AOA's "Desired State" of Optometry Includes Surgery

[John_Doe]

April 27, 2006

AOA's "Desired State" of Optometry Includes Surgery

The development of a nationwide, uniform, self-regulated licensure with an available residency program in optometric surgery topped the list of priorities established at a national summit hosted by the American Optometric Association. Optometrists also agreed to:

Strive for the delivery of care "with no restrictions on physical location, affordability or scope of practice."
Employ new technologies that "will allow optometry to focus more on diagnosing and treating ocular and systemic conditions/diseases."
Seek public recognition of optometry as the industry leader in development of "optical, medical, functional and technological advances" relating to eye care and eye health.
The Academy's Surgical Scope Fund is our most effective tool for warding off optometry's extreme vision of quality patient care. Your contributions provide the resources that make our efforts so successful: radio and print public education materials, expert political consultation, professional lobbyists and communications specifically targeted at lawmakers wherever optometry pushes its surgical agenda.

Please Act Today to ensure surgery by surgeons with a $1,000, $500 or $365 contribution to the Surgical Scope Fund. Optometry's "desired state" does not have to be your future.
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Oklahoma no longer appears to be an aberration; numerous states throughout the country have had surgical-scope bills, laser-scope bills, narcotics bills, and oral-scope bills. Optometry’s threat of creating a “parallel profession” therefore needs to be taken very seriously. The take-home lesson is, the absent are in the wrong. If you are not involved in the political system, it is assumed that you do not care. Get involved with your state and national academies, or optometry will define ophthalmology.
http://www.crstoday.com/PDF Articles/1004/F8_Lanciano.html

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Members don't see this ad.

 

[RonaldColeman]

April 27, 2006

AOA's "Desired State" of Optometry Includes Surgery

The development of a nationwide, uniform, self-regulated licensure with an available residency program in optometric surgery topped the list of priorities established at a national summit hosted by the American Optometric Association. Optometrists also agreed to:

Strive for the delivery of care "with no restrictions on physical location, affordability or scope of practice."
Employ new technologies that "will allow optometry to focus more on diagnosing and treating ocular and systemic conditions/diseases."
Seek public recognition of optometry as the industry leader in development of "optical, medical, functional and technological advances" relating to eye care and eye health.
The Academy's Surgical Scope Fund is our most effective tool for warding off optometry's extreme vision of quality patient care. Your contributions provide the resources that make our efforts so successful: radio and print public education materials, expert political consultation, professional lobbyists and communications specifically targeted at lawmakers wherever optometry pushes its surgical agenda.

Please Act Today to ensure surgery by surgeons with a $1,000, $500 or $365 contribution to the Surgical Scope Fund. Optometry's "desired state" does not have to be your future.

Barf...

 

[smiegal]

Seek public recognition of optometry as the industry leader in development of "optical, medical, functional and technological advances" relating to eye care and eye health.

Industry leader in medical technological advances...hmmm.

What do the resident SDN OD's think about this radical mission statement? Do any of you still belong to this organization?

 

[blazenmadison]

Industry leader in medical technological advances...hmmm.

What do the resident SDN OD's think about this radical mission statement? Do any of you still belong to this organization?

I will be attending opt school next fall.

I have no interest in performing surgeries, otherwise I would have applied to med school.

The objective of this sensational article is your money. Donate to a noble cause and prevent ODs from doing surgeries.

But it does bring up my concern that ODs will be able to one day perform surgeries in many states and unlicensed opticians will be doing a lot more refractions. Ophthalmology isn't looking too good. What are the chances that the OD will become doctor of optometric medicine. If DPMs and dental surgeons can function outside the realm of MD/DO, what is stopping other fields from gaining more turf. Some psychologists have prescribing powers and I also read that some pharm.d's want to prescibe too. What a shame.

 

[Caffeinated]

I am no longer a member of AOA (American Optometric Association), but not for political reasons. I cancelled my membership after I started med school 3 years ago. It didn't seem worth it to keep my membership since I would no longer be practicing optometry. As a side note, I still maintain my membership as a Fellow of the American Academy of Optometry. I had to work for fellowship, so it means more to me. It's more of an accomplishment, and the AAO tends to be more of an academic and research-oriented organization.

Does anyone have any links to AOA positions or any other optometry organizations with position statements on "desired states"? I am quite sure that there are individual optometrists that have agendas similar to that which the OP describes, but I was curious to see if there was an official AOA position statement that I could review.

