should i go to OD or MD?

[dara678]

Hey all,

I was diagnosed with dry eye syndrome recently by an ophthalmologist and I've noticed that I can't wear contact lenses anymore. The M.D. told me to go back to him if I had any problems so i can get fitted with new ones, but since I have had an optometrist I've been going to I was wondering if I could just go to her to get fitted with super-hydrating lenses. (sorry to sound ignorant) But do OD's have experience with contact lenses and dry eyes and can treat them effectively?

Thanks for the help!

---

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[jchod]

I would go to an OD, they just have more experience with contacts. Two things I would ask about are Proclear contacts, these are awesome for dry eyes!!! I would try these before gong with any of the O2 Optix or Acuvue advance/oasys etc. The other thing is if this is a chronic condition, ask about Restasis. This is a Rx eye drop that works very well, particularly on yournger patients (under 50). Hard to tell you without seeing your eyes. But two things to consider.

 

[Richard_Hom]

Hey all,

I was diagnosed with dry eye syndrome recently by an ophthalmologist and I've noticed that I can't wear contact lenses anymore.
Thanks for the help!

Dear dara678,

The optometrist (OD) is a logical choice for different contact lens alternatives and choices as he/she is more knowledgeable and interested in this form of care. In addition, the optometrist is also able to supplement or complement the contact lens option with lubricants, punctal plugs or prescription medicines.

The ophthalmologist is a logical choice if all contact lens options are exhausted and the patient still doesn't want to wear glases. Then refractive surgery is the logical option. In addition, certain medical conditions may exacerbate dry eyes and may require laboratory and physical testing which most optometrists are not interested or equipped to do but most ophthlmologists are.

Richard Hom, OD,FAAO
San Mateo, CA

 

[ProZackMI]

Hey all,

I was diagnosed with dry eye syndrome recently by an ophthalmologist and I've noticed that I can't wear contact lenses anymore. The M.D. told me to go back to him if I had any problems so i can get fitted with new ones, but since I have had an optometrist I've been going to I was wondering if I could just go to her to get fitted with super-hydrating lenses. (sorry to sound ignorant) But do OD's have experience with contact lenses and dry eyes and can treat them effectively?

Thanks for the help!

Go to an MD!

 

[jchod]

Go to an MD!

uh, yah, that the answer to everything!!

 

[lnn2]

Go to an MD!

Did you just pull the answer of out your @ss? because it stinks!

contact lenses.... super-hydrating lenses..... contact lenses...

could you figure out the answer?!

...dry eyes....

either one, just don't go to the proctologist.

 

[Ben Chudner]

Go to an MD!

What an insightful reply! I believe the OP was asking if an MD or an OD would be a better choice for a contact lens fitting. It is interesting that an MD who is so shocked by the limited training of OD's when it comes to disease management is willing to recommend an MD for a contact lens fit. Do you realize that most ophthalmologists spend very little time learing about contact lens fitting? At Bascom Palmer, it couldn't have been more than a month and they hated every minute of it. Let's compare that to an OD's training which I would guess amounts to about 3 years. So if it should be "surgery by surgeons", then I guess it should be "CL fits by CL specialists".

 

[dara678]

Did you just pull the answer of out your @ss? because it stinks!

could you figure out the answer?!

either one, just don't go to the proctologist.

LOL I know what kind of lenses I need, I just a professional to recommend a brand. And i wanted to know if an OD could give me an Rx for eye drops. But THANK YOU everybody for the replies! IT was very helpful

 

[ProZackMI]

Did you just pull the answer of out your @ss? because it stinks!

could you figure out the answer?!

either one, just don't go to the proctologist.

The OP asked a question, and I gave my opinion. You're being rude, why? If it's a medical problem, an MD should be consulted, not an optometrist. No need to be rude and hostile.

 

[VA Hopeful Dr]

The OP asked a question, and I gave my opinion. You're being rude, why? If it's a medical problem, an MD should be consulted, not an optometrist. No need to be rude and hostile.

Actually, the original question asked if ODs had experience fitting contacts and dealing with dry eye. The answer to both of those is yes. ODs are better at contacts and since dry eye is hardly a major medical problem, I'd recommend an OD.

I do agree, however, that the other poster being so rude and hostile wasn't neccesary.

 

[rpie]

Even if there is a medical eye condition the OD should be able to diagnosis and treat the condition unless surgical treatment is indicated in which the OD should then refer to a fellowship trained sub-specialist OMD.

 

[futuredoctorOD]

Go to an MD!

Your comment is foolish. (This is not a confrontational response) No matter what the circumstance was (dry eye, glasses, contacts, etccc) you would "reccomend" an MD because you feel OD's are inferior---all your previous posts point to this philosophy. For 99% of primary eye care issues Optometric Physicians are the first choice and the right choice! This includes medical conditions that fall under the scope of practice of an optometrist--(dry eye, early stage glaucoma, conjunctivitis, blepheritis, etc...!) 80% of primary eye care in this country is handled by doctors of optometry............Do you know what statistics are? I only have BS and currently I am applying to optometry school and I know what they are.....


Have you been taking too much prozac?

 

[cpw]

you did fine futuredoctor OD.. you killed your point with your last two sentances.

Time to town it down on this thread y'all. You can make your points without flaming!

 

[rpie]

A note that I came across and wanted to share with everyone.



Off the Cuff: Degrees of Stupidity


Not long ago, I attended a dinner presentation on dry eye with the focus on one of my favorite and most frequently prescribed drugs. The attendees included a mix of MDs and ODs. The food was nothing short of incredible, and the company reps that put this meeting together were as good as good reps can get.

Dry eye is a personal interest of mine, and I have presented somewhere around 100 times on the subject. I have also listened to dry eye presentations from dozens of MDs and ODs, and have only rarely failed to learn something. So, as you could imagine, I was really looking forward to this lecture.

