To all the practicing optometrists out there--

[luckyfool]

Hi, I think most of you know the usefulness and importance of fluorescent angiography in helping with diagnosis -- mainly used by ophthalmologists. Is there any way for optometrists to get the training to do it too?

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[POJO]

There are two sides here.

1. First the patient preparation, injection, photography side of it
2. Second the interpretation.

Which do you want information on?

 

[rpames]

I'm 5 months from being a practicing OD, but this is my opinion. FA's are great...but does an OD really need to do it? I will and do practice full scope optometry and as aggressive with my scope at possible, but if you thing you need as FA, shouldn't you be sending this patient to a retinal specialist anyway. One thing I learned on externs, is "know your limits." I'm currently working with several OMDs, and they never hesitate before sending a patient to another doctor. If the anterior seg guy thinks there is some neo going on, they refer it to the retina guy to decide if a FA is needed.

From a practice management side, how often would you need to do one? The equipment is expensive, the liability is relatively high, and the staff person to do it would demand a high salary. You could do the FA yourself (if your state allows you to) but why would you, the doctor, spend 30 minutes getting all setup and doing the test and getting paid like $50 from the insurance when you could see a full general exam and make $300 on services and material sales in the same time frame?

If you really want to get an FA, you can send it to an office that does it and have them send you the films. In school you will learn to read them so why not have another office do the test and submit the procedure code modifier and you can submit for the interpretation code modifier. That way you can get the info and not worry about having the equipment in your office. In the 2 years I have been seeing patients as a student doctor, I have only wanted an FA for myself a handful of times. Otherwise I have been working with a retina guy that needed them. So, as an OD practice in a private office without a retina specialist in the next room, I don't imagine needing a FA more than a few times a year. So the cost effectiveness of having my own just does not sound like a good financial move.

With all the said, I'm just a 4th year. I could be completely wrong.

 

[POJO]

RPAMES has a point. Why are you interested in it? That is why I proffered the question of whether you want to perform the FA or you want to read it or you want to offer it?

In most cases, optometrists aren't likely to offer t his service independently of an ophthalmologist.

 

[r_salis]

Besides North Carolina and VA hospitals (and Oklahoma?), which states grant the right to perform FAs?

 

[luckyfool]

I'm 5 months from being a practicing OD, but this is my opinion. FA's are great...but does an OD really need to do it? I will and do practice full scope optometry and as aggressive with my scope at possible, but if you thing you need as FA, shouldn't you be sending this patient to a retinal specialist anyway. One thing I learned on externs, is "know your limits." I'm currently working with several OMDs, and they never hesitate before sending a patient to another doctor. If the anterior seg guy thinks there is some neo going on, they refer it to the retina guy to decide if a FA is needed.

From a practice management side, how often would you need to do one? The equipment is expensive, the liability is relatively high, and the staff person to do it would demand a high salary. You could do the FA yourself (if your state allows you to) but why would you, the doctor, spend 30 minutes getting all setup and doing the test and getting paid like $50 from the insurance when you could see a full general exam and make $300 on services and material sales in the same time frame?

If you really want to get an FA, you can send it to an office that does it and have them send you the films. In school you will learn to read them so why not have another office do the test and submit the procedure code modifier and you can submit for the interpretation code modifier. That way you can get the info and not worry about having the equipment in your office. In the 2 years I have been seeing patients as a student doctor, I have only wanted an FA for myself a handful of times. Otherwise I have been working with a retina guy that needed them. So, as an OD practice in a private office without a retina specialist in the next room, I don't imagine needing a FA more than a few times a year. So the cost effectiveness of having my own just does not sound like a good financial move.

With all the said, I'm just a 4th year. I could be completely wrong.

I'm more concerned about optometrists' ability to perform the procedure, rather than their need to do it. I'm completely unconcerned on whoever that do FAs. I'm just interested to know how to get the training. That's all. I thought it was a straight forward question.

 

[VA Hopeful Dr]

I'm more concerned about optometrists' ability to perform the procedure, rather than their need to do it. I'm completely unconcerned on whoever that do FAs. I'm just interested to know how to get the training. That's all. I thought it was a straight forward question.

1) Make sure you practice in a state that allows you do to it (they are very few in number).

2) I would suspect, like many other learned techniques, that you'll go through some type of training. Weekend seminar perhaps, then make sure you have all the proper equipment in your office to be prepared for adverse reactions.

 

[POJO]

I'm more concerned about optometrists' ability to perform the procedure, rather than their need to do it. I'm completely unconcerned on whoever that do FAs. I'm just interested to know how to get the training. That's all. I thought it was a straight forward question.