 

[POJO]

The American Optometric Association is not unlike many other professional organizations. In my opinion the AOA is quickly losing relevance to many practitioners who see more pressing issues rather than optometric surgery. I feel that painting all optometrists as supporting this position will only inflame the situation. I would guess (SWAG) that only 5% or less support his initiative.

Non-AOA member.

 

[xmattODx]

I'm not an AOA member because it seems to me that they are trying to take optometry in a direction I am not comfortable with.

 

[vtrain]

I'm not an AOA member because it seems to me that they are trying to take optometry in a direction I am not comfortable with.

Agreed. This is one of the reasons why I left the profession. There is little reason why an optometrist should be doing surgery. It will be a gross diservice to our patients should this be allowed to occur on a major front. If you want to do surgery, go get your MD.

 

[Elephantitan]

I appreciate your opinions, and as an ophtho resident, I would be interested in your obviously unscientific but honest opinion as to the percentage of optoms who think similarly. It's not the same to still pay dues to the optom society that is so vigorously pushing expanded surgical scope as it is to vote with your pocketbook and stop paying dues and get out of the society (like several of you have). Money talks and lack of money can't talk on a national level and more people getting out of a society that is pushing the desires of a few is likely what will have to happen for the optoms to abandon this mission so we can all coexist a little more peacefully.

 

[Visioncam]

Why don't they add that the desired state of optometry also includes cosmetic surgery, including breast enlargement and liposuction? Have they also thought of selling lottery tickets, cigarettes, making copies of keys, shoe shine, notary public, and Fedex services? Hey, ophthalmologist could add that to an optical shop, if they have one (i.e. Glasses and Lottery Tickets).

 

[John_Doe]

AOA Calls Entire House of Medicine "the Enemy"

Physicians are mobilized to win much-needed regulatory and legislative battles, and our recent successes have put other groups on notice. The American Optometric Association (AOA) recently issued a desperate warning to its members saying, "Our opponent is not just ophthalmology but the entire house of medicine…. Organized medicine is more aggressive and better organized than at any time in the past." The national optometry lobby has mounted a new plan to raise $1.5 million for their PAC this election cycle. To be ready, our Academy has a major goal this year of expanding the numbers of ophthalmologists who give to OPHTHPAC. The AOA's funding goal is a wake-up call to all of ophthalmology that we need to do better. Please join OPHTHPAC today.

 

[Caffeinated]

Again, I am left with the same question as before. Do you have any links to any statements directly from AOA? Any plea to join a PAC is always going to contain a certain degree of spin. I don't doubt that there are some optometrists that might think this way, but I would like to see something directly from the AOA rather than the interpretation that John Doe provides.

 

[ddown]

The AOA should be focusing on more pressing OD issues such as oversupply, student debt, and commercialization. The AOA leadership is being quite myopic in their view of the future.

 

[Mirror Form]

Again, I am left with the same question as before. Do you have any links to any statements directly from AOA? Any plea to join a PAC is always going to contain a certain degree of spin. I don't doubt that there are some optometrists that might think this way, but I would like to see something directly from the AOA rather than the interpretation that John Doe provides.

Your request for a link is certainly reasonable. However, keep in the mind that John Doe has posted on here multiple times over the past several years, and his information has been accurate so far.

 

[Caffeinated]

I am sure John Doe is a trustworthy guy. And like I said before, I don't doubt that there are optometrists whose "desired state" is exactly what JD outlines. As a former optometrist myself, I am sure I could even name some for you. Furthermore, this may be the official position of AOA. But without more objective information, his post is simply a fundraiser disguised as an accusation.

 

[drgregory]

most ODs dont want to do eye surgery anything more invasive than removing a chalazion/lash epilation/fb removal/. we actually have greater internal problems than trying to become jr ophthalmologists. as stated above, our problem lies in oversupply, commercialization, and a VERY large current spectrum of training/mentality.
i can see why OMDs are leary of us with all of our corporate ODs degrading eye care, and with all of our outdated refractionists ODs who graduated in the era where they were basically trained as opticians. please realize that it only is a small (very small) percentage of ODs who are attempting to gain major eye surgery privileges. most of us want to be THE primary eye care provider, and most of us have realized that WORKING WITH surgeons is both economically rewarding and patients get the best in care. ophthalmologists doing surgery, and optometrists doing primary eye care, and both being happy with what they are doing (and chose as a career path). a dream, perhaps.