Our speaker was a cornea specialist who began by stating that there is no real clinical difference between fluorescein and rose bengal, something even a first-year optometry student knows is absurd. As he continued, it became apparent that our lecturer had slept through more than a few basic physiology classes and seemingly had not opened a journal since he left his fellowship. While you can’t expect a person to know what they don’t know, I am still flabbergasted that anyone would willingly flaunt their own shortcomings so openly.

I sometimes get e-mails from MDs who tell me that MDs are superior to ODs. Oddly, I also get emails from ODs who tell me that they think ODs are inferior to MDs. Well, both are wrong. Knowledge and clinical ability is unique to an individual, not a profession. Stupidity however, knows no such boundaries.

Editor's Note: Last week hurricane Katrina dealt our country a devastating blow. Our thoughts and prayers are with our colleagues and friends on the Gulf Coast during this difficult period. Given the magnitude of the tragedy and the impact on our colleagues and their families, I call on all state boards to enact emergency reciprocity for ODs in the affected areas. More on this next week.




CORRECTION: Last week, our Case in Point incorrectly stated that degenerative retinoschisis causes a relative scotoma. It results in an absolute scotoma. Also, while 2.5 percent of patients with retinal detachment were found to have retinoschisis, the risk of a clinically progressive detachment occurring in a retinoschisis patient is in actuality minimal. -- AE





Arthur B. Epstein, OD, FAAO
Chief Medical Editor
[email protected]

 

[futuredoctorOD]

Understood....But CPW, this Prozac guy is a troll......His opinions are so biased and lacking objectivity........I have never trashed ophthalmology on here because that would be wrong......


I understand your point though......

 

[DOCTORSAIB]

Knowledge and clinical ability is unique to an individual, not a profession. Stupidity however, knows no such boundaries.

Great post! SDN is full of immature pre-meds, med students with absolutely NO life experience, or some resident who thinks he/she knows it all b/c they're higher up in the medical hierarchy.

I worked as an ophthalmic tech for a couple of years before starting med school. The department was very well-organized and managed. The medical/surgical patients were seen by respective ophthalmologists (comprehensive, cornea, retina, oculo-plastics, neuro, etc) and the CL fitting, refractions, and basic eye exams were distributed among the general ophthalmologists and the optometrist.

You're definetly right. When it comes to CL fitting, optometrists usually have ALOT more training/experience. Often, it's a waste of time/money/effort for an ophthalmologist to fit CL's when they could be diagnosing, treating, and performing surgery for eye Dz. Besides, isn't that what they were trained to do in the first place.

 

[ProZackMI]

Your comment is foolish. (This is not a confrontational response) No matter what the circumstance was (dry eye, glasses, contacts, etccc) you would "reccomend" an MD because you feel OD's are inferior---all your previous posts point to this philosophy. For 99% of primary eye care issues Optometric Physicians are the first choice and the right choice! This includes medical conditions that fall under the scope of practice of an optometrist--(dry eye, early stage glaucoma, conjunctivitis, blepheritis, etc...!) 80% of primary eye care in this country is handled by doctors of optometry............Do you know what statistics are? I only have BS and currently I am applying to optometry school and I know what they are.....


Have you been taking too much prozac?

I can tell you're only a BS. Optometrists are NOT physicians; they are primary health care providers. I gave my opinion. I re-read the OP and I agree, I misread it. An OD should have no problem fitting CLs, since that's what they do best -- refractive correction, not medical treatment. I also disagree with your stats about 80 percent of primary eye problems being treated by ODs. I would say this figure applies to MD/DO internists, not optometrists.

You, and the chiropractors, can go around calling yourselves physicians all you want, but unless you attend medical or osteopathic medical school, you will never be a physician. An OD should never treat any complicated medical problem -- period. If you do, you're engaging in the unauthorized practice of medicine and deserve to lose your license.

 

[ProZackMI]

Understood....But CPW, this Prozac guy is a troll......His opinions are so biased and lacking objectivity........I have never trashed ophthalmology on here because that would be wrong......


I understand your point though......

I'm NOT a troll. You have proven that you're immature and uninformed. I have a lot of respect for ODs, but I also believe that many health care professionals are unnecessarily trying to enhance their scope of practice without enhancing their education. NPs, PAs, PsyDs, PharmDs, DPTs, AuDs, and ODs all want to have MD/DO privileges in terms of RxP, admitting, dx, tx, etc.

There are plenty of internists out there, both DO and MD, who can treat conjunctivitis and other ocular conditions without consulting an OMD. If given the choice between an Internist and an OD, see an Internist first. You'd be surprised what they know in terms of ocular pathology and tx. While an OD has the ability to do some dx and tx, in MI, most do not. In your state, it might be different. ODs here are pretty much corrective in nature, not diagnostic or treatment oriented. I admit, I have a lot to learn about optometry, but as an MD, I certainly would not attempt to practice optometry or dentistry or podiatry without proper training and licensure, so neither should other professionals attempt to practice medicine without going to medical school.

Like I said, I stand corrected -- I skimmed the original question and misread it. My revised response is: go where you know and trust, whether its an MD or OD. If you have a serious medical problem, however, see a qualified physician, not an OD.

Zack, MD, JD

 

[ProZackMI]

What an insightful reply! I believe the OP was asking if an MD or an OD would be a better choice for a contact lens fitting. It is interesting that an MD who is so shocked by the limited training of OD's when it comes to disease management is willing to recommend an MD for a contact lens fit. Do you realize that most ophthalmologists spend very little time learing about contact lens fitting? At Bascom Palmer, it couldn't have been more than a month and they hated every minute of it. Let's compare that to an OD's training which I would guess amounts to about 3 years. So if it should be "surgery by surgeons", then I guess it should be "CL fits by CL specialists".

I misread the OP and stand corrected. An OD is more than qualified to fit this person with appropriate lenses. I also agree that OD's have much more training in corrective lenses, contact lenses, and treatment of low vision. However, I stand firm with my opinion that ODs are not qualified to treat complex ocular diseases.

