Scope of practice / optometry

[Ime]

Which states allow the largest scope of practice? Which have the least? Is there a site I can go to in order to get information on what Optometrists can do in each state?

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[DrVinzKlortho]

"Largest" scope of practice:
Oklahoma - ODs can do PRK/LASEK, PI/YAG/SLT and other procedures as well as solid prescribing rights.
Kentucky - ODs can do PI/YAG/SLT with other procedures as well as good prescribing rights but what makes Kentucky such a good state is that the Kentucky Optometric Association controls the legislation of Optometry. So if a new technology comes out that should certainly be within an ODs scope of practice the state wouldn't have to grovel through legislation for months and months to add it to Kentucky scope of practice.
As of right now there's roughly 3-4 states that are pushing for similar legislation like that of Kentucky.

Least:
New York, Massachusetts, Maryland, Florida - All these states suck. You can't Rx any orals (other than Doxy for bleph in MD).

The AOA has all sorts of charts and graphs illustrating the scope of practice as it pertains to topical meds, orals and injections per state but you have to be an AOA or AOSA to see it.

 

[Ime]

Thanks! That is helpful.

 

[vistaril]

"Largest" scope of practice:
Oklahoma - ODs can do PRK/LASEK, PI/YAG/SLT and other procedures as well as solid prescribing rights.
Kentucky - ODs can do PI/YAG/SLT with other procedures as well as good prescribing rights but what makes Kentucky such a good state is that the Kentucky Optometric Association controls the legislation of Optometry. So if a new technology comes out that should certainly be within an ODs scope of practice the state wouldn't have to grovel through legislation for months and months to add it to Kentucky scope of practice.
As of right now there's roughly 3-4 states that are pushing for similar legislation like that of Kentucky.

How much of this stuff do most oklahoma and ky optos actually do in practice however? Because if I had something wrong with my eye(medically) besides simple redeye(which I would probably just treat myself or have a pcp friend phone something in), it wouldn't even enter my mind to go to an optometrist. Likewise, when I need a rx for new contacts lens it doesn't even enter my mind to go to an optho.

 

[DrVinzKlortho]

How much of this stuff do most oklahoma and ky optos actually do in practice however? Because if I had something wrong with my eye(medically) besides simple redeye(which I would probably just treat myself or have a pcp friend phone something in), it wouldn't even enter my mind to go to an optometrist. Likewise, when I need a rx for new contacts lens it doesn't even enter my mind to go to an optho.

Surprisingly a good number of ODs in these states perform these procedures (I believe about 1/3rd of OK ODs perform some type of laser procedure). In Oklahoma most of the ODs that are performing refractive surgery act as level 2 surgeons for a large comanagment laser center and basically come into the center and rent the laser per use.

I graduated in 2011 and a couple of classmates in Kentucky are routinely doing YAGs/LPIs/SLTs. That's about all I know regarding Kentucky.

Just because you have something wrong with your eye doesn't mean an OD can't handle it. There's a massive disconnect between what DOs/MDs/OMDs think we are trained to do and what we are actually trained to do. I'm hesitant to say that ODs are over-educated because more education is never a bad thing--we do get very extensive training in treating and managing zebras, didactically. (Didactically, many OD programs take most, if not all, basic science courses with DO, DMD, etc.). What the OD curriculum lacks is the massive volume, or minimum numbers, of managing the zebras.

 

[vistaril]

Just because you have something wrong with your eye doesn't mean an OD can't handle it. There's a massive disconnect between what DOs/MDs/OMDs think we are trained to do and what we are actually trained to do.

but how are these medical/surgical patients gotten to the office? I've never referred a patient to opto/optho before. but if I did it would never cross my mind to send a medical or surgical eye pt to the optometrist. are pcps in ky and ok regularly referring these pts to opto and not optho?

 

[VA Hopeful Dr]

but how are these medical/surgical patients gotten to the office? I've never referred a patient to opto/optho before. but if I did it would never cross my mind to send a medical or surgical eye pt to the optometrist. are pcps in ky and ok regularly referring these pts to opto and not optho?

I, as a family doctor, routinely send my patients to local ODs - both regular check ups (diabetics) and problem visits, most recently what turned out to be a pretty nasty uveitis.

 

[east]

but how are these medical/surgical patients gotten to the office? I've never referred a patient to opto/optho before. but if I did it would never cross my mind to send a medical or surgical eye pt to the optometrist. are pcps in ky and ok regularly referring these pts to opto and not optho?