 

[georgeyboy]

What I don't get is why MD's are against optometrists doing any form of "cutting" at all yet are perfectly fine with what dentists do every day. Dental school and optometry school are the same length. I'm sure that optometry schools could put in classes on some basic eye surgery such as dentists do basic mouth surgery. I don't really understand why opthalmology isn't like oral surgery is with dentistry, a specialization after optometry school.

 

[ophtho1122]

OMFS "dental surgeons" have to finish dental school, plus do two years of medical school, plus do a surgical residency in OMFS. It is alot more involved than you alluded to. Many years of training after dental school, with actual medical school and surgical training in a surgical residency.

What I don't get is why MD's are against optometrists doing any form of "cutting" at all yet are perfectly fine with what dentists do every day. Dental school and optometry school are the same length. I'm sure that optometry schools could put in classes on some basic eye surgery such as dentists do basic mouth surgery. I don't really understand why opthalmology isn't like oral surgery is with dentistry, a specialization after optometry school.

 

[drgregory]

our training is limited on surgical technique (in this case limited = very little exposure (observing only), depending on optometry school). removal of small lid lesions and injections is about the limit. i would say we certainly have the anatomical knowledge upon completion of optometry school that would afford us a similar option (residency) as mentioned above with dentistry. however, most of us really only have a desire to limit our "surgery" to small lid lesions and perhaps yag, but really have no plans of becoming cataract et al surgeons. most of us already work with surgeons, and just have them drop in for even the above mentioned things (lid lesions and other minor things). real-life anatomy (ie surgical cases and exposure) is needed, in my opinion, for oculoplastic, corneal, and any globe penetrating surgical technique. we just dont get alot of it in optometry school - we may get to see a staff OMD doing it, but obviously not us. really there isnt a demand for more ocular surgeons. we already have very, very highly trained eye surgeons, and they are called ophthalmologists. its just that every now and then, due to oversupply of ODs and OMDs, we get some cowboys who want to practice out of their realm - meaning ODs doing surgery and OMDs doing primary care. part of it (in my opinion) is because optometry has its own problems. i touched on them above. we have some ODs, usually older ones, who were trained as basically an optician. their knowledge of eye disease and medical treatment of such is limited. recent graduates are frusterated because their knowledge is far beyond what the everyday optometric encounter entails. of course, the fact that most new ODs end up in shopping malls doesnt help. do you think mother will bring "little johnny" to the place next to the hair salon to get his red eye treated? really, we should cut back optometry school admission and ophthalmology residencies and see where we're at. i bet you'd see less problems with either party overstepping, and also by that time you'd see the old curmudgeon (sp?) ODs and OMDs retire - its those folks who dont realize that working together is symbiotic. happiness would reign on planet eyecare. this is a recurring dream i have - thought id just share it.

 

[PDT4CNV]

I would have to say that this is the worst analogy ever. There is no such thing as "medical dentistry." Dentristy is a procedure based specialty. The majority of the time spent in dental school is learning the procedures and surgical techniques to be a dentist. There is no comparison to optometry school.

I understand that most optometrists have no interest in surgery. But despite all of this talk about working together, most OD's have NOT quit their national academy that recently declared war on ophthalmology and called all of organized medicine, the enemy. Drop your academy membership and stop making waves. Stop donating to your political lobby. Then maybe more people will believe you as sincere.

This niche that optometry is carving out as the "primary eye care provider" is sort of bizarre as well. The idea that ophthalmologists are out of their realm prescribing glasses or owning optical shops is silly. The patient volume that most ophthalmology residents see is much higher than that of optometry students, that graduating ophthalmologists have prescribed far more glasses than most ODs going into practice.

I would have to disagree with the most recent comment. Removing lid lesions, laser procedures, and injections of any kind are not in the realm of the optometrist or optician. This sort of thing should not exist in OD school or in any OD practice.

I truly believe there is some value left in medical school, internship, residency and becoming a licensed board certified physician or surgeon. I'm scared to think that the future doctors and surgeons of america will be a bunch of nurse practicioners, pyschologists, optometrists, pharmacists, and physical therapists.

Anyway, I know who my family and I will be seeing. It will be the most knowledgable, most highly trained and rigorously tested group of health care providers, not the opposite.

 

[VA Hopeful Dr]

This niche that optometry is carving out as the "primary eye care provider" is sort of bizarre as well. The idea that ophthalmologists are out of their realm prescribing glasses or owning optical shops is silly. The patient volume that most ophthalmology residents see is much higher than that of optometry students, that graduating ophthalmologists have prescribed far more glasses than most ODs going into practice.