 

[rpie]

Interesting that your impression is that most of the OD’s in MI do not Dx and Tx especially since there is and excellent OD school at Ferris St Univ. I agree that there are fine internists that treat variety of ocular conditions effectively. However, there are also many cases where the “red eye “ is not a simple conjunctivitis. Since you are also an Attorney you may find this interesting. I know a wonderful PCP that was found negligent because the conjunctivitis that he was treating was really an iritis, and evolved into secondary angle closure glaucoma. Sending the patient to a general OMD, the general OMD was unable to sufficiently break the angle closure and had to have a fellowship trained Glaucoma sub-specialists do filtration surgery. The end result was that the patient lost the eye because of an RD. The PCP was advised that he should have referred the patient to a general OMD or an OD when patient’s condition did not begin to improve in the first 24 hrs. The recommendation to refer to an OD is because, as you also know, in court of law OD’s are held to the same standard and competency for Dx, TX and management of ocular diseases as an OMD.

 

[Richard_Hom]

I misread the OP and stand corrected. An OD is more than qualified to fit this person with appropriate lenses. I also agree that OD's have much more training in corrective lenses, contact lenses, and treatment of low vision. However, I stand firm with my opinion that ODs are not qualified to treat complex ocular diseases.

Dear ProZackMI- There is much truth in what you say but only because most OD's are not permitted to use many oral or any surgical procedures to treat "complex" medical eye problems.

However, I must say that there are several entities which evolve from simple problems, that when left untreated can become complex cases. In these cases, intervention by an OD at this stage can forestall the simple case from becoming a complex case.

In summary, your statement is true and is unarguable, but I feel it is misleading in some respects.

Richard

 

[ProZackMI]

Dear ProZackMI- There is much truth in what you say but only because most OD's are not permitted to use many oral or any surgical procedures to treat "complex" medical eye problems.

However, I must say that there are several entities which evolve from simple problems, that when left untreated can become complex cases. In these cases, intervention by an OD at this stage can forestall the simple case from becoming a complex case.

In summary, your statement is true and is unarguable, but I feel it is misleading in some respects.

Richard

I agree, Dr. Hom. I apologize for any misleading comments and I also am learning more about optometry. Thank you.
Zack

 

[ProZackMI]

Interesting that your impression is that most of the OD’s in MI do not Dx and Tx especially since there is and excellent OD school at Ferris St Univ. I agree that there are fine internists that treat variety of ocular conditions effectively. However, there are also many cases where the “red eye “ is not a simple conjunctivitis. Since you are also an Attorney you may find this interesting. I know a wonderful PCP that was found negligent because the conjunctivitis that he was treating was really an iritis, and evolved into secondary angle closure glaucoma. Sending the patient to a general OMD, the general OMD was unable to sufficiently break the angle closure and had to have a fellowship trained Glaucoma sub-specialists do filtration surgery. The end result was that the patient lost the eye because of an RD. The PCP was advised that he should have referred the patient to a general OMD or an OD when patient’s condition did not begin to improve in the first 24 hrs. The recommendation to refer to an OD is because, as you also know, in court of law OD’s are held to the same standard and competency for Dx, TX and management of ocular diseases as an OMD.

rpie, good point. I think it's dangerous for any internist, FP, or GP to treat conditions for which he/she is unqualified or to go beyond the scope of his/her practice. I'm a psychiatrist and have forgotten a great deal of my IM training, but I know enough to treat basic ocular conditions. If it was something that was beyond my training, I'd refer to an OMD as soon as possible. As far as I know, in MI, an OD has TPA and DPA RxPs, but is not allowed to legally treat medical conditions that go beyond TPA/DPA RxPs.

I think your point is well taken, however. Thanks for the input!

BTW, I'm not an attorney yet. I have to take and pass the bar exam first!
Zack

 

[Ben Chudner]

I'm a psychiatrist and have forgotten a great deal of my IM training, but I know enough to treat basic ocular conditions. If it was something that was beyond my training, I'd refer to an OMD as soon as possible.

I don't want to pick a fight with you because I think you are really trying to learn more about optometry, but I would say you are not qualified to treat basic ocular conditions unless you have the proper equipment in your clinic to accuately diagnose basic ocular conditions. Simply looking at a red eye and saying it must be a conjuctivitis without looking more closely with a slit lamp is exactly how doctors misdiagnose iritis. You may know enough to treat, but you cannot treat what you cannot correctly diagnose.

Also, you have made the comment that OD's are not qalified to treat complex ocular conditions. And while I completely agree with Dr. Hom's post, I am curious as to what you would consider a complex ocular condition. For example, I would not consider a patient with Type 2 Diabetes and advanced (but controlled) glaucoma to be basic, and yet OD's follow these patients successfully all the time. I only ask because I am trying to understand your side of this arguement. I think there are many things we would agree upon as to the appropriate scope of practice for OD's.

 

[rpie]

Best of luck on the bar exam. I was wondering if you would share why your interest in OD’s?
Being that we all are concerned with liability to certain degree, I think everyone may find this helpful. Having been in academics for 10 years before joining a group practice I have had the unique privilege of being asked to testify for and against OD’s and OMDs. Form this experience, I have found that most OD’s tend to be cautious but get into trouble when they become complacent with their referrals. OMD generally tend to get into trouble when they treat an area where they have limited experience.

OMDs are broken down into general OMDs, and fellowship trained sub-specialist OMDs. (Corneal/cataract, retina, glaucoma, ocular plastics and pediatrics/strabismus) Optometry also has specialties. Those OD’s that usually have done a residency in corneal/contacts, ocular disease/ retina, low vision, behavioral/vision therapy, and children’s vision/ pediatrics.