I get referrals literally every day from either ER or PCP. also many pts. self refer to me for eye problems.

 

[DrVinzKlortho]

but how are these medical/surgical patients gotten to the office? I've never referred a patient to opto/optho before. but if I did it would never cross my mind to send a medical or surgical eye pt to the optometrist. are pcps in ky and ok regularly referring these pts to opto and not optho?

Many are from ER/PCP/NP referrals. Some are new or established patients within the office already.

 

[PBEA]

How much of this stuff do most oklahoma and ky optos actually do in practice however? Because if I had something wrong with my eye(medically) besides simple redeye(which I would probably just treat myself or have a pcp friend phone something in), it wouldn't even enter my mind to go to an optometrist. Likewise, when I need a rx for new contacts lens it doesn't even enter my mind to go to an optho.

"simple redeye".........says the guy who doesnt know his asss from his elbow. I take little comfort in your cavalier attitude towards a specialty that you know basically nothing about (your 4 week rotation through ophtho notwithstanding 🙄). BTW, there are plenty of MD's who fit/prescribe contact lens. Maybe when you escape the blissful ignorance of your cocoon, you'll realize "hey I just went through all that schooling/training.........and I still have a lot to learn." That would be a start in the right direction.

Oh and I see referrals everyday.

 

[east]

no to pile on, but i was wondering what a "simple red eye" was as well, much less the treatment for a "simple red eye". i guess i have a lot to learn though. don't you see the irony in this..."i will just treat it myself, or have my pcp friend call in something" and yet the very same people who post ridiculous things like this scream "patient safety" everytime.

 

[PBEA]

no to pile on, but i was wondering what a "simple red eye" was as well, much less the treatment for a "simple red eye". i guess i have a lot to learn though. don't you see the irony in this..."i will just treat it myself, or have my pcp friend call in something" and yet the very same people who post ridiculous things like this scream "patient safety" everytime.

what you didnt get the memo? Didnt you know it was good "healthcare" to make empirical diagnosis based on limited or superficial (or gasp even NO physical findings outside of "redeye"), I'm pretty sure that's called an "educated guess"🙄. Sprinkle in a few scary words like "conjunctivitis" oooooooh....................now that sounds authoritative. Contrast that with the lowly OD who provides DEFINITIVE diagnosis supported by either pathognomonic or otherwise incontrovertible evidence in the form of 100% evidence-based physical findings. How dare you question the head-shrinker who wants to dabble in other fields, didnt you know they sometimes do a whole month rotation in some specialty fields, which is more then enough time to absorb the vast body of knowledge of those fields. Get with the program, and stop comparing apples to oranges.

Pile on

 

[vistaril]

what you didnt get the memo? Didnt you know it was good "healthcare" to make empirical diagnosis based on limited or superficial (or gasp even NO physical findings outside of "redeye"), I'm pretty sure that's called an "educated guess"🙄. Sprinkle in a few scary words like "conjunctivitis" oooooooh....................now that sounds authoritative. Contrast that with the lowly OD who provides DEFINITIVE diagnosis supported by either pathognomonic or otherwise incontrovertible evidence in the form of 100% evidence-based physical findings. How dare you question the head-shrinker who wants to dabble in other fields, didnt you know they sometimes do a whole month rotation in some specialty fields, which is more then enough time to absorb the vast body of knowledge of those fields. Get with the program, and stop comparing apples to oranges.

Pile on

if I had or thought I had redeye, I'd probably have a family medicine buddy look at it. If he was like "yep, looks like redeye", he or I'd probably call something in. I'm not going to make an appt for that. Now if something else medical were going on, as I've already said, I'd make an appt with an optho.

I can only speak to what I would do. Given that this forum is filled with post after post lamenting the fact that opto is mainly refractingand glasses/CL, I thought that the way I would handle such a situation was rather common. Apparently other optos though, many in here, have clinics full of patients with all sorts of eye pathology.

 

[vistaril]

no to pile on, but i was wondering what a "simple red eye" was as well, much less the treatment for a "simple red eye". i guess i have a lot to learn though. don't you see the irony in this..."i will just treat it myself, or have my pcp friend call in something" and yet the very same people who post ridiculous things like this scream "patient safety" everytime.

oh I can't speak for others, but I am all for expanded rights for just about everyone.....