Anyway, I know who my family and I will be seeing. It will be the most knowledgable, most highly trained and rigorously tested group of health care providers, not the opposite.

When it comes to glasses/contacts Rx-ing, I'd prefer to go to an OD. I would suspect that they spend more time learning the science behind refractions and contact lens fittings. MDs spend 3 years learning EVERYTHING there is to know about the eyes/orbits. ODs spend 3 years on the eye, but in less detail on certain areas and more emphasis, I suspect, on vision sciences (I cut a year out of OD school to allow to basic sciences that don't directly affect the eyes).

Besides, even ignoring all that, my experience has been that more ODs do the refraction personally compared to MDs. Anecdotal, I know, but that's just me.

That said, I agree with you that for any complex medical or any surgical, I'd go to an MD.

 

[HOLLYWOOD]

Unfortunately, optometry's leaders have misrepresented od's throughout the country. the biggest problem that ods have is they are slowly being taken over by corporate america ie. costco, walmart ,lenscrafters. MOST ODS DON'T EVEN WORK FOR THEMSELVES. most ods are just trying to make a living, not do surgery. these students that are posting know NOTHING about the profession. as far the leaders of optometry they should get out in the real world to see what is really going on. as you guys may know most ods are not part of the aoa. (though i'am). another problem optometry has, is that it is graduating 70% women. most will work full time for about 5-6 years then cut back to part time.

 

[drgregory]

The patient volume that most ophthalmology residents see is much higher than that of optometry students, that graduating ophthalmologists have prescribed far more glasses than most ODs going into practice.

so youre saying that surgeons have more experience/training in refractive and binocular evaluation than ODs? thats as ridiculous as saying ODs have more training in surgical/medical eye care than surgeons. unbelievable. "id trust my grandmother with an optometrist doing a scleral buckle" = "id rather have my grandmother undergo refractive care from her ophthalmologist".

 

[Mirror Form]

The idea that ophthalmologists are out of their realm prescribing glasses or owning optical shops is silly. The patient volume that most ophthalmology residents see is much higher than that of optometry students, that graduating ophthalmologists have prescribed far more glasses than most ODs going into practice.

Perhaps, but OD's definitely focus greater of prescribing glasses during training, but that's beside the point. OMD's shouldn't be doing a lot of glasses prescriptions. It doesn't matter if we're trained well to do it. We still should do our best to respect the OD's turf so that they'll likewise respect the turf of OMD's.

A good analogy would be retinal surgeons doing cataract procedures. If there is a good general ophthalmologist readily available, then that is who does the phaco. It doesn't matter that the retinal surgeon may have actually done more cataract surgeries during residency.

 

[PDT4CNV]

Perhaps, but OD's definitely focus greater of prescribing glasses during training, but that's beside the point. OMD's shouldn't be doing a lot of glasses prescriptions. It doesn't matter if we're trained well to do it. We still should do our best to respect the OD's turf so that they'll likewise respect the turf of OMD's.

That is absurd...Refraction is a big part of ophthalmologic training, and you think they they should just avoid doing it.

Guess who developed nearly all of the currently used refractive techniques?
OPHTHALMOLOGISTS. And you think it is not their turf.

Herman Snellen-Ophthalmologist-20/20 notation
FC Donders-Ophthalmologist-developed scientific basis of refraction
Cuignet-ophthalmologist-developed retinoscopy
Jackson-Ophthalmologist-popularized retinoscopy, developed the cross-cyliner
Hemholtz-Ophthalmologist-invented the ophthalmoscope
Gullstrand-Ophthalmologist and nobel prize winner-extensive work on physiologic optics and astigmatism
Hjalmar Schiotz-ophthalmologist-developed the tonometer
Adolf Fick-physiologist and physician-developed the first true contact lens
American Ophthalmologic Society-the very first medical specialty organization in the US, and Ophthalmology was the first specialty board examination

..And the list goes on and on.

Ophthalmologists developed the techniques of refraction that we still use today and have been practicing them and building upon them for over a century.

The idea that optometrists are somehow better than ophthalmologists at refraction is absurd and without any basis to support it other than the picture of optometry that is painted for the public by optometry.

I guess its just too easy to steal the knowledge and discoveries of another profession, and then claim that your profession is better at it and has the "turf" rights to it.

Anyway, there is no arguing this point, the "big bad MDs" just can't be good at everything, how is that possible. There must be a place for OD's, there just has to be, right? And it is the job of the MD's to terminate portions of their practice to make room for the OD's and "respect" their turf.