Many of the cases that I consulted on involved a general OMD that had surgical/medical complications and had to refer to OMD sub-specialists. Minimal or no Tx could be done by the sub-specialists due to a high probability of total loss of the eye if additional procedures were attempted. Unfortunately for the general OMD since the sub-specialist would have given the patient the best chance of obtaining an optimal outcome, thus the argument that ensued is, why didn’t the general OMD consult the sub-specialists from the beginning? Or why didn’t the initial referring OD refer directly to the sub? In almost all cases where the OD did not refer directly to sub-specialists the OD was found partially liable. The same is also true for PCPs but since PCPs are not considered an ocular specialist the % of liability is usually small if any at all.

Over a period of time I have found growing numbers of busy OMD sub-specialists that only accept referrals from OD’s or OMDs, and of the two referral sources preferring the OD’s referral because they are not only getting patients that specifically need their area of expertise but also patients that have not been “touched”.

Zack, if you get a chance to work with a good OD I think you will find how well versed OD’s can be as far as being able to manage ocular pathology.

One point I find unique about Optometry is that OD’s have been helping train and teach OMD residents for the past 35 or so years, and are appointed as professors of Ophthalmology at many schools. I am not aware of any other profession that helps train medical residents.
.

 

[ProZackMI]

I don't want to pick a fight with you because I think you are really trying to learn more about optometry, but I would say you are not qualified to treat basic ocular conditions unless you have the proper equipment in your clinic to accuately diagnose basic ocular conditions. Simply looking at a red eye and saying it must be a conjuctivitis without looking more closely with a slit lamp is exactly how doctors misdiagnose iritis. You may know enough to treat, but you cannot treat what you cannot correctly diagnose.

Also, you have made the comment that OD's are not qalified to treat complex ocular conditions. And while I completely agree with Dr. Hom's post, I am curious as to what you would consider a complex ocular condition. For example, I would not consider a patient with Type 2 Diabetes and advanced (but controlled) glaucoma to be basic, and yet OD's follow these patients successfully all the time. I only ask because I am trying to understand your side of this arguement. I think there are many things we would agree upon as to the appropriate scope of practice for OD's.

I agree with you, Dr. Chudner. I meant that since I have training in IM, I feel confident that with the proper equipment, I would be able to treat "basic" eye disorders. By that, I mean conditions that are not progressive, insidious, or invasive. Right now, I don't think I'm qualified to treat much, and I would most certainly refer the patient to more competent medical professional if he/she presented with an avulsion, enculeation, aqueous hemorrhage, lazy eye lid, nystagmus, macular degeneration, proliferative diabetic retinopathy, etc. I'm a psychiatrist. I know my area very well, but have forgotten a great deal of my IM training. That's not to say I couldn't re-learn some of it and go back to IM -- I know I could.

My only point was that internists probably treat more basic/simple eye conditions than optometrists. I have no doubt that ODs have expanded their professional scope of practice in most states and operate legally within their training. I still have a great to learn about your profession. Forgive my ignorance.

Thanks,
Zack

 

[ProZackMI]

PART I
Rpie,

To be honest, I have no idea why I’m interested in optometry. It’s one of those fields that I considered to be a “glorified technician” and previously snubbed as being inferior to medicine. I admit that. My opinion changed greatly about six months ago. I’m 34 years old and am in good health. I’ve never worn glasses or CL before. About six months ago, I started experiencing eye strain and headaches. I attributed it to lack of sleep due to work and law school. I also figured it was due to too much caffeine. However, nothing I did remedied the problem. I went in to see my PCP, who right away saw that I was holding some of the papers I was reading and filling out too close. He suggested I see an optometrist. I did.

The OD I went to has an OD from Ferris State University (Michigan College of Optometry) and did post OD training in CL. She was very professional and thorough and, forgive the pun, “opened my eyes” about an optometrist’s education, training, and scope of practice. So, when I joined SDN, I started to read some of the posts here.

I don’t have a problem with non-physicians seeking expanded or enhanced scope of practice privileges so long as such professionals possess the requisite training and skills. For example, I support Rx privileges for PhD/PsyD psychologists who possess advanced post-doc training in psychopharmacology and medical assessment. I think there is a great need for mental health professionals who can handle it all: counseling and medication. I think MSWs are poorly trained and do not help many people. I also find most psychiatrists to be “pill pushers” and unskilled in the art and science of counseling and psychotherapy. There is a legitimate need for mental health professionals that can prescribe medications, provide comprehensive counseling and therapy, and admit and d/c patients from hospitals/clinics.

I think there is a great deal of parallel between psychiatry/psychology and ophthalmology and optometry. Both psychology and optometry started off as “measurement” professionals – psychometrists measured one’s IQ or personality and optometrists measured one’s visual acuity, etc. Neither treated patients. Both professions evolved and continue to evolve to become more like clinical medicine.

That’s why I’m interested in ODs. My only concern is that there may not be a great need for ODs to expand their scope of practice, unlike clinical psychology. Severe ocular medical problems can be treated by OMDs. Less complicated ocular problems can be treated by PCPs.

That’s my two cents…
Zack

 

[Ben Chudner]

I agree with you, Dr. Chudner. I meant that since I have training in IM, I feel confident that with the proper equipment, I would be able to treat "basic" eye disorders. By that, I mean conditions that are not progressive, insidious, or invasive. Right now, I don't think I'm qualified to treat much, and I would most certainly refer the patient to more competent medical professional if he/she presented with an avulsion, enculeation, aqueous hemorrhage, lazy eye lid, nystagmus, macular degeneration, proliferative diabetic retinopathy, etc. I'm a psychiatrist. I know my area very well, but have forgotten a great deal of my IM training. That's not to say I couldn't re-learn some of it and go back to IM -- I know I could.

My only point was that internists probably treat more basic/simple eye conditions than optometrists. I have no doubt that ODs have expanded their professional scope of practice in most states and operate legally within their training. I still have a great to learn about your profession. Forgive my ignorance.

