ALERT: Florida optometrists gaining ground with recent bill

[kid Icarus 3]

The below article is incredibly alarming. It was one thing to hear about the potential battle about to ensue in NC... This article already shows the ground ophthalmologists are LOSING in Florida in a big way. Honestly, we CANNOT SIT AROUND AND NOT DO ANYTHING ANYMORE. I am urging anyone reading this to write your state senator (super easy to do) and contact your state ophthalmology society and ask how you can get involved. I contacted the Florida ophtho society and they informed me that there will be a hearing about this recent bill that narrowly passed in the next couple weeks and they told me they NEED ophthalmologists (residents or practitioners) to testify at these types of meetings. If we don't do something now we will continue to lose ground and all our long years of training will be considered as "equivalent" to optoms by the government and the general public. Optoms will continue to try to get access to our procedures and privileges and we need to rally. There is so much more to say but just wanted to post this quick message. Thanks for reading!

https://www.aao.org/eye-on-advocacy-article/optometry-narrowly-clears-first-hurdle-in-florida-
(Florida optometrists have taken an early lead in their brazen attempt to earn primary-care provider status for eye diseases. A legislative proposal giving optometry laser and scalpel surgery privileges passed out of a House of Representatives subcommittee this week by a razor-thin margin. The House proposal and its Senate counterpart represent a grave danger to Florida eye patients. It would result in the Florida Board of Optometry becoming the state’s sole authority for expanding optometrists’ scope, redefining optometrists as primary eye care providers. As a result, thousands of optometrists would be elevated to nearly the same scope of eye care that is currently exclusive to ophthalmologists.)

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[sab3156]

Why aren't the big guns over at BPEI testifying? This is really unfortunate.

 

[LightBox]

Why aren't the big guns over at BPEI testifying? This is really unfortunate.

Because some of these academic docs are meek as mice and don't know what it is really like in the real world of practicing Ophthalmology.

They also are training the ODs in "ocular disease". This gives the ODs more ammunition during their testimonies to the state delegates.

If Ophthalmologists had any sense in them, they would 1) kick out ODs out of all of their training programs (e.g. Bascom) and 2) kick out and blackball any Ophthalmologist that trains an OD in any laser or surgical procedure. But many Ophthos are too meek to put up a fight and instead play the 'nice guy.'

http://optometry.nova.edu/residency/forms/internal/bascom_palmer_eye_institute.pdf

 

[jadedphysiotherapist]

Nvm

 

[hello lady!]

Because some of these academic docs are meek as mice and don't know what it is really like in the real world of practicing Ophthalmology.

They also are training the ODs in "ocular disease". This gives the ODs more ammunition during their testimonies to the state delegates.

If Ophthalmologists had any sense in them, they would 1) kick out ODs out of all of their training programs (e.g. Bascom) and 2) kick out and blackball any Ophthalmologist that trains an OD in any laser or surgical procedure. But many Ophthos are too meek to put up a fight and instead play the 'nice guy.'

http://optometry.nova.edu/residency/forms/internal/bascom_palmer_eye_institute.pdf

The ophthos are worried about losing their referrals.

All it takes is 1 ophtho in an area to say "I'm on your side!" and now they will get every cataract in the area.

 

[LightBox]

The ophthos are worried about losing their referrals.

All it takes is 1 ophtho in an area to say "I'm on your side!" and now they will get every cataract in the area.

We should post every "Uncle Tom" ophtho on a "wall of shame." The first ones that come to mind are the ones that testify in support of Optometry scope expansion bills. They are just greedy opportunists who don't care about our profession at all.

 

[OD/ MD student]

Get a grip on reality. No one profession has a lock on knowledge or exclusivity towards said knowledge. As an OD and med school student these comments are both arrogant and condescending. Been at Bascom Palmer. Did my optometry residency side by side the Ophthalmology residents at University of Kentucky. Both PRK certified, SLT certified, and YAG. Come on fellas these arent difficult procedures to do. My best friend is a DO dermatologist in Broward county and he like myself will be testifying in support of the bill. I hope I am not called an "optom" when i interview for residency programs in a few years as its rude, unprofessional and condescending. Check those egos in at the door people. I AM paying my way through med school on my PRK surgeries i perform in the summer between classes. Lets drop this "uncle tom" nonsense right now.

 

[LightBox]

Why are you in medical school? Was practicing Optometry not enough? What's the point of testifying in Florida Eric? Inquiring minds want to know.

 

[ophtholife12345]

. I AM paying my way through med school on my PRK surgeries i perform in the summer between classes.

OD/MD student: You have to understand the resentment that comes up when ophthalmology residents read this. We have done 4 years of medical school and up to almost 4 years of residency (with often awful hours) and if we were to go out and do PRK prior to finishing residency, it would be considered malpractice. And optometrists can do 4 years of optometry school and a 13 month fellowship and do PRK's. I am a resident and would love to "moonlight" doing PRK's on the side.

 

[OD/ MD student]

OD/MD student: You have to understand the resentment that comes up when ophthalmology residents read this. We have done 4 years of medical school and up to almost 4 years of residency (with often awful hours) and if we were to go out and do PRK prior to finishing residency, it would be considered malpractice. And optometrists can do 4 years of optometry school and a 13 month fellowship and do PRK's. I am a resident and would love to "moonlight" doing PRK's on the side.

Oh trust me i know the hours are ****ty, im in med school as well. I get it my brother. But the prk procedure has a fast learning curve. My first one took sbout six minutes . Next two about five and fourth just under five minutes. Alcohol takes off the epithelium, then apply the laser for roughly 30 to 45 seconds and you are done.

 

[OD/ MD student]

I e

Why are you in medical school? Was practicing Optometry not enough? What's the point of testifying in Florida Eric? Inquiring minds want to know.

I enjoyed performing the superficial and relative easy laser procedures so much i was encouraged by several ophthalmologists to harness that talent and go deeper. Optometry never will be into cataract surgery or the more invasive surgeries and i have a steady hand and great results on my surgeries. Its a passion for what i do.

 

[kid Icarus 3]

Get a grip on reality. No one profession has a lock on knowledge or exclusivity towards said knowledge. As an OD and med school student these comments are both arrogant and condescending. Been at Bascom Palmer. Did my optoetry residency side by side the Opthalmology residents at University of Kentucky. Both PRK certified, SLT certified, and YAG. Come on fellas these arent difficult procedures to do. My best friend is a DO dermatologist in Broward county and he like myself will be testifying in support of the bill. I hope I am not called an "optom" when i interview for residency programs in a few years as its rude, unprofessional and condescending. Check those egos in at the door people. I AM paying my way through med school on my PRK surgeries i perform in the summer between classes. Lets drop this "uncle tom" nonsense right now.