Your "theories" that OD's focus more on refraction are unfounded. The scleral buckle analogy was ridiculous. And binocular vision/strabismus? You honestly believe that? This whole discussion is ridiculous.

 

[VA Hopeful Dr]

The idea that optometrists are somehow better than ophthalmologists at refraction is absurd and without any basis to support it other than the picture of optometry that is painted for the public by optometry.

Your "theories" that OD's focus more on refraction are unfounded. And binocular vision/strabismus? You honestly believe that? This whole discussion is ridiculous.

I certainly hope that my ophthalmologist spends more of his time learning about disease and surgery than he does refracting and learning all about contact lenses. And take a look at OD school curriculum. They spend quite a bit of time on all the different aspects of refraction/contact lenses. I'm sure MDs are very good at all that, but my guess is that ODs are better.

 

[Hines302]

i changed my mind. not worth the response.

 

[smiegal]

its just that every now and then, due to oversupply of ODs and OMDs, we get some cowboys who want to practice out of their realm - meaning ODs doing surgery and OMDs doing primary care.


really, we should cut back optometry school admission and ophthalmology residencies and see where we're at.

I can't even believe you compared ODs doing surgery to Ophthalmologists doing primary care. Maybe I'm misunderstanding your point, but WTF?

The oversupply of OD entry spots is undeniable. I disagree with reducing Ophthalmology residency spots due to the Baby Boomer effect, we'll be needed.

 

[smiegal]

MDs spend 3 years learning EVERYTHING there is to know about the eyes/orbits.

Don't fool yourself, MDs spend 8 years learning about medical/surgical treatment of the eyes/orbits. I use so much of my first 5 years of medical training every day. There's unbelievable amount of knowledge and skills that go into complex eye care.

 

[VA Hopeful Dr]

I can't even believe you compared ODs doing surgery to Ophthalmologists doing primary care. Maybe I'm misunderstanding your point, but WTF?

The oversupply of OD entry spots is undeniable. I disagree with reducing Ophthalmology residency spots due to the Baby Boomer effect, we'll be needed.

I agree with you in part, I don't believe there are too many MDs to meet the needs that are out there. As to the primary care, I think Dr. Gregory is just rehashing what's been said here before. As a practicing ophthalmologist, which would you rather see more of in your office: 20-30 year old patients for yearly check-ups who, at most, need some Patanol for their allergies; or, more eldery patients with a whole host of health problems as well as macular degeneration, possibly some diabetic retinopathy, and likely a touch of glaucoma on top of that? This is especially true if you have a very busy practice and the more urgent patients would have to wait a few days/weeks longer if you saw lots of the 1st type of patient.

Don't fool yourself, MDs spend 8 years learning about medical/surgical treatment of the eyes/orbits. I use so much of my first 5 years of medical training every day. There's unbelievable amount of knowledge and skills that go into complex eye care.

Your medical school must focus on eyes more than mine, or perhaps just more in the later years that I am unaware of. Having just completed my M1 year, we didn't spend much time at all. 1 hour lecture on the anatomy, 1 hour lecture on microanatomy, and 4 hours of neuro. To my mind, that isn't very much. But, as I mentioned, I'm very open to the possibility that my school doesn't teach as much as others or that more is taught later.

 

[drgregory]

my family doctor treated a tooth abscess during his residency. he is an expert on all dental care, and i'll be going to him for my 6 month cleanings as well.
the idea that surgeons are THE expert in refractive care is absurd. surely, thats not saying that one cannot position themselves to become an expert, however the fundamental aspect of optometry school lies in refractive theory and practice, whereas a surgical residency is focused on surgery. again, what one does after their surgical residency could certainly make their practicing knowledge of refractive care elite. yes i realize that there is a good portion of didactic and practical care for refraction/binocular testing during a surgical residency, but what do you think we do in optometry school most of the time during those 4 years? im tired with what this thread has become. we've obviously filtered out the cowboy OMDs who think they are the authority on every aspect of eye care. maybe i could give some of you maverick OMDs the telephone numbers of some of our cowboy ODs who want to try to be surgeons and let your parties argue. the rest of us who seem to get along and dont have to bark at each other as to who is the "best" at this and that are busy.
please just let us "little optometrists" cling to our "little island" of eye care - refraction.