Thanks,
Zack

I think you would be surprised how much basic/simple eye conditions OD's treat. In my experience internists treat a lot of red eyes (often times with an outdated antibiotic such as sulfonimide), but that is usually the extent to which they get involved. Again, it would be helpful for me to understand your position if I knew what you thought was a basic eye condition vs a complex one.

Thanks,

Ben

 

[ProZackMI]

PART II
Rpie,

Just to comment on your point about specialists and sub-specialists and practicing with one’s area of competence.

Unfortunately for the general OMD since the sub-specialist would have given the patient the best chance of obtaining an optimal outcome, thus the argument that ensued is, why didn’t the general OMD consult the sub-specialists from the beginning? Or why didn’t the initial referring OD refer directly to the sub? In almost all cases where the OD did not refer directly to sub-specialists the OD was found partially liable. The same is also true for PCPs but since PCPs are not considered an ocular specialist the % of liability is usually small if any at all.

Essentially, I think the problem is one of ego and possibly greed. Many physicians feel that they can competently treat conditions for which they have little or no training in. This occurs across specialties. In my line of work, I am amazed and outraged to see how many GEs, OB-GYNs, cardiologists, and plastic surgeons prescribe complicated psychotropic meds to their patients. I’ve seen orthopods Rx TCAs for mild situational depression after a TKA/THA, or even after a simple ORIF of a fx. What the hell does an orthopod know about TCAs or SSRIs? They are not trained in psychotropics and should not be prescribing such powerful meds to their patients without consulting a psychiatrist. However, in medicine, there is a pervasive arrogance commonly known as the “God Complex” where the physician feels he/she is competent to treat all disorders, pathologies, and maladies known to man and beast.

This “God Complex” results in the situation(s) you referred to above. I think this problem is much more prevalent in allopathic medicine than it is in optometry. My guess is that most ODs would refer any patient that he/she did not feel competent or comfortable treating, whereas many MDs would attempt to treat the patient regardless of training or competence. I have a friend who is a vet and he told me about a cardiologist who brought in a dog with a patent foramen ovale (heart condition). The cardiologist recognized specific cardiac symptoms in his dog (e.g., dyspnea, cyanosis, and orthopnea), but instead of brining the poor canine into the vet, operated on the animal himself, which of course, made it worse since this ***** did not realize there were important differences between a canine and human heart. This idiot caused his poor pooch’s untimely demise by playing “God”.

In law school, I took many health care law classes. Among the practicing health care professions in the US, optometrists, dentists, and pharmacists are among the most trusted and respected, and consequently, are sued less for malpractice/negligence. Psychiatrists, surgeons, and chiropractors are sued the most. Many chiropractors seem to overlook their training and often feel that they are qualified to treat cancer, diabetes, GERD, depression, ADHD, etc. Many also believe they are experts on nutrition and herbal supplements. Many patients suffer because of this. My concern is that ODs might begin to adopt this attitude and try to lobby for more and more privileges. This could be dangerous.

One last comment….you mentioned ODs serving on the faculties of medical schools. At MSU College of Human Medicine, my medical school, we had many PhD psychologists in the Department of Psychiatry, one PharmD in IM and ID, a PhD audiologist in ENT, and one DPM in endocrinology. You’d be surprised at how many non-scientists and non-physicians serve on med school faculties!
Thanks,
Zack

 

[Ben Chudner]

That’s why I’m interested in ODs. My only concern is that there may not be a great need for ODs to expand their scope of practice, unlike clinical psychology. Severe ocular medical problems can be treated by OMDs. Less complicated ocular problems can be treated by PCPs.

Zack,

That is not a bad scenario - PCP's for less complicated ocular problems and OMD's for severe ocular medical problems. The problem is that PCP's are really not that qualified to treat less complicated ocular problems. I realize they have the proper background, but they just don't do it enough, and do not want to spend the money on the equipment to really be proficient. Since the real money in eyes is in the surgery, a lot of OMD's don't want to handle the less complicated stuff. That is why there is a niche for optometry. Should we continue to expand our scope? I think in a lot of states, we've gone as far as we can go with our current educational system.

There is a big misconception that all OD's want to perform surgery. I can tell you this is not the thinking of the majority of my profession. If you took a poll on SDN of all of us in practice, I would bet less than 1% believe OD's should perform surgery such as cataract extraction. Most of the expanded scope legislation that is going on now, is in states that need to catch up with the majority of the country.

 

[ProZackMI]

Zack,

That is not a bad scenario - PCP's for less complicated ocular problems and OMD's for severe ocular medical problems. The problem is that PCP's are really not that qualified to treat less complicated ocular problems. I realize they have the proper background, but they just don't do it enough, and do not want to spend the money on the equipment to really be proficient. Since the real money in eyes is in the surgery, a lot of OMD's don't want to handle the less complicated stuff. That is why there is a niche for optometry. Should we continue to expand our scope? I think in a lot of states, we've gone as far as we can go with our current educational system.

There is a big misconception that all OD's want to perform surgery. I can tell you this is not the thinking of the majority of my profession. If you took a poll on SDN of all of us in practice, I would bet less than 1% believe OD's should perform surgery such as cataract extraction. Most of the expanded scope legislation that is going on now, is in states that need to catch up with the majority of the country.

Ben, that makes A LOT of sense. I never thought about it like that. Excellent point. Thanks for feedback. Now that you explained it like you did, I can see how there is a sincere need for expanded OD scope of practice. As an MD, I can see how allopathic medicine struggles to maintain its perceived dominance over health care. This type of thinking will hopefully fade into oblivion as other health care professions expand and fill niches left by allopathic and osteopathic medicine. In some cases, we MDs have no one to blame but ourselves (e.g., psychiatry).

