Ben Chudner said:
"look he only did a weekend course with a few cases under supervision".
You said it, not me. I'm going to take a few minutes to respond to this, even though my wife is rolling her eyes at me. I can appreciate that you must be a bright, motivated self-starter, because I'm sure a year at Bascom Palmer is not easy. I'm sure that you're so bright (seriously, no sarcasm here) that you can turn any educational experience into much more than it was intended to be. Take optometry school, for instance. Like your colleagues posting on this forum, even futuredoctorod, I don't think that optometric education on the whole can currently prepare optometrists to do surgery, including anterior segment lasers.
I had the opportunity during my residency to spend a fair amount of time with optometry students and residents at PCO during my residency, and I would have classified none of them as *****s. I certainly had a fair amount of respect for their profession, and (to the horror of many ophtho residents on this forum) allowed them to watch me perform LPIs, YAG capsulotomies, and DLTs. All I can say is that there's something about being trained to approach the eye from a surgical standpoint that sets the two professions apart. I think PCO is a fairly well-regarded school, but I got questions from those students that led me to believe that there was a fundamental lack of understanding. All of this transpired prior to the current major push for surgical privileges, so I didn't give it much thought. Now, of course, I'm absolutely incensed that a minority of optometrists think that a weekend course is adequate.
What could go wrong? Plenty.
What is your next step going to be when your angle closure patient doesn't respond to a PI? Send him/her packing to an ophthalmologist? Good choice, except that now the eye is angrier, the cornea has sloughed because of your attempt, and the patient has wasted another hour or two with an IOP in the stratosphere. That's going to be a treat to deal with.
What about DLTs? Pressure spikes that you can't handle. It's less common than it used to be, but not at all extinct. My last one was a long and protracted spike into the 50s that didn't even respond to Diamox. Two days later, I did a trab. Sure, you could send the patient off to the local ophthalmologist, but having to sort out someone else's mess and establish rapport right before surgerizing a patient isn't exactly optimum.
What about YAG capsulotomies? These are benign enough, but I'm of the opinion that if I put a lens in an eye, I don't want an optometrist mucking around with it. It's OK for the patient to make the hour's drive to be sure it's done right, because there's nothing like a nice big pit in the middle of the lens to make the patient happy. There are a good percentage of times when a patient's symptoms are generated by the lens, not the PCO, and doing a capsulotomy is only going to make the lens exchange that much more difficult. Again, this is a call I think only the surgeon should make.
Good God, I'm exhausted. I can appreciate that you're out to save the world with a laser, or at least save your patients a few bucks in gas, but let's consider something else. Each of your patients only has two eyes. That means that an individual patient can have a MAXIMUM of two capsulotomies, four DLTs (180 each time), and two PIs. That's eight trips that you've saved this remarkable patient over his or her LIFETIME. I don't know about you, but where I come from people think nothing of making an hour's drive to go to a decent mall, let alone have surgery.
I'll tell you what. Just to give us all a reality check and demonstrate how altruistic your field is, why don't you tell me how much the AOA would back a bill that allowed all anterior segment lasers except PRK, LASIK, and LASEK.
I'm going to bed now.