OD/MD - I get where you're coming from and I hear what you're saying. I really do. Furthermore - Job well done in taking the appropriate route (med school and ophthalmology residency) to further your goals regarding eye care and broadening your scope of practice to include eye surgery, etc.

I get that my first post likely seemed strong handed. It wasn't meant to be a lambast to optometrists, I'm not here to insult their intelligence or belittle what they do. I have a lot of CLOSE friends that chose optometry school coming out of college and because I was unsure of what exact medical profession I wanted I chose the MD route to keep options open. Some of those friends of mine who are optometrists were top students in my undergrad class and great people. I'm not trying to stereotype optometrists.

I feel like the language I used regarding optometry and broadening their scope of practice is by necessity strong as they continually are seeking more and more ground. What is frustrating is that optometrists are attempting to create a shortcut and it actually is insulting to those that spend 9-10 years of medical education compared to 4 years of mostly classroom learning with only 1 year of full clinic exposure in order to do some of the same procedures. And more than that you have to agree that optometry will never stop pushing for more. Ophthalmology HAS to push back because if there were no push back then optometry would want something new next year, and the year after that, and the year after that. THERE IS an option for them to do WHATEVER they want, and it is called doing what you are doing. Going to medical school and going to ophthalmology residency. It's not cool to skirt around it and just be given privileges to all these things that were at one point taught to them by ophthalmologists in the first place.

I recognize that what I'm saying probably sounds insulting to optometrists and I'm not trying to be that guy. I feel like I understand the fight to a certain degree from their side. I just feel like what they are trying to do is irresponsible and at baseline unfair to those who have worked so hard to get where they are. They are undermining the results, progress, and achievements of medical doctors and are trying to get a whole lot by not doing much at all for it.

 

[Dusn]

OD/MD - I would wait until you have finished ophthalmology before you make up your opinion. Every former-OD I know, who is now an ophthalmologists, is strongly against optometry gaining more privileges. Once you've gone through ophtho residency I think you'll realize how little you learned in optometry school. You'll also see patients being sent to you by optometrists who followed their eye disease without appropriate treatment until it reached end-stage. You'll see optometrists billing for visual fields and fundus photos for every patient who walks into their offices (using those useless FDT fields) -- every patient to many of them is a "glaucoma suspect" and every patient with pigment in the retina has a "choroidal nevus." There will be many patients who don't really have glaucoma or PCO getting YAGs and SLTs soon.

 

[MstaKing10]

You can train a monkey to do laser. That's not the point. The point is can you appropriately choose on who to laser and who not to laser and in what situations? Will laser be done when incisional surgery was the better approach because that option was not available? Also, can you deal with the complications yourself or will you need to be bailed out by an ophthalmologist? And if so how will that go over? Let's not kid ourselves here, this boils down to money and increased revenue in an ever shrinking reimbursement pot. Ultimately this space will be so crowded (if legislation passes) that everyone will lose. Please don't argue that this is what's best for patients because that's absurd.

 

[sab3156]

@OD/ MD student

The laser treatments may not be the most technically challenging things, but....

What do you make of this?

Comparison of Outcomes of Laser Trabeculoplasty Performed by Optometrists vs Ophthalmologists in Oklahoma. - PubMed - NCBI

The art of surgery isn't as simple as you are making it sound. Even a high schooler can press the pedal on the intralase and create a flap. But things can go wrong, and what will an optometrist do then? Will he be able to fix a surgical mistake or will he have to wait for an ophthalmologist to come later?

Just to clarify, not a doctor - I'm a technician at MEEI entering medical school, but have seen lots of procedures.

 

[hello lady!]

Get a grip on reality. No one profession has a lock on knowledge or exclusivity towards said knowledge. As an OD and med school student these comments are both arrogant and condescending. Been at Bascom Palmer. Did my optoetry residency side by side the Opthalmology residents at University of Kentucky. Both PRK certified, SLT certified, and YAG. Come on fellas these arent difficult procedures to do. My best friend is a DO dermatologist in Broward county and he like myself will be testifying in support of the bill. I hope I am not called an "optom" when i interview for residency programs in a few years as its rude, unprofessional and condescending. Check those egos in at the door people. I AM paying my way through med school on my PRK surgeries i perform in the summer between classes. Lets drop this "uncle tom" nonsense right now.

I e

I enjoyed performing the superficial and relative easy laser procedures so much i was encouraged by several opthalmologists to harness that talent and go deeper. Optometry never will be into cataract surgery or the more invasive surgeries and i have a steady hand and great results on my surgeries. Its a passion for what i do.

If you're trying to make the switch from optometry to ophthalmology, it would be nice if you learned how to spell our field correctly

 

[LightBox]

Just because one gets into a med school doesn't mean one gets accepted into Ophthalmology. I think putting the bullet point "Testified against Florida Ophthalmologists" under your "Extracurricular Activities" for your sfmatch application will really help you gain admission to a top 10...no, no... top 5 program. Well, as long as you are at least 45 years old when you apply.

 

[ophthope]

Get a grip on reality. No one profession has a lock on knowledge or exclusivity towards said knowledge. As an OD and med school student these comments are both arrogant and condescending. Been at Bascom Palmer. Did my optoetry residency side by side the Opthalmology residents at University of Kentucky. Both PRK certified, SLT certified, and YAG. Come on fellas these arent difficult procedures to do. My best friend is a DO dermatologist in Broward county and he like myself will be testifying in support of the bill. I hope I am not called an "optom" when i interview for residency programs in a few years as its rude, unprofessional and condescending. Check those egos in at the door people. I AM paying my way through med school on my PRK surgeries i perform in the summer between classes. Lets drop this "uncle tom" nonsense right now.

What testimony could a DO dermatologist offer in regards to this situation? Dermatologists know incredibly little about ocular surgery. Is it just because they're a doctor too? I mean if cRNAs start lobbing to do vasectomies am I going to need to take the stand as the owner of one or more testicles? I feel like I'm living in some bizarro matrix world.


