice medicine in general you need the 3 steps of boards, for me, that was COMLEX I, II, & III. I had to give MI my scores to get my license. In CA, I also had to take oral boards.

To be board certified specifically in ophtho, I will have to take a written and oral board exam in ophtho at the end of training.

Docs who practice medicine right out of internship without subspecializing have to pass the 3 part boards, then they are called general practitioners. They are not BE/BC for anything.

 

[Andrew_Doan]

This is scary stuff in Oklahoma. Read the bill:
http://www.aao.org/aao/advocacy/loa...fm&PageID=37379&CFID=4368194&CFTOKEN=60086598

Remember, the optometric surgery bill was an amendment to the original Pharmacy Bill. The approval of this bill has little to do with the public's confidence in optometry, but rather it was more important to pass the original Pharmacy Bill.

I've written about the Mid-Year Forum Experience here:
http://forums.studentdoctor.net/showthread.php?t=118416

 

[Visionary]

Okay, I know, I got carried away there. Pregnancy hormones! But does it not concern anyone else that ODs can be licensed without passing all 3 parts of their boards?

Great post! I don't think you got carried away at all. I was really surprised to hear those details.

Another point (probably raised sometime during this ever re-emerging thread topic) is that only a small percentage of medical students (~2-3% per my school's average) can actually pursue ophthalmology. These are typically among the strongest MD (and DO) graduates. Understand, I am not implying that ophthalmologists are smart and optometrists are dumb (although I'm sure some will read it as so). I'm simply trying to explain that, prior to beginning their advanced training, ophthalmologists have already demonstrated exceptional knowledge/skills in general medicine/surgery. That foundation is something ODs will never have.

 

[Tony.]

Dr. Doan,
I've read both the house bill NO. 2321 and your midyear forum experience...
First of all...i'd like to say thank you! your contributions to SDN is AMAZING...and its kinda cool to see that you're not hiding online all the time and actually go and speak to real Senators about important issues...
(very cool, I respect that)

Second thing: After reading what you had to say, I think it just comes down to one thing: There are not enough ophthalmogists like yourself that get out there and voice what they think about patient care and the real differences between optometry and ophthamology. Ophthalmologists as a group are not ACTIVE enough in the political scene (like optometrists are) and its a shame........

Like you said, in the U.S there are 40,000 optometrists compared to 14,000 ophthalmologists.
My opinion: ......if you keep letting us, we'll run all over you and complicate patient care even more. It all comes down to educating the public and thats a challenge thats by far the hardest to tackle....

 

[xmattODx]

. In 4 jurisdictions, including North Carolina (don't the ODs there have a broad scope of practice?) they don't have to pass part 3 of their boards...

So in FL, LA, NC, and VI (yeah, virgin islands) ODs do not necessarily have to be able to examine actual patients, etc.... Nice.

Okay, I know, I got carried away there. Pregnancy hormones! But does it not concern anyone else that ODs can be licensed without passing all 3 parts of their boards?

Hi, I'm pretty sure but not positive that the reason you don't need to pass part 3 of national boards in the above states is because those states still conduct state boards. National boards in optometry have just begun to be considered adequate by most states as a means of determining who is competent. The above states still want to determine on their own, apart from the national boards, who can practice in their state. These states basically conduct their own part 3, therefore, you don't need to pass the national part 3 because you will just be repeating it for those states.

Anyone more familiar with FL, LA, NC, VI please correct me if I'm wrong.

 

[Richard_Hom]

Dear Forum,

I think it's rather presumptious or over simplistic to assume or to characterize present optometric legislative efforts as "equalizing" optometry and ophthalmology or trivializing ophthalmic surgery or even minimalizing the differences between the professions.

The last is the one I'd like to comment. In the minds of many optometrists, their view of eyesight and vision is different than ophthalmology's and are quite happy to differentiate themselves from ophthalmology on that basis. Most optometrists are functionalist in viewpoint. This actually will prevent optometry from completely adapting the medical model because of the structural emphasis that ophthalmology views eyesight.

In my opinion, optometry will pull up short of its efforts in this regard and need not be feared that it will try to be"equal" to ophthalmology.

Regards,
Richard_Hom

 

[cpw]

Hi, I'm pretty sure but not positive that the reason you don't need to pass part 3 of national boards in the above states is because those states still conduct state boards. National boards in optometry have just begun to be considered adequate by most states as a means of determining who is competent. The above states still want to determine on their own, apart from the national boards, who can practice in their state. These states basically conduct their own part 3, therefore, you don't need to pass the national part 3 because you will just be repeating it for those states.

Anyone more familiar with FL, LA, NC, VI please correct me if I'm wrong.

Yes, Florida and North Carolina are the two HARDEST states to become a practicing OD in because they have the widest scope of practice.

They do NOT accept the national part III exam because they pimp you with their own state given practical, oral qualifiying exam, and written law exams. ODs in Florida and NC are put through the RINGER to get licensed.

so, before y'all go and start claiming the sky is falling and the world is coming to an end and OH MY GOD OD's are SOOOO stupid...

Get your facts straight!!

 

[Richard_Hom]

BTW, do you check diurnal curves in NTG patients?

Good luck and continue your high level of care for your patients.

Dr. Doan,

Do you believe that central cecal defects will be the first field defect seen in a NTG patient?
Regards,
Richard_Hom