 

[rpie]

Oops! That last comment was edited out from a post about Optometry’s history. I inserted the wrong comment. (I am aware that medical schools have non-physician professors)

What was supposed to be inserted is, since Optometry has had OD’s that help teach and train OMD residents for the past 35 or so years, most OMDs should be aware of what OD’s capabilities are. What’s sad is when these OMDs testify in front of state legislature that OD’s only role in health care is to provide glasses and contacts. Anything beyond that is above their training.

I am also disappointed when I read posts on the Ophthalmology board from practicing OMD’s openly criticize OD’s ability’s because some of referrals they get from OD’s have a wrong initial Dx or a simple conjunctivitis. What I think these OMD fails to recognize is that when the OD refers a patient because in many cases, they are either not comfortable treating the ocular condition, not sure what they may have, or in the case of older practitioners, not comfortable using TPAs and desire that the OMD take over care. To use these examples to discredit Optometry I think is wrong and unprofessional.

Ben summarized the fight of scope expansion well. Invasive intra ocular surgery is not the goal of Optometry. OD’s goal has always been to become the primary eye care provider or “gate keep keeper” that refers to the OMD when surgical or specialized medical intervention is indicated.

A point made by Andrew Doan, which I agree with is that there are adequate numbers of ocular surgeons in this country. This is very evident in areas where the general OMDs have Optical dispensary to supplement income to cover the dwindling surgical cases that are being taken by the sub-specialists.

 

[smiegal]

.....Dry eye is a personal interest of mine, and I have presented somewhere around 100 times on the subject. I have also listened to dry eye presentations from dozens of MDs and ODs, and have only rarely failed to learn something. So, as you could imagine, I was really looking forward to this lecture.

Our speaker was a cornea specialist who began by stating that there is no real clinical difference between fluorescein and rose bengal, something even a first-year optometry student knows is absurd. As he continued, it became apparent that our lecturer had slept through more than a few basic physiology classes and seemingly had not opened a journal since he left his fellowship. While you can’t expect a person to know what they don’t know, I am still flabbergasted that anyone would willingly flaunt their own shortcomings so openly.

I sometimes get e-mails from MDs who tell me that MDs are superior to ODs. Oddly, I also get emails from ODs who tell me that they think ODs are inferior to MDs. Well, both are wrong. Knowledge and clinical ability is unique to an individual, not a profession. Stupidity however, knows no such boundaries.

1) ProZackMI - Internists do not know nearly as much about anything eye-related as do Optometrists. MAYBE some of them are more up to date about the percentage of patients with fungemia who might progress to endogenous fungal endophthalmitis (esp. if they're ID-trained), or the risk of ocular graft-vs-host, or certain meds that have dry eye side effect, or certain aspects of uveitis or neuro-ophthalmology. Again, maybe. Also, SOME ER docs might be better equipped to handle certain eye emergencies than SOME ODs. But most of this knowledge relates to when to get an Ophthalmology consult. No offense to Internists, but they know little to nothing about the eye compared to Optom's.

2) rpie - I can't believe you are still posting here after your deceit & dishonesty were exposed on a previous thread. For those who didn't see what happened, he was proven (by identical IP address) to have created (at least) one other posting handle with which he posted and gave supposed corroboration to an apparently otherwise unsupportable claim he had made. He/She is intellectually dishonest and all posts should be read in that context.

Plus, anecdotal reports of supposed incompetence by different types of eye docs (by another type) are worthless (even if not coming from someone as untrustworthy as yourself). I've got plenty of those types of anecdotes, too, but they're not appropriate or effective in this type of forum.

By the way, you gotta love the "...even a first year optometry student knows is absurd" line. Classic. Dr. Epstein sure seemed proud of himself...wonder why he felt the need to publish such an anecdote?

3) FuturedoctorOD - your fuse is amazingly short. You're right up there with Ohio State football fans on some of the football forums!

 

[smiegal]

I am also disappointed when I read posts on the Ophthalmology board from practicing OMD’s openly criticize OD’s ability’s because some of referrals they get from OD’s have a wrong initial Dx or a simple conjunctivitis. What I think these OMD fails to recognize is that when the OD refers a patient because in many cases, they are either not comfortable treating the ocular condition, not sure what they may have, or in the case of older practitioners, not comfortable using TPAs and desire that the OMD take over care. To use these examples to discredit Optometry I think is wrong and unprofessional.

Invasive intra ocular surgery is not the goal of Optometry. OD’s goal has always been to become the primary eye care provider or “gate keep keeper” that refers to the OMD when surgical or specialized medical intervention is indicated.

Couple of things. In this very thread you posted an anecdotal second-hand tale of an Ophthalmologist's supposed lack of knowledge / incompetence. Now you say this anecdote game is wrong and unprofessional? What gives?

To say intraocular surgery is not the goal of Optometry is somewhat misleading. True, 99% of OD's (Dr. Chudner's estimate) probably don't want to perform cataract extractions. We all know what the 1% accomplished in Oklahoma. It is quite reasonable for Ophthalmologists to be as concerned as we are re: some of organized Optometry's recent actions in the political forum. Until the 99% try to reign in the minority they can't be surprised by certain types of backlash.

ProZackMI - rereading your list of conditions for which you'd refer to an eye specialist (including avulsion, enucleation, aqueous hemorrhage, etc.), you should probably just refer everyone with an eye problem. Non-eye specialists truly don't have the equipment to do an appropriate eye exam. Also, only OD's and OMD's should give out any topical steriods.

As far as your point that OD's are probably less likely than MD's to refer too late, that's probably not an accurate generalization, either. That's clearly a person-dependent problem, not degree-dependent.

 

[rpie]

Couple of things. In this very thread you posted an anecdotal second-hand tale of an Ophthalmologist's supposed lack of knowledge / incompetence. Now you say this anecdote game is wrong and unprofessional? What gives?