And PLEASE come back on here after you get further into medical school and realize how much you didn't know that you didn't know, and especially after residency which I hope is in Ophthalmology because we really do need MORE people who were ODs first and then became OMDs so that you can actually give an informed opinion on the differences. I have no doubt what your opinion will be after being at a tertiary care hospital for residency. I am serious about this - I really hope you become an Ophthalmologist. And because of that you should really consider carefully what you're about to do if you testify. Your name will be googled when you apply to residency. If an article pops up about what you did, you're never matching.

*edit-some typos

 

[Slide]

I e

I enjoyed performing the superficial and relative easy laser procedures so much i was encouraged by several opthalmologists to harness that talent and go deeper. Optometry never will be into cataract surgery or the more invasive surgeries and i have a steady hand and great results on my surgeries. Its a passion for what i do.

I'm glad that you wanted to go further in ophthalmology and go to medical school, but statements like your first statement is what pisses me off so much. Every ophthalmologist that's finished residency knows that if your procedures are always pretty easy, you haven't done enough of them. Even these straightforward procedures can have complications if you do it on enough patients, and the tough part isn't the technique, it's the patient selection and dealing with complications and unsatisfactory results.

Get a grip on reality. No one profession has a lock on knowledge or exclusivity towards said knowledge. As an OD and med school student these comments are both arrogant and condescending. Been at Bascom Palmer. Did my optoetry residency side by side the Opthalmology residents at University of Kentucky. Both PRK certified, SLT certified, and YAG. Come on fellas these arent difficult procedures to do. My best friend is a DO dermatologist in Broward county and he like myself will be testifying in support of the bill. I hope I am not called an "optom" when i interview for residency programs in a few years as its rude, unprofessional and condescending. Check those egos in at the door people. I AM paying my way through med school on my PRK surgeries i perform in the summer between classes. Lets drop this "uncle tom" nonsense right now.

So much wrong with this. Where should I start?
-Go ahead and testify in support of this bill. What do you think your interviewers will say when they find out you've testified for optometry encroachment? Do you honestly think this will endear you towards their program?
-How do you think your upper levels also feel that you're doing PRK to pay for tuition while they're slumming away seeing 30-50 train wrecks a day without the ability to moonlight?
-It's not about a lock on knowledge or exclusivity. It's about patient safety and appropriateness. I've performed at the highest percentiles of my OKAPs and boards, but even near the end of my fellowship, I still get the fact there's not a lot I know in retina, and you have to know what you don't know. Believing otherwise is how patients suffer bad outcomes.
-Let's drop the facade: this bill is simply a way for more optometrists to gain access to the market for more money, and you're damn right that ophthalmologists are going to fight like hell to protect their livelihoods. Optometrists gaining privileges to these procedures is simply just an inroad. It won't take much of a leap in logic for the bill authors to later add PRPs, focal lasers, intravitreal injections, and lid procedures to these bills so optometrists can capture a larger market share.

Really, what ultimately is the crux of the issue is that only a small percentage of optometrists even want to do these things. However, there's been a strong push by the optometry leadership to expand privileges. I suspect a large part of it is that optometry enrollment has been increasing because, like law schools, it means more money to these institutions. Just like the surplus of lawyers not being able to find jobs, the leadership has to find ways to make sure optometrists can stay employed. Instead of pushing for more privileges, optometry leadership should take a closer look at what the optometry community truly wants.

 

[OD/ MD student]

With all due respect i am not going to shy away from testifying because of a fear of being blacklisted. I live my life pursuing the truth and the truth is tgat over 25,000 laser procedures have been performed by Doctors of Optometry over the last 20 years, safely and without incident. These procedures have provided invaluable access to health care. Ive seen Dr Mullen and Dr Katz lie through their teeth on what the bill encompasses and that disappoints me that people that should be ethical are very far from it. But in Florida its not easy to put ophthalmology and ethical in the same sentence. Dr Mendeleson is one. The dr whose medicare fraud trial is starting this week is a third. Katz and Mullen blatantly lying on their vero beach interview is another. I politely respect my peers until they step outside of bounds and lie or manipulate to achieve their end goals. Im going through med school to push me further and to become deeper than the Optometric eye surgeon I am now. But that doesnt mean im going to stop speaking the truth simply to please doctors that push the boundaries of clean living.

 

[OD/ MD student]

My

@OD/ MD student

The laser treatments may not be the most technically challenging things, but....

What do you make of this?

Comparison of Outcomes of Laser Trabeculoplasty Performed by Optometrists vs Ophthalmologists in Oklahoma. - PubMed - NCBI

The art of surgery isn't as simple as you are making it sound. Even a high schooler can press the pedal on the intralase and create a flap. But things can go wrong, and what will an optometrist do then? Will he be able to fix a surgical mistake or will he have to wait for an ophthalmologist to come later?

Just to clarify, not a doctor - I'm a technician at MEEI entering medical school, but have seen lots of procedures.

The study your referring to is the highly flawed and politically motivated jama 2016 article. That article implies that omd slt outcones are better than od procedures because of Medicare data I believe. This article is highly misleading because it implies that optometry retreats the same area with repeat slt procedures. Whereas in fact optometry performing slt treats the first 180 degrees of tge meshwork then , if warranted will treat the remaining 180 degrees. Because there is a higher standard for the procedures we perform many ods wait to see if the desired iop lowering is achieved with 180 tx vs 360. In med school this is known as correlation without causation. I was interviewed today in fact refuting this jama 2016 article and the counter reply in the Orlando Sentinel should be out tomorrow or the next day.

 

[OD/ MD student]

There

If you're trying to make the switch from optometry to ophthalmology, it would be nice if you learned how to spell our field correctly

There you go my brother. Just spell checked it for you. Didnt have time in between block 1 med exams. All good now?

 

[OD/ MD student]

I

Just because one gets into a med school doesn't mean one gets accepted into Ophthalmology. I think putting the bullet point "Testified against Florida Ophthalmologists" under your "Extracurricular Activities" for your sfmatch application will really help you gain admission to a top 10...no, no... top 5 program. Well, as long as you are at least 45 years old when you apply.

Im sure testifying to the truth is much better than all the corruption thats riddled Florida Ophthalmology as of late. But with one convicted felon omd and a second soon on the way, i would rather live my life my way compared to the Florida OMD way of life.