 

[Fascia Lata]

I'm an ophthalmologist who practices overseas. I understand that optometrists in the US have a much wider scope of practice than do optometrists where I practice. Where I practice, optometrists only refract and do CL fitting. They are also responsible for prescribing low vision aids and visual rehabilitation. Some do pre-op evaluation for refractive surgery patients. We do trust them and appreciate their input a lot. I myself would definitely go to an optometrist for refraction, although I and my colleague ophthalmologists received very solid training in refraction. However this remains an area that optometrists excel in. We do refract the occasional patient, but you cannot compare the skill of someone who refracts 40 patients a day, including some with corneal grafts, keratoconus and lens subluxation to someone who refracts 2-3 patients a day.

I am however not convinced that optometrists should be granted a much bigger scope of practice. I know the optometry education in the US includes exposure to most ocular disease processes in terms of diagnosis and management, but should optometrists really be granted the right to treat these disorders? I noticed that some optometrists are disappointed that in most states they are not allowed to prescribe systemic medications. Well, I am sure they know that systemic medications do affect other body systems that they have not studied "enough" during their optometry training. Can you assess the patient medically before prescribing steroids? before prescribing a systemic carbonic anhydrase inhibitor? Can you really work the patient up before giving IV mannitol for acute angle closure glaucoma? Do you know enough drug interactions? Can you handle the complications associated with systemic antimicrobial therapy (diarrhea, colitis, idiosyncrasy...etc). It is not whether you know what medication is given to treat what ocular condition. It is so much more, including lab tests and general medical knowledge.Now if you want to get exposed to all this "enough", you should go to medical school. And BTW, reading about all this doesn't make you qualified to include this stuff into your scope of practice. Clinical training involving real patients is a must.

What about topical medications? Beta blockers for people with heart block, arrhythmias or pulmonary disease can be fatal. Can you assess a patient for that before prescribing topical beta blockers?

Now when it comes to surgery. It is not about your technical abilities. Any person whether they are medically qualified or not will be able to perform a surgical procedure if they train enough on it. BUT, what if a patient codes during a procedure? That ALONE would make me just not ever agree, if it is up to me, that optometrists are granted ANY surgical privileges.

Thanks.

 

[Tippytoe]

Jumping into a post I shouldn't.

Just for the record, a "red eye" means absolutely nothing about what is wrong with your eye. Calling your PCP buddy and saying I have a "red eye" is about as helpful as calling your mechanic and telling him you have a "red car" and wanting him to diagnose why it's not running.

The lack of knowledge is scarry. We all, OD and OMD, see pts treated with sulfacetamide (an eye med that is virtually never used by ECPs, probably since 1975) by their family MD or ER doc. We've all seen uveitis treated with expensive antibiotic drops that are completely useless for the condition. It's a shot-gun approach that is used by general practitioners that know essentially nothing about eye disease. Fortunately, most cases of "red eye" are self-limited and will be better with anything or nothing.

All of us with more than a few weeks of eye training know a 'red eye' could be viral, bacterial, fungal, infectious, non-infectious, inflammatory, etc...... It could be resultant from an internal eye problem, glaucoma or a host of other conditions a person untrained in eye care and without a slit lamp and the abilty to look into the eye, not to mention check the intraocular pressure, would know nothing about.

So go ahead, write yourself an Rx for Polytrim. Might as well treat your own HTN, migraines and gout too.

"Coding". Now that's funny. I don't think many patients are "coding" from YAG PIs or SLT or capsulotomies. If they do, an OD would do what 99% of OMDs would do..........CALL 911 and jump out of the way. I've seen OMDs do this more than a few times.

I'm not a big OD cheerleader. But when I see non-sense, I must respond.

 

[Fascia Lata]

"Coding". Now that's funny. I don't think many patients are "coding" from YAG PIs or SLT or capsulotomies. If they do, an OD would do what 99% of OMDs would do..........CALL 911 and jump out of the way. I've seen OMDs do this more than a few times.

No one said they are "many". It is just having the knowledge and ability to act in emergencies. Anyway the laser procedures you mentioned are not the only "surgical" procedures optometrists are trying to include within their scope of practice.

I believe the reason for ophthalmologists resisting giving more privileges to optometrists is not because of financial reasons as optometrists are trying to argue. It is mainly a matter of principles. Who should decide whether a particular privilege is given to a group of practitioners of a certain profession? Is it their professional association? I don't think so.