To say intraocular surgery is not the goal of Optometry is somewhat misleading. True, 99% of OD's (Dr. Chudner's estimate) probably don't want to perform cataract extractions. We all know what the 1% accomplished in Oklahoma. It is quite reasonable for Ophthalmologists to be as concerned as we are re: some of organized Optometry's recent actions in the political forum. Until the 99% try to reign in the minority they can't be surprised by certain types of backlash.

ProZackMI - rereading your list of conditions for which you'd refer to an eye specialist (including avulsion, enucleation, aqueous hemorrhage, etc.), you should probably just refer everyone with an eye problem. Non-eye specialists truly don't have the equipment to do an appropriate eye exam. Also, only OD's and OMD's should give out any topical steriods.

As far as your point that OD's are probably less likely than MD's to refer too late, that's probably not an accurate generalization, either. That's clearly a person-dependent problem, not degree-dependent.

Smiegal-

What you might want to realize is that in our group practice there is more than one doctor here. We all use the same Internet connection and router thus having the same IP address. My associates read and occasionally post on the SDN website.

 

[PDT4CNV]

... Since the real money in eyes is in the surgery, a lot of OMD's don't want to handle the less complicated stuff. That is why there is a niche for optometry. Should we continue to expand our scope? I think in a lot of states, we've gone as far as we can go with our current educational system.

Your comment suggesting that ophthalmologists perform eye surgery because of the money is out of line. Thats like saying urologists do prostate surgery because of the money and let internists handle the less complicated stuff. It simply isn't true. Most physicians go into surgical specialties like Urology, Ophthalmology, and Otolaryngology because of the nice mix of both surgical and medical management of disease.

The practice of Ophthalmology is SURGERY. Ophthalmologists do ocular, orbital, lacrimal, and facial plastic surgery. They also treat ocular diseases. They also perform refractions. They also treat systemic disease with ocular manifestations. This is what the profession of Ophthalmology IS.

The fact is, Ophthalmology and optometry are different professions, PERIOD. Don't be confused by some optometrists who would like to blur those lines lately.

 

[maxwellfish]

The practice of Ophthalmology is SURGERY.

Then I guess they should stick to surgery.

MF

 

[PDT4CNV]

Then I guess they should stick to surgery.

MF

Keep guessing. Probably what you usually do.

 

[maxwellfish]

Keep guessing. Probably what you usually do.

Ouch, that hurts! You know the bruising of a member's ego is not tolerated here on sdn.

 

[cpw]

guys seriously.... go to your respective corners and lets take the testosterone down a few notches.

play nice !!

 

[VA Hopeful Dr]

Your comment suggesting that ophthalmologists perform eye surgery because of the money is out of line. Thats like saying urologists do prostate surgery because of the money and let internists handle the less complicated stuff. It simply isn't true. Most physicians go into surgical specialties like Urology, Ophthalmology, and Otolaryngology because of the nice mix of both surgical and medical management of disease.

The practice of Ophthalmology is SURGERY. Ophthalmologists do ocular, orbital, lacrimal, and facial plastic surgery. They also treat ocular diseases. They also perform refractions. They also treat systemic disease with ocular manifestations. This is what the profession of Ophthalmology IS.

The fact is, Ophthalmology and optometry are different professions, PERIOD. Don't be confused by some optometrists who would like to blur those lines lately.

I don't think anyone is saying that MDs should stop having clinic time and only do surgery all day every day. Think about it this way: you spend 8 years training to do ophthalmology, do you really want to spend your days doing refractions, pink eye, allergic conjunctivitis, or monitoring the progression of cataracts? If you do, that's great. However, I tend to think that most MDs like to actually put their advanced training to use. This means that in order for you guys to have time to do the surgery and see the complex cases, someone has to be around to pick up all the other stuff. That is the niche for ODs.

 

[Ben Chudner]

Your comment suggesting that ophthalmologists perform eye surgery because of the money is out of line. Thats like saying urologists do prostate surgery because of the money and let internists handle the less complicated stuff. It simply isn't true. Most physicians go into surgical specialties like Urology, Ophthalmology, and Otolaryngology because of the nice mix of both surgical and medical management of disease.

The practice of Ophthalmology is SURGERY. Ophthalmologists do ocular, orbital, lacrimal, and facial plastic surgery. They also treat ocular diseases. They also perform refractions. They also treat systemic disease with ocular manifestations. This is what the profession of Ophthalmology IS.

The fact is, Ophthalmology and optometry are different professions, PERIOD. Don't be confused by some optometrists who would like to blur those lines lately.

I suggest you reread my post. Unlike on your forum where it's been said that optometrists tend to over prescribe glasses for the money. Please don't try to pretend that if given a choice between 4 days of surgery per week and 4 days of clinic, that the majority of the ophthalmologists would choose the latter.

 

[PDT4CNV]

I suggest you reread my post. Unlike on your forum where it's been said that optometrists tend to over prescribe glasses for the money. Please don't try to pretend that if given a choice between 4 days of surgery per week and 4 days of clinic, that the majority of the ophthalmologists would choose the latter.

You are right, most Ophthalmologists would prefer to spend more time in the OR than in clinic. But, you suggest this is because "the real money in eyes is in the surgery..." This is what I have a problem with. I hate to think that either OD's or MD's make decisions based on the reimbursement. The truth is this behavior probably happens in every aspect of healthcare. But, I feel confident saying this is NOT the way the vast majority of Ophthalmologists practice. They just prefer to spend time operating because they enjoy operating. Surgery can challenging, interesting, difficult, fun, rewarding..etc.

While I can't speak for everybody, at least initially, most physicians decided to go into the surgical sub-specialty of Ophthalmology because they do enjoy some clinic time. This is in contrast to to other surgical specialties that are purely surgical, such as CV surgery, Gen surgery, Neuro surgery, etc.. Furthermore, the patients you see in clinic aren't always pink eyes and refractions, there are quite a few patients out there with very interesting non-surgical problems. Wouldn't it be nice if you could pick your patients, but you can't.