 

[sab3156]

My

The study your referring to is the highly flawed and politically motivated jama 2016 article. That article implies that omd slt outcones are better than od procedures because of Medicare data I believe. This article is highly misleading because it implies that optometry retreats the same area with repeat slt procedures. Whereas in fact optometry performing slt treats the first 180 degrees of tge meshwork then , if warranted willtreat the remaining 180 degrees. Because there is a higher standard for the procedures we perform many ods wait to see if the desired iop lowering is achieved with 180 tx vs 360. In med school this is known as correlation without causation. I was interviewed today in fact refuting this jama 2016 article and the counter reply in the Orlando Sentinel should be out tomorrow or the next day.

But what about the other point I asked about regarding surgical procedures gone wrong - don't you think the law should protect patients and make it so that even basic laser treatments like slt/lasik/prk are performed by someone who is surgically competent enough to manage them when things go wrong? And what about retinal procedures like injections and lasers to seal holes? Lid procedures? Remember, this is not just about basic laser treatments. Do you really think people should be under a scalpel wielded by someone who has zero systemic medical knowledge? Do you trust the pre-operative planning of such a person?

 

[OD/ MD student]

But what about the other point I asked about regarding surgical procedures gone wrong - don't you think the law should protect patients and make it so that even basic laser treatments like slt/lasik/prk are performed by someone who is surgically competent enough to manage them when things go wrong? And what about retinal procedures like injections and lasers to seal holes? Lid procedures? Remember, this is not just about basic laser treatments. Do you really think people should be under a scalpel wielded by someone who has zero systemic medical knowledge? Do you trust the pre-operative planning of such a person?

But what about the other point I asked about regarding surgical procedures gone wrong - don't you think the law should protect patients and make it so that even basic laser treatments like slt/lasik/prk are performed by someone who is surgically competent enough to manage them when things go wrong? And what about retinal procedures like injections and lasers to seal holes? Lid procedures? Remember, this is not just about basic laser treatments. Do you really think people should be under a scalpel wielded by someone who has zero systemic medical knowledge? Do you trust the pre-operative planning of such a person?

First of all the bill does not encompass anything more than the procedures we are already trained in upon. Second, the most common side affects of procedures such as slt would be post operative iop spike. With co management we are already the primary people managing 89 out of those 90 post operative days right now. So when you say what would you do or handle complications. As a doctor we use and tweak the appropriare post operative medications after the respective procedure. There are very few side affects from these surgery that arent managed with tweaking the respective steroid/ glaucoma medication (in the case of slt or steroid / antibiotic in the case of prk.

 

[Mad Jack]

Get a grip on reality. No one profession has a lock on knowledge or exclusivity towards said knowledge. As an OD and med school student these comments are both arrogant and condescending. Been at Bascom Palmer. Did my optometry residency side by side the Ophthalmology residents at University of Kentucky. Both PRK certified, SLT certified, and YAG. Come on fellas these arent difficult procedures to do. My best friend is a DO dermatologist in Broward county and he like myself will be testifying in support of the bill. I hope I am not called an "optom" when i interview for residency programs in a few years as its rude, unprofessional and condescending. Check those egos in at the door people. I AM paying my way through med school on my PRK surgeries i perform in the summer between classes. Lets drop this "uncle tom" nonsense right now.

Surgery is fine until it isn't. That's why four years of residency training is so critical. Optometrists are in no way prepared for actual surgical practice, nor should they be, as they lack the core medical training for it.

 

[immunology89]

First of all the bill does not encompass anything more than the procedures we are already trained in upon. Second, the most common side affects of procedures such as slt would be post operative iop spike. With co management we are already the primary people managing 89 out of those 90 post operative days right now. So when you say what would you do or handle complications. As a doctor we use and tweak the appropriare post operative medications after the respective procedure. There are very few side affects from these surgery that arent managed with tweaking the respective steroid/ glaucoma medication (in the case of slt or steroid / antibiotic in the case of prk.

Where is the evidence expanding these rights to other providers would solve any patient access issue?

 

[cobrastyle7]

Emailed my FL senator. Anyone in FL (or really anywhere) should do the same! Takes 10 minutes and could really make a difference. Find yours below:

Find Your Legislators - The Florida Senate

The bill is Senate Bill 1168.

Also, for some basic information on the bill, see this article in the Orlando Sentinel:

Florida optometry bill clears House subcommittee

 

[OD/ MD student]

Emailed my FL senator. Anyone in FL (or really anywhere) should do the same! Takes 10 minutes and could really make a difference. Find yours below:

Find Your Legislators - The Florida Senate

The bill is Senate Bill 1168.

Also, for some basic information on the bill, see this article in the Orlando Sentinel:

Florida optometry bill clears House subcommittee

If you want to quote the article in the Orlando Sentinel you better realize that this article is operating under misinformation. That information being namely that the JAMA article made it sound as if if optometry is performing repeat procedures over intial SLT procedures. Whomever did the JAMA 2016 article must have used Medicare data as their source. This data does not differentiate between primary and repeat procedures. Meaning was the SLT performed OVER the initial SLT procedure, or was it the remaining 180 degrees of the trabecular meshwork. Optometry tends to be much more conservative in its SLT approach and for many years has been taught to approach SLT surgery with 180 degrees first, wait for IOP lowering and then if necessary proceed on to the second 180 degrees. The obvious effect is less laser energy in the eye and therefore less risk of Intraocular pressure increase. The Orlando Sentinel article last week has the glaucoma ophthalmologist quoting this study as if this approach is a sign of decreased care... and it's not ... at all. Remember from epidemiology the famous phrase correlation does not create causation. But, if you choose to manipulate facts based on a highly suspect study then more power to you.

 

[EyeDR_oo]

With all due respect i am not going to shy away from testifying because of a fear of being blacklisted. I live my life pursuing the truth and the truth is tgat over 25,000 laser procedures have been performed by Doctors of Optometry over the last 20 years, safely and without incident. These procedures have provided invaluable access to health care. Ive seen Dr Mullen and Dr Katz lie through their teeth on what the bill encompasses and that disappoints me that people that should be ethical are very far from it. But in Florida its not easy to put ophthalmology and ethical in the same sentence. Dr Mendeleson is one. The dr whose medicare fraud trial is starting this week is a third. Katz and Mullen blatantly lying on their vero beach interview is another. I politely respect my peers until they step outside of bounds and lie or manipulate to achieve their end goals. Im going through med school to push me further and to become deeper than the Optometric eye surgeon I am now. But that doesnt mean im going to stop speaking the truth simply to please doctors that push the boundaries of clean living.