Then all you need to do is to work for a retinal surgeon or an eye surgeon and hope or make that one of the requirements for the job. I was recruited by several ophthalmic surgeons to take over the diabetic and glaucoma practice while they did just the lasers and he added that a 2 week training period to read FA's could be arranged with the local university.

You need to see a lot of them to get comfortable.

 

[DrEyeBall]

Is 2 weeks really enough? During an ophthalmology residency you spend months looking at FA's and then most general guys do not do them, they send them to a retina person knowing that these guys keep up on the latest information, techniques and literature regarding the indications for treatment, etc.

If it were your eye would you rather have someone with 2 weeks of training do it and read it and make the decision about the need for further consultation or would you like to have the guy who does dozens of these each and every day do it?

Why offer your patients something different than what you would personally want?

 

[KHE]

Is 2 weeks really enough? During an ophthalmology residency you spend months looking at FA's and then most general guys do not do them, they send them to a retina person knowing that these guys keep up on the latest information, techniques and literature regarding the indications for treatment, etc.

If it were your eye would you rather have someone with 2 weeks of training do it and read it and make the decision about the need for further consultation or would you like to have the guy who does dozens of these each and every day do it?

Why offer your patients something different than what you would personally want?

Most general ophthalmolgists don't do them because they aren't going to treat anything they find so there is not much point or financial gain in doing them.

Before anyone gets their knickers in a knot, I think this also applies to ODs. The few times that I have worked in environments where I have had FA available to me as an OD, I used it to determine if exudation or leakage was present or not. If there was, out they went. This was all done with the IHS where the nearest retinal surgeon was 4 hours away.

For the most part, FA is not something that the overwhelming majorities of ODs need to have at their disposal, and the ones that do are likely working in very unusual environments, or are working alongside retina specialists.

 

[DrEyeBall]

I agree with that. In situations where far travel is an issue that makes sense. However, when there is a retina specialist nearby, it makes little sense to be doing these. In most cases, it does not save a referral and in a good number of cases, it means the patient will have the test repeated which is a waste of time and money

 

[POJO]

Dr EyeBall,

I don't think any one is trying to presume, subsume or assume the duties of an ophthalmologist. It was a simple question. If the poster says that they wanted to do them (inject and interpret) that is one thing. If the the poster wanted it just for information that is another.

Let's see what the poster meant before jumping down anyone's throat. I always wondered why some trolled other forums and say such accusatory stuff.

 

[DrEyeBall]

My comment was not directed to the original poster. It was directed toward the idea that a 2 week course could prepare you to perform and evaluate FAs in a manner to best help your patients.

 

[luckyfool]

thanks for all your inputs. i'd like to know if anyone can offer specifics in terms of the actual training. do optometry schools teach FA and require students to practice it? and is there some sort of certificate that gives you the right to perform FA?

 

[Ben Chudner]

thanks for all your inputs. i'd like to know if anyone can offer specifics in terms of the actual training. do optometry schools teach FA and require students to practice it? and is there some sort of certificate that gives you the right to perform FA?

I don't know how the schools do it now, but I received very little FA training at Berkeley. We had a lecture on it, but we were not equipped at the time for the retina specialist to order them on campus so there was little opportunity to learn. That may have changed (I graduated in 1997). During my residency, however, we went to FA conference with the ophthalmology residents every week. We also had the opportunity to work in retina clinics with the ophthalmology faculty and some of them were willing to teach the OD residents. I have a lot of experience reading FA's and after my residency felt very comfortable interpreting them. That being said, there really is no place in an optometric practice for FA's. If an FA is required, then it should be performed at the office of the physician that will have to treat if necessary. Even if I could perform FA's in my office I wouldn't.

 

[luckyfool]

I don't know how the schools do it now, but I received very little FA training at Berkeley. We had a lecture on it, but we were not equipped at the time for the retina specialist to order them on campus so there was little opportunity to learn. That may have changed (I graduated in 1997). During my residency, however, we went to FA conference with the ophthalmology residents every week. We also had the opportunity to work in retina clinics with the ophthalmology faculty and some of them were willing to teach the OD residents. I have a lot of experience reading FA's and after my residency felt very comfortable interpreting them. That being said, there really is no place in an optometric practice for FA's. If an FA is required, then it should be performed at the office of the physician that will have to treat if necessary. Even if I could perform FA's in my office I wouldn't.

Is there some kind of person out there that's trained to just do FAs all the time? Like a FA technician? All he/she does is FA?