I certainly enjoy seeing and interacting with patients in clinic, I think most of my colleagues at our institution do too. Optometry has a niche, for sure, but it is not replacing the clinic time of Ophthalmology. VA Hopeful states it well, I'm not sure how many optometry folks would agree. And I think if every patient walking into my clinic was complicated and a "train wreck" I would not be happy.

What would be an interesting discussion for this group would be optometrist-Ophthalmologist relationships and what is ethical and what is not.

 

[gsinccom]

Optometry has a niche, for sure, but it is not replacing the clinic time of Ophthalmology. VA Hopeful states it well, I'm not sure how many optometry folks would agree. And I think if every patient walking into my clinic was complicated and a "train wreck" I would not be happy.

What would be an interesting discussion for this group would be optometrist-Ophthalmologist relationships and what is ethical and what is not.

what is Optometry's niche in your opinion? And why don't you start the discussion on the best optometrist/opthalmologist relationship...

 

[Ben Chudner]

I hate to think that either OD's or MD's make decisions based on the reimbursement. The truth is this behavior probably happens in every aspect of healthcare.

I am afraid you are right.

But, I feel confident saying this is NOT the way the vast majority of Ophthalmologists practice. They just prefer to spend time operating because they enjoy operating. Surgery can challenging, interesting, difficult, fun, rewarding..etc.

Forgive me if I am wrong, but I assume you are still in either a residency or fellowship. I feel very confident in saying that until ophthalmologists complete their education, they do not have an accurate understanding of what private practice entails. I worked at one of your training hospitals, working side-by-side with ophthalmology residents and fellows. That is why I truely understand the difference in training between our two professions. I have a lot of respect for your profession, but with all due respect, private practice ophthalmology is not like your residency. If you are a cataract surgeon, the majority of your private practice patients will not have ocular or systemic disease that needs to be treated in your chair. The sub-specialists will have clinics filled with disease, but not the general OMD. That is who I am talking about. If you look at the financials of a general OMD, the majority of his income comes from surgery. I can assure that when he looks at where his income comes from, he would rather be in surgery than in clinic. I don't think this is wrong. I am not saying he performs surgery on patients only because he will make more money. I believe the vast majority of surgeons make the decision to perform surgery based on the patient, and not based on how much money they will generate. I am only saying that given the choice, the majority of private practice OMD's would rather spend their time in the OR because it is more profitable.

While I can't speak for everybody, at least initially, most physicians decided to go into the surgical sub-specialty of Ophthalmology because they do enjoy some clinic time.

This may be true at first, but once you are in private practice, the bills need to get paid.

Furthermore, the patients you see in clinic aren't always pink eyes and refractions, there are quite a few patients out there with very interesting non-surgical problems. Wouldn't it be nice if you could pick your patients, but you can't.

I agree with you on this. I would not say these interesting non-surgical patients would make up a large percentage of the average private practice OMD.

I certainly enjoy seeing and interacting with patients in clinic, I think most of my colleagues at our institution do too.

You will be very successful if you enjoy interacting with your patients.

What would be an interesting discussion for this group would be optometrist-Ophthalmologist relationships and what is ethical and what is not.

I am not sure that the students on this forum, at least the 1st through 3rd years, would have the necessary experience to have this discussion, but it would be interesting to see.

 

[Richard_Hom]

what is Optometry's niche in your opinion? And why don't you start the discussion on the best optometrist/opthalmologist relationship...

Dear gsinccom,

The best relationship unfortunately is far apart in the views of each profession. The most outspoken on each side are fervent in their opinions. Here is my views, though.

1. Ophthalmology-optometry joint practice where each can share in the proceeds of their efforts. In addition, there is equity of some kind that is possible.

2. Optometrists are the first to see the patient to determine whether refractive, medical or surgical care is appropriate (or all), especially if referred by primary care medicine. Where necessary, the optometrist may definitively medically manage the patient. When appropriate, the optometrist will refer to the ophthalmologist for specialty care and return the patient to the optometrist for continuing surveillance (an example would be a diabetic who may have moderate or advance NPDR without retinal edema or thickening who is not yet ready for medical or laser surgical intervention).

3. The ophthalmologist concentrates on complex medical and surgical care. They shouldn't be seeing any well-seeing patients at all. Except for ego-hungry patients who are well-seeing, which you can never dissuade.

The above is a foundation. Anybody else want to chime in? Of course, let's not get into who is better arguement.

Richard_Hom

 

[Ben Chudner]

Dear gsinccom,

The best relationship unfortunately is far apart in the views of each profession. The most outspoken on each side are fervent in their opinions. Here is my views, though.

1. Ophthalmology-optometry joint practice where each can share in the proceeds of their efforts. In addition, there is equity of some kind that is possible.

2. Optometrists are the first to see the patient to determine whether refractive, medical or surgical care is appropriate (or all), especially if referred by primary care medicine. Where necessary, the optometrist may definitively medically manage the patient. When appropriate, the optometrist will refer to the ophthalmologist for specialty care and return the patient to the optometrist for continuing surveillance (an example would be a diabetic who may have moderate or advance NPDR without retinal edema or thickening who is not yet ready for medical or laser surgical intervention).

3. The ophthalmologist concentrates on complex medical and surgical care. They shouldn't be seeing any well-seeing patients at all. Except for ego-hungry patients who are well-seeing, which you can never dissuade.

The above is a foundation. Anybody else want to chime in? Of course, let's not get into who is better arguement.

Richard_Hom

Well said.

 

[gsinccom]

Well said.

everyone please begin to post your discussion on this topic in the new thread titled Optometrist-Ophthalmologist Relations - hope that sounds good - thanks

 

[psionic_blast]

Go to DO. They are more holistic.

 

[ariel winter]

even better: go to a doctor of naturopathic medicine. they are even mor holistic.

Go to DO. They are more holistic.