Did I catch an "optometric surgeon" somewhere in there? Who needs to check what ego at the door?

 

[OD/ MD student]

Did I catch an "optometric surgeon" somewhere in there? Who needs to check what ego at the door?

It's not really an ego check and nothing was meant in that manner. My qualifications ( as are the OD's that have advanced training on lasers and perform either SLT, YAG, capsulotomy or PRK ) are "optometric eye surgeons." Professionally that is the designation in our profession to differentiate the advanced skills. Not an ego trip at all so when patients ask if I am certified or not to perform the procedures, that differentiates between not having said certified skills. Does that make sense? A general dentist who doesn't have advanced oral facial maxillary skills wouldn't use the oral facial maxillary designation because they had not received advanced skills and doesn't do those surgeries. There's a closed facebook group "optometric eye surgeons on facebook" in which we share our clinical pearls, case studies to promote continuing improvement which of course sharpens our skills . We have a guest cardio guy from Rochester Medical today so need to get back to these power points. But, no to answer your question, no ego involved here that's simply the skills that I have acquired and what I am legally licensed to do.

 

[awftho]

If you want to quote the article in the Orlando Sentinel you better realize that this article is operating under misinformation. That information being namely that the JAMA article made it sound as if if optometry is performing repeat procedures over intial SLT procedures. Whomever did the JAMA 2016 article must have used Medicare data as their source. This data does not differentiate between primary and repeat procedures. Meaning was the SLT performed OVER the initial SLT procedure, or was it the remaining 180 degrees of the trabecular meshwork. Optometry tends to be much more conservative in its SLT approach and for many years has been taught to approach SLT surgery with 180 degrees first, wait for IOP lowering and then if necessary proceed on to the second 180 degrees. The obvious effect is less laser energy in the eye and therefore less risk of Intraocular pressure increase. The Orlando Sentinel article last week has the glaucoma ophthalmologist quoting this study as if this approach is a sign of decreased care... and it's not ... at all. Remember from epidemiology the famous phrase correlation does not create causation. But, if you choose to manipulate facts based on a highly suspect study then more power to you.

Does it not still show that you are exposing a patient to an additional procedure, and therefore are exposing the patient again to all of the potential side effects, complications and costs of that procedure?

 

[awftho]

It's not really an ego check and nothing was meant in that manner. My qualifications ( as are the OD's that have advanced training on lasers and perform either SLT, YAG, capsulotomy or PRK ) are "optometric eye surgeons." Professionally that is the designation in our profession to differentiate the advanced skills. Not an ego trip at all so when patients ask if I am certified or not to perform the procedures, that differentiates between not having said certified skills. Does that make sense? A general dentist who doesn't have advanced oral facial maxillary skills wouldn't use the oral facial maxillary designation because they had not received advanced skills and doesn't do those surgeries. There's a closed facebook group "optometric eye surgeons on facebook" in which we share our clinical pearls, case studies to promote continuing improvement which of course sharpens our skills . We have a guest cardio guy from Rochester Medical today so need to get back to these power points. But, no to answer your question, no ego involved here that's simply the skills that I have acquired and what I am legally licensed to do.

And you can hardly compare your "advanced training" to OMFS residency.

 

[OD/ MD student]

And you can hardly compare your "advanced training" to OMFS residency.

You are absolutely correct, that's why I often distinguish that by specifically saying, "PRK, SLT, YAG certified optometric eye surgeon." Ethically, that's not right to deceive implying I can do cataract or retinal surgery when I cannot. Those are the procedures I've done and am trained in upon, therefore, those are the ones that go on the signature line or header as the case may be (depending on the type of correspondece.) I DO NOT misrepresent what I am and not trained in on, especially going through medical school as you are much better off to state exactly your level of certification and skills acquired.

 

[immunology89]

If you want to quote the article in the Orlando Sentinel you better realize that this article is operating under misinformation. That information being namely that the JAMA article made it sound as if if optometry is performing repeat procedures over intial SLT procedures. Whomever did the JAMA 2016 article must have used Medicare data as their source. This data does not differentiate between primary and repeat procedures. Meaning was the SLT performed OVER the initial SLT procedure, or was it the remaining 180 degrees of the trabecular meshwork. Optometry tends to be much more conservative in its SLT approach and for many years has been taught to approach SLT surgery with 180 degrees first, wait for IOP lowering and then if necessary proceed on to the second 180 degrees. The obvious effect is less laser energy in the eye and therefore less risk of Intraocular pressure increase. The Orlando Sentinel article last week has the glaucoma ophthalmologist quoting this study as if this approach is a sign of decreased care... and it's not ... at all. Remember from epidemiology the famous phrase correlation does not create causation. But, if you choose to manipulate facts based on a highly suspect study then more power to you.

So are the ophthalmologists doing the procedure incorrectly and the optometrists doing it correctly?

 

[LightBox]

I just don't understand why Optometrists can't find pride in being called an "Optometrist". Why all of the confusing terms like "Optometric Physician" or "Optometric Surgeon" or "Therapeutic Optometrist." Oh wait a minute, I remember the answer: confusing the layperson.

Stop having such a chip on your shoulders. You will live a happier life that way

 

[EyeDR_oo]

It's not really an ego check and nothing was meant in that manner. My qualifications ( as are the OD's that have advanced training on lasers and perform either SLT, YAG, capsulotomy or PRK ) are "optometric eye surgeons." Professionally that is the designation in our profession to differentiate the advanced skills. Not an ego trip at all so when patients ask if I am certified or not to perform the procedures, that differentiates between not having said certified skills. Does that make sense? A general dentist who doesn't have advanced oral facial maxillary skills wouldn't use the oral facial maxillary designation because they had not received advanced skills and doesn't do those surgeries. There's a closed facebook group "optometric eye surgeons on facebook" in which we share our clinical pearls, case studies to promote continuing improvement which of course sharpens our skills . We have a guest cardio guy from Rochester Medical today so need to get back to these power points. But, no to answer your question, no ego involved here that's simply the skills that I have acquired and what I am legally licensed to do.

I really do get what you are saying, but on the other hand, 'Facebook closed group chat' for surgical knowledge and continuing medical education --- Impact factor?

 

[OD/ MD student]

I really do get what you are saying, but on the other hand, 'Facebook closed group chat' for surgical knowledge and continuing medical education --- Impact factor?