Bottom line, optometrists are a respectable group of professionals who know way more about certain aspects of eye care than do ophthalmologists. On the other hand, ophthalmologists should remain the only eye care professionals to administer pharmacologic treatment and perform procedures to cure eye diseases. The 2 groups of professionals complement each other. I respect my colleague optometrists very much and admit I cannot practice without their help.

 

[Fascia Lata]

Just for the record, a "red eye" means absolutely nothing about what is wrong with your eye. Calling your PCP buddy and saying I have a "red eye" is about as helpful as calling your mechanic and telling him you have a "red car" and wanting him to diagnose why it's not running.

The lack of knowledge is scarry. We all, OD and OMD, see pts treated with sulfacetamide (an eye med that is virtually never used by ECPs, probably since 1975) by their family MD or ER doc. We've all seen uveitis treated with expensive antibiotic drops that are completely useless for the condition. It's a shot-gun approach that is used by general practitioners that know essentially nothing about eye disease. Fortunately, most cases of "red eye" are self-limited and will be better with anything or nothing.

All of us with more than a few weeks of eye training know a 'red eye' could be viral, bacterial, fungal, infectious, non-infectious, inflammatory, etc...... It could be resultant from an internal eye problem, glaucoma or a host of other conditions a person untrained in eye care and without a slit lamp and the abilty to look into the eye, not to mention check the intraocular pressure, would know nothing about..

Can't agree more

 

[east]

"I am however not convinced that optometrists should be granted a much bigger scope of practice. I know the optometry education in the US includes exposure to most ocular disease processes in terms of diagnosis and management, but should optometrists really be granted the right to treat these disorders? "

have already been doing it for YEARS. do some research.

"I noticed that some optometrists are disappointed that in most states they are not allowed to prescribe systemic medications."

most states have allowed systemic meds for YEARS. do some research

"Well, I am sure they know that systemic medications do affect other body systems that they have not studied "enough" during their optometry training. "

yes...we are aware.

"Can you assess the patient medically before prescribing steroids?"

yes

"before prescribing a systemic carbonic anhydrase inhibitor?"

yes

"Can you really work the patient up before giving IV mannitol for acute angle closure glaucoma? "

refer for IV meds

"Do you know enough drug interactions?"

yes


"Can you handle the complications associated with systemic antimicrobial therapy (diarrhea, colitis, idiosyncrasy...etc)."

yes


"It is not whether you know what medication is given to treat what ocular condition. It is so much more, including lab tests and general medical knowledge."

we know

"Now if you want to get exposed to all this "enough", you should go to medical school. And BTW, reading about all this doesn't make you qualified to include this stuff into your scope of practice. Clinical training involving real patients is a must."

have been doing this on real pts. for years

"What about topical medications? Beta blockers for people with heart block, arrhythmias or pulmonary disease can be fatal. Can you assess a patient for that before prescribing topical beta blockers?"

yes


"Now when it comes to surgery. It is not about your technical abilities. Any person whether they are medically qualified or not will be able to perform a surgical procedure if they train enough on it. BUT, what if a patient codes during a procedure? That ALONE would make me just not ever agree, if it is up to me, that optometrists are granted ANY surgical privileges."

vast majority of ODs not interested in surgery.

hope this answers some of your questions.

cheers.

 

[Fascia Lata]

Sounds like you could learn what MDs learn in 4 years of med school + 1 year of internal medicine or other internship + 3 years of ophthalmology residency + an optional year or two in a fellowship in only 4 years of OD school. Impressive.

 

[east]

nope, just learned enough to answer your previous question in the affirmative.

 

[VA Hopeful Dr]

Sounds like you could learn what MDs learn in 4 years of med school + 1 year of internal medicine or other internship + 3 years of ophthalmology residency + an optional year or two in a fellowship in only 4 years of OD school. Impressive.

I would also suggest that you could learn more about American ODs compared to the ones wherever you're working.

 

[Fascia Lata]

I would also suggest that you could learn more about American ODs compared to the ones wherever you're working.

I am a proud student of 2 very capable American ODs. They were my mentors during residency.

 

[Optogal]

Bottom line, optometrists are a respectable group of professionals who know way more about certain aspects of eye care than do ophthalmologists. On the other hand, ophthalmologists should remain the only eye care professionals to

Family doctors here prescribe meds (antibiotics) for the eyes all the time. They don't even have the equipment to assess the eyeball (closed-angle glaucoma, iritis, etc). Why don't you go to the medical student forum and tell them that non-ophthalmology doctors shouldn't be prescribing for the eyes?