Well if you understand how Doctors of Optometry have been treated like **** the last few years by ASCRS, the AAO and being band from their meetings you'll understand the hesitance to make it an open group. You could go on my facebook page which has a significant amount of both ophthalmology colleagues and OD colleagues and click on Dennis Golden or his brother Dixon Golden, they are the admins of the 200 strong group of optometric eye surgeons and if you wanted to POSITIVELY contribute I'm sure they would probably allow you to join the group . They are one of the chief providers of SLT, YAG, and PI, and other minor eyelid procedures for East Texas / Louisiana with their surgery center based out of Louisiana. Their partner John McCall will soon be introducing a new lens that is likely to replace the LUNA lens in the SLT procedure. He's marketing it as a four mirror lens. Imagine that a product innovation in laser eye surgery (gasp, insert polite sarcasm) that's coming from a SLT certified optometric physician. I would agree that the free flow of knowledge amongst professionals only leaves the patients out in the cold. But, lets not forget that the ban on OD's attending AAO meetings has been around the better part of a decade. I wonder if as a medical student I can attend these meetings with my medical school ID and apply the credits towards my continuing education for OD licensure. I'll have to check into that one. Technically as a med student shouldn't I get free attendance at Academy of Ophthalmology and / or ASCRS? Then I can hang out with Dr. Mendelson and Dr. Katz and tell them how great they are....

 

[hello lady!]

So are the ophthalmologists doing the procedure incorrectly and the optometrists doing it correctly?

Well seeing as the optoms wait until after the global period so they can bill twice as much for the same amount of work, I would say that the ophthalmologists ARE doing it wrong.

 

[OD/ MD student]

I just don't understand why Optometrists can't find pride in being called an "Optometrist". Why all of the confusing terms like "Optometric Physician" or "Optometric Surgeon" or "Therapeutic Optometrist." Oh wait a minute, I remember the answer: confusing the layperson.

Stop having such a chip on your shoulders. You will live a happier life that way

If I don't specify what I do then people don't know I have the advanced training to do PRK eye surgery. Those PRK surgeries are my extra revenue in between med school, intersession, and what keeps me fed and a room over my head and keeping the exorbitant cost of med school at least somewhat in check. I guess I don't understand why Ophthalmology instead of bitching, concocting lies, distorting the truth on bogus studies (the JAMA 2016 study that everyone knows was a hit job on optometry), doesn't reach out to create the bridge program between Ophthalmology and Optometry. Look my esteemed colleagues, this issue is not going away. Instead of going full on nuclear and scorched earth in relationships with your Doctor of Optometry colleagues (not optoms to the lyrical poet earlier who threw this term out, that you know fully well is a back-handed slap in the face), why not work with the OD community to create the same type of program that exists for Dentistry but do it with Optometry. Find the middle ground in this issue, work constructively, take away your heavy handed my way or the highway approach and maybe then both sides will find the common ground. Look, over 25,000 laser procedures are in the books with no reported side effects or surgical mishaps. If ophthalmology wanted to find common ground on this they could work to set up that bridge program that way they WOULD have input into the training process of OD's. The main argument in this issue isn't what's been done safely because the OD community has an impeccable record of safe procedures. The problem, if I"m hearing my esteemed colleagues in medicine correctly is that they believe we don't have enough surgical volume to be cut loose earlier. And aside from the smart ass who made the monkey comment earlier, we are just as capable of being as skilled on these procedures as our ophthalmology counter parts just as an oral facial maxillary surgeon can be just as skilled on the Rhinoplasty's as their plastic surgeon counterparts. So, maybe now is a good time, instead of lying through ones teeth like the Dr. Katz interview in Vero Beach last week, or the glaucoma specialist who mal aligned and misquoted a medical study to the Orlando Sentinel just to scare the **** out of Florida citizens, to propose bridging and commonality and middle ground solutions. Gotta run. Bunch more lectures on fetal heart tomorrow and I need to listen to some Kahn videos to prep.

 

[immunology89]

If I don't specify what I do then people don't know I have the advanced training to do PRK eye surgery. Those PRK surgeries are my extra revenue in between med school, intersession, and what keeps me fed and a room over my head and keeping the exorbitant cost of med school at least somewhat in check. I guess I don't understand why Ophthalmology instead of bitching, concocting lies, distorting the truth on bogus studies (the JAMA 2016 study that everyone knows was a hit job on optometry), doesn't reach out to create the bridge program between Ophthalmology and Optometry. Look my esteemed colleagues, this issue is not going away. Instead of going full on nuclear and scorched earth in relationships with your Doctor of Optometry colleagues (not optoms to the lyrical poet earlier who threw this term out, that you know fully well is a back-handed slap in the face), why not work with the OD community to create the same type of program that exists for Dentistry but do it with Optometry. Find the middle ground in this issue, work constructively, take away your heavy handed my way or the highway approach and maybe then both sides will find the common ground. Look, over 25,000 laser procedures are in the books with no reported side effects or surgical mishaps. If ophthalmology wanted to find common ground on this they could work to set up that bridge program that way they WOULD have input into the training process of OD's. The main argument in this issue isn't what's been done safely because the OD community has an impeccable record of safe procedures. The problem, if I"m hearing my esteemed colleagues in medicine correctly is that they believe we don't have enough surgical volume to be cut loose earlier. And aside from the smart ass who made the monkey comment earlier, we are just as capable of being as skilled on these procedures as our ophthalmology counter parts just as an oral facial maxillary surgeon can be just as skilled on the Rhinoplasty's as their plastic surgeon counterparts. So, maybe now is a good time, instead of lying through ones teeth like the Dr. Katz interview in Vero Beach last week, or the glaucoma specialist who mal aligned and misquoted a medical study to the Orlando Sentinel just to scare the **** out of Florida citizens, to propose bridging and commonality and middle ground solutions. Gotta run. Bunch more lectures on fetal heart tomorrow and I need to listen to some Kahn videos to prep.

Why doesn't team optometry have 10 Florida patients who have suffered vision loss from lack of access to laser treatments from ophthalmologists testify? That would be a much stronger argument than and saying we haven't had any lawsuits in Oklahoma and Kentucky and complaining that ophthalmologists are a bunch of greedy liars.

 

[Slide]

My

The study your referring to is the highly flawed and politically motivated jama 2016 article. That article implies that omd slt outcones are better than od procedures because of Medicare data I believe. This article is highly misleading because it implies that optometry retreats the same area with repeat slt procedures. Whereas in fact optometry performing slt treats the first 180 degrees of tge meshwork then , if warranted will treat the remaining 180 degrees. Because there is a higher standard for the procedures we perform many ods wait to see if the desired iop lowering is achieved with 180 tx vs 360. In med school this is known as correlation without causation. I was interviewed today in fact refuting this jama 2016 article and the counter reply in the Orlando Sentinel should be out tomorrow or the next day.

First of all the bill does not encompass anything more than the procedures we are already trained in upon. Second, the most common side affects of procedures such as slt would be post operative iop spike. With co management we are already the primary people managing 89 out of those 90 post operative days right now. So when you say what would you do or handle complications. As a doctor we use and tweak the appropriare post operative medications after the respective procedure. There are very few side affects from these surgery that arent managed with tweaking the respective steroid/ glaucoma medication (in the case of slt or steroid / antibiotic in the case of prk.

Did you even read the original paper before spewing your verbal diarrhea? Your arguments sound more like talking points given by the optometric board. The primary results described that the probability of performing SLT within 11 to 30 days by an ophthalmologist after the first SLT is 1.1%, and for an optometrist performing the procedure, it was 10.3%. In addition, repeat procedures performed on eyes were consistently higher for optometrists (3.9% for OMDs versus 24.9% for ODs for 6 months; 17.7% for OMDs versus 34.3% for ODs for 3 years). You've already undermined your argument for using a higher standard because the ODs consistently have higher repeat rates, and at much sooner times than the standard of care. You can argue about how flawed Medicare data can be, but many studies, CMS, and analysis uses Medicare data for all fields of medicine. If you're using your argument about being cautious, that means the repeat procedures are due to a) treating the other 180 aggressively within 30 days due to IOP not going down, b) the initial SLT was not done properly or that the patient could not tolerate it (and if the latter is true, that's just sad on whoever is performing it), or c) the ODs performing the procedure are aggressively performing to bill outside the global period.

Your regurgitation of how you perform SLT is standard of care that ophthalmologists perform, so I'm not sure what point you're trying to prove with that. If anything, your argument is contrary to the data provided. If there were a higher standard of doing the other 180 degrees, then why was the repeat probability higher in ODs for 11-30 days after the initial procedure and 3 years out?

I enjoyed performing the superficial and relative easy laser procedures so much i was encouraged by several ophthalmologists to harness that talent and go deeper. Optometry never will be into cataract surgery or the more invasive surgeries and i have a steady hand and great results on my surgeries. Its a passion for what i do.

Oh you sweet child of summer......every OMD knows the refractive and phototherapeutic lasers aren't technically difficult once you've done enough. The clinical aspect of patient selection (like handling non-FDA approved refractive changes), adjusting your nomograms, and managing complications along with patient expectations is the real part of this all. That part you cannot just learn in a weekend course.

I don't have an agenda against optometrists either; I work with several and we help each other out a lot because we have a good working relationship, and we understand our roles in patient care. I'm going to be very frank here. I usually try to give everyone the benefit of the doubt, but based on your posts, you are the prime example of why a little bit of knowledge can be a dangerous thing. Your arrogance does not help your case either, and name dropping and talking about your life as a first year medical student is not impressing anyone here. Your attitude also isn't making any good impressions of having the OMDs work with the OD community for eye care in the future.

 

[Slide]

Why doesn't team optometry have 10 Florida patients who have suffered vision loss from lack of access to laser treatments from ophthalmologists testify? That would be a much stronger argument than and saying we haven't had any lawsuits in Oklahoma and Kentucky and complaining that ophthalmologists are a bunch of greedy liars.

Exactly. The argument about access to care is a very fallacious one, because the access issue isn't about not enough providers, it's more that many graduating providers simply don't want to go to rural areas. We're still Gen Y'ers and millenials, even with our degrees.

Plus, I'm pretty sure lack of access to PRK, SLT, or YAG capsulotomies isn't the reason why people are going blind in rural areas.

 

[LightBox]

Plus, I'm pretty sure lack of access to PRK, SLT, or YAG capsulotomies isn't the reason why people are going blind in rural areas.

From my experience, a much more common reason that patients are going blind is because some eye care providers (ahem, I won't say which suffix) delay their referrals because of their ego or because they are afraid of losing a patient. A specialist could be across the street, but the eye care provider would rather send the patient 60 miles away because of fear of losing a patient. It is always interesting to hear these patients say, "so why wasn't I just sent to you when you are so close by?" A little awkward to say the least.

 

[long]

A large measure of the issue boils down to "is there an actual need for optometrists to be doing PRK, SLT and YAGs". And the answer is a flat no. ESPECIALLY PRK. That PRK is even on the table as part of a specious push for "improved patient access and safety" is totally laughable and exposes the whole thing as just the money grab that it is. And no one is going blind waiting for a yag or continuing their travatan for a month while they wait for an SLT appointment. So what is the real argument for letting ODs do these? There isn't one.


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[LightBox]

Instead of going full on nuclear and scorched earth in relationships with your Doctor of Optometry colleagues (not optoms to the lyrical poet earlier who threw this term out, that you know fully well is a back-handed slap in the face), why not work with the OD community to create the same type of program that exists for Dentistry but do it with Optometry. Find the middle ground in this issue, work constructively, take away your heavy handed my way or the highway approach and maybe then both sides will find the common ground.

I guess the philosophical question is why does Ophthalmology always have to give up something while Optometry always just takes, takes, takes? I am sure Optometry is fighting its own scope battle with online glasses websites and the like, so how is this any different?

Unlike what ODs testify about, there is absolutely no need for more people doing eye surgery. None whatsoever. And if there is no need, then why do we need an influx of half-assed trained providers?

I'm not trying to insult any Optometrists out there, but let's face it -- most Optometry students would not be accepted into medical school and gaining an Ophtho residency spot is even tougher. So you can see the angst and backlash when less qualified people are taking shortcuts into our field especially when there is no 'eye health crisis.' Imagine when Optometrists would feel if there was suddenly a 1 year program where opticians or whoever were allowed to dispense glasses and contact lenses. ODs would wonder why they saddled themselves with 250k of debt when they could have just taken the shortcut.