 

[VA Hopeful Dr]

Family doctors here prescribe meds (antibiotics) for the eyes all the time. They don't even have the equipment to assess the eyeball (closed-angle glaucoma, iritis, etc). Why don't you go to the medical student forum and tell them that non-ophthalmology doctors shouldn't be prescribing for the eyes?

My general philosophy for this is as follows...

If the eye looks particularly bad, straight to someone with a slit lamp.

If its red but not terrible looking, Woods Lamp to check for ulcer/abrasion/herpes. If those, start treatment and refer. If not, trial of abx. If worse/no better after 24 hours (unless I'm 99% sure its viral to begin with), refer.

 

[Fascia Lata]

"
most states have allowed systemic meds for YEARS. do some research
.

Sorry about that mistake. Now I know.

Btw, I was not trying to be offensive to optometrists. Sorry if any of you guys felt I was.

 

[Fascia Lata]

My general philosophy for this is as follows...

If the eye looks particularly bad, straight to someone with a slit lamp.

If its red but not terrible looking, Woods Lamp to check for ulcer/abrasion/herpes. If those, start treatment and refer. If not, trial of abx. If worse/no better after 24 hours (unless I'm 99% sure its viral to begin with), refer.

So do you start topical antiviral before referral if you think it's herpes? coz there are very subtle findings that differentiate a herpetic ulcer from a pseudo-herpetic one and these need the magnification of a slit lamp.

 

[hurdlepup]

My general philosophy for this is as follows...

If the eye looks particularly bad, straight to someone with a slit lamp.

If its red but not terrible looking, Woods Lamp to check for ulcer/abrasion/herpes. If those, start treatment and refer. If not, trial of abx. If worse/no better after 24 hours (unless I'm 99% sure its viral to begin with), refer.

Not sure how all these PCPs prescribing unnecessary abx gts affect bug resistance. Wonder how much of the time it is dry eye, allergic conjunctivitis, etc...

Why trial of abx? It doesn't make sense...

 

[VA Hopeful Dr]

So do you start topical antiviral before referral if you think it's herpes? coz there are very subtle findings that differentiate a herpetic ulcer from a pseudo-herpetic one and these need the magnification of a slit lamp.

Depends on how quickly I can get the patient in to see an eye doctor. If same day, I do nothing. If next day, I will start topical antivirals under the idea that a handful of doses won't do much damage if they take a few doses and it isn't herpes.

 

[VA Hopeful Dr]

Not sure how all these PCPs prescribing unnecessary abx gts affect bug resistance. Wonder how much of the time it is dry eye, allergic conjunctivitis, etc...

Why trial of abx? It doesn't make sense...

My local ophthalmologists have told me not to worry about resistance.

I can usually differentiate dry eye (tear film with fluorescein) and allergies (other symptoms, slightly different appearance to conjunctiva).

 

[Tippytoe]

I believe the reason for ophthalmologists resisting giving more privileges to optometrists is not because of financial reasons as optometrists are trying to argue. It is mainly a matter of principles.

Nonsense my good sir (or madam). It's 100% financial. Same reason ODs don't want opticians refracting. The "safety" issue would be ironed out very quickly by trial lawyers. The first couple of blind eyes would put an eye to any problems.

If it was out of 'principle', you'd be fighting dentists all day long since they do more surgery than any OD is asking for (and they didn't go to the only place on earth where knowledge of the human body can be obtained......... medical school). 🙄

 

[DrVinzKlortho]

I'm shocked nobody else has mentioned this so far:

http://www.cpha.com/associations/7884/files/SB 491-492-493 Fact Sheet.pdf

 

[DrVinzKlortho]

"SB 492 will remove restriction in current law to permit optometrist to examine, prevent, diagnose, and treat conditions and disorders of the visual system and the human eye to the full extent of their training. The bill permits an optometrist to diagnose, treat and manage additional conditions with ocular manifestations. To ensure public safety is of the highest priority, SB492 will direct the State Board of Optometry to establish education and examination requirements of optometrists including but not limited to completion of the National Board of Examiners in Optometry. Finally, this bill will permit optometrists to perform vaccinations and allow them to perform surgical and non-surgical primary care procedures requiring no more than topical or local anesthetic."

SB 491 and SB 493 outline similiar legislation for NPs and PharmDs. To quote Kanye West, "Dat **** cray."