 

[Eyefixer]

To ophthalmologists posting on this thread: having been on this forum over 10 years, take my word for it- there is no sense talking to these optoms who drank the Cool Aid. Don't waste your breath; you won't change their minds. And they certainly won't change ours. Therapeutic optometrist... just wow.


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[kid Icarus 3]

OD/MD - I dislike the fact that we are all arguing on here with you when you're essentially entering the same path we all are on, and for that choice I say well done. Without trying to sound omniscient on the matter I must say I'm convinced your view point will change. The only way it won't is if we are all too ruthless on here that you end up being forever irritated from this forum.

But really, my viewpoint as a early medical student to now being mid residency is 100% different with the way I appreciate and see things in medicine and ophthalmology. Even that first PGY-1 year will absolutely change you. When you're coding patients in the ICU all day, treating heart failure, HIV/AIDS, pulmonary issues, stroke patients, etc... when you are dealing with your 1-millionth narcotic addicted patient and realizing what a freaking epidemic we have on are hands then the idea of allowing optometrists to prescribe narcotics will finally manifest itself to you as complete tom foolery. I mean, geeze, I am just now getting my license to prescribe narcotics after 5 years of medical training! Not after 4 years of optometry school, (insert laugh/crying emoticon here).

It's not a slam on optometrists, or their intelligence, or their capability. They are the ones slamming us and every other dedicated professional (including yourself) that have walked the long road, done the hard time, and can appreciate the wide and deep scope of comprehensive medical and surgical eye care and how it interacts with the entire body. It can't be learned from 2 semesters of abbreviated anat and phys, or from a brief pharmacology class. Heck, everyday I realize how little I still know. You know this is true, you're a smart guy. I'm just urging you to tread lightly because in 6 years I really think you'll have a different vibe about this whole topic.

 

[OD/ MD student]

OD/MD - I dislike the fact that we are all arguing on here with you when you're essentially entering the same path we all are on, and for that choice I say well done. Without trying to sound omniscient on the matter I must say I'm convinced your view point will change. The only way it won't is if we are all too ruthless on here that you end up being forever irritated from this forum.

But really, my viewpoint as a early medical student to now being mid residency is 100% different with the way I appreciate and see things in medicine and ophthalmology. Even that first PGY-1 year will absolutely change you. When you're coding patients in the ICU all day, treating heart failure, HIV/AIDS, pulmonary issues, stroke patients, etc... when you are dealing with your 1-millionth narcotic addicted patient and realizing what a freaking epidemic we have on are hands then the idea of allowing optometrists to prescribe narcotics will finally manifest itself to you as complete tom foolery. I mean, geeze, I am just now getting my license to prescribe narcotics after 5 years of medical training! Not after 4 years of optometry school, (insert laugh/crying emoticon here).

It's not a slam on optometrists, or their intelligence, or their capability. They are the ones slamming us and every other dedicated professional (including yourself) that have walked the long road, done the hard time, and can appreciate the wide and deep scope of comprehensive medical and surgical eye care and how it interacts with the entire body. It can't be learned from 2 semesters of abbreviated anat and phys, or from a brief pharmacology class. Heck, everyday I realize how little I still know. You know this is true, you're a smart guy. I'm just urging you to tread lightly because in 6 years I really think you'll have a different vibe about this whole topic.

I understand the opioid epidemic, but most states in our narcotic prescribing ability goes no further than a seven to ten day supply of typically schedule III narcotics. Been prescribing medications for 15 years, and of the times I needed to prescribe a narcotic it was never longer than a seven to ten day period with zero refills. As I said to the Orlando Sentinel reporter yesterday in the interview, we are not and cannot contribute to the opioid epidemic on seven to ten day supply that isn't refillable. The problem lies in the chronic pain clinics (i. e. lower back, post-traumatic accident, etc.). Those are the true and real causes of the opioid epidemic. Not modulating the pain with a tough corneal abrasion or post-operative PRK healing. In fact, even tough I could prescribe a narcotic post PRK I stick to an NSAID whenever possible. There are so many states we already prescribe narcotics in and we simply ARE NOT the cause of the epidemic and will not ever be. Our scripts are highly watched and if we ever prescribed multiple refills, which we are taught we do not do, then that would be a problem. But, the reality is that problem IS NOT present and will never be present. Respectfully, gotta run and teach the med 2's everything about the eye for their OSCI ICM clinical exam including some Grave's , Cushing's, glaucoma, you know all the things that are allegedly not in our curriculum or in our patient experience (smh)....

 

[kid Icarus 3]

I understand the opioid epidemic, but most states in our narcotic prescribing ability goes no further than a seven to ten day supply of typically schedule III narcotics. Been prescribing medications for 15 years, and of the times I needed to prescribe a narcotic it was never longer than a seven to ten day period with zero refills. As I said to the Orlando Sentinel reporter yesterday in the interview, we are not and cannot contribute to the opioid epidemic on seven to ten day supply that isn't refillable. The problem lies in the chronic pain clinics (i. e. lower back, post-traumatic accident, etc.). Those are the true and real causes of the opioid epidemic. Not modulating the pain with a tough corneal abrasion or post-operative PRK healing. In fact, even tough I could prescribe a narcotic post PRK I stick to an NSAID whenever possible. There are so many states we already prescribe narcotics in and we simply ARE NOT the cause of the epidemic and will not ever be. Our scripts are highly watched and if we ever prescribed multiple refills, which we are taught we do not do, then that would be a problem. But, the reality is that problem IS NOT present and will never be present. Respectfully, gotta run and teach the med 2's everything about the eye for their OSCI ICM clinical exam including some Grave's , Cushing's, glaucoma, you know all the things that are allegedly not in our curriculum or in our patient experience (smh)....

You're missing the point again. And you can't speak for optometrists at large and say no one does more than 7-10 days and that they know what they are doing. You can't speak for the endless amount of optometrists who have no idea about the narcotic epidemic and have never treated a pain patient. In this climate we need to be restricting who can give narcotics, not broadening scope to those who are under educated about them.

If you really believe that optometrists should be granted the power to prescribe narcotics then I'm afraid you're totally lost on the conversation. And furthermore it shows you don't understand the opioid epidemic as I've actually spoken to multiple patients first hand that indeed we're hooked on shorter than a 10 day course. And the smug remark and the end was anything but respectful, so don't say respectfully. We disagree, so be it, but man, I'll be curious to see how you've evolved 6 years from now.