 

[PDT4CNV]

my family doctor treated a tooth abscess during his residency. he is an expert on all dental care, and i'll be going to him for my 6 month cleanings as well.
the idea that surgeons are THE expert in refractive care is absurd. surely, thats not saying that one cannot position themselves to become an expert, however the fundamental aspect of optometry school lies in refractive theory and practice, whereas a surgical residency is focused on surgery. again, what one does after their surgical residency could certainly make their practicing knowledge of refractive care elite. yes i realize that there is a good portion of didactic and practical care for refraction/binocular testing during a surgical residency, but what do you think we do in optometry school most of the time during those 4 years?

The point has sort of been lost here. It is impossible to say physicians vs optometrists are superior at refraction. It is entirely an individual thing. Some physicians intensely dislike refraction or choose not to do it. But overall, some are better than others in either field. I think the point that was trying to be made was that

1) Refraction is not the "turf" of the optometrist. If an ophthalmologist chooses to do refractions, and many do, that they are equally as qualified to do so. And, it is perfectly appropriate for them to do so.

It is very easy to make generalizations that optics and refractive theory are taught in more detail in optometry school. But not generalizing and actually looking at specifics, most graduating ophthalmology residents will have refracted many more patients than a graduating optometry student. That is fact. Hardly a family doctor treating one tooth abscess. Poor analogy.

2) What might be considered minor procedures such as giving ocular or periocular injections and biopsying lid lesions or performing laser surgery,these have no place in optometry practice or school. These procedures constitute the practice of medicine and require medical training and a medical license which means medical school, internship, residency, USMLE 1,2,3 and boards.

Just a quick comment to the medical student. As a first year, you really have no place to comment on what is taught in medical school with regard to the eye. You will soon learn in the next few years of your training that many diseases can have profound ocular, neurologic, and systemic effects more than you now realize.

Just to list some you may have heard of by now:
Pseudotumor Cerebri
Syphilis
Tuberculosis
Rheumatoid Arthritis
Sarcoidosis
Waegners Granulomatosis
HSV
VZV
Seronegative Spondyloarthropathies
Polyarteritis Nodosa
Bechets disease
Myotonic Dystrophy
Eaton-Lambert
Myasthenia-Gravis
Thyrotoxicosis
Neurofibromatosis
Lymphoma
Leukemia
Relapsing Polychondritis
GC and Chlamydia
Stevens-Johnsons
Pemphigoid
Sturge Weber
Cat-scratch
CNS meningiomas and gliomas
Miller-Fisher Synd/Guilon Barre
Cystinosis
Wilsons disease
Lyme disease
Toxoplasmosis
Cerebrovascular disease
Fungal septicemia
Inflammatory bowel disease
Trisomy 13
Hypertension
Diabetes
Carotid Occlusive disease
Multiple Sclerosis
Trauma affecting the facial skeleton/orbit (Lefort fractures)
Tumors involving the orbit, cavernous hemangioma, rhabdomyosarcoma, fibrous histiocytoma
Lacrimal gland tumors (pleomorphic adenoma, adenocystic carcinoma)
Tumors affecting the lids, cornea, and conjunctiva (squamous cell ca, basal cell ca, sebaceous cell Ca)
Intraocular tumors (uveal melanomas, medulloepitheliomas, retinoblastomas, hemangioblastomas, melanocytomas)
AIDS
Pagets
Sickle Cell
PXE
Sjogren
Bacterial Endocarditis
Oculopharyngeal Dystrophy
Gardner Syndrome
Refsum disease
Tay Sachs
Devic's disease
Carotid-Cavernous fistula
Fabry's disease
Giant Cell Arteritis
Meretoja Syndrome and other amyloidoses
Progressive Supranuclear Palsy and other parkinsons-like diseases
Wilm's Tumor (WAGR)
Von Hippel Lindau disease
Wernicke Encephalopathy
Neuroblastoma
Horners Syndrome (apical lung ca, paraganglioma, etc..)


Jeez, I could go on forever. And these are systemic diseases involving the eye that often are diagnosed by or managed by/with ophthalmologists. Look them up and I think you will find that what you learn in medical school is extremely pertinent to the practice of ophthalmology. And then there is the list of "primary" ocular diseases.

Ophthalmologists require a very good foundation and broad base of medical knowledge. Then there is the surgical training and surgical knowledge. There is a reason why only the top students in any given class match in ophthalmology. Anyways, if you decide to pursue ophthalmology, you will see that you diagnose quite a lot of very interesting diseases and manage these and comanage these with other physicans in a variety of specialties. It is just too early for you to say much about what medical school teaches regarding ophthalmology based on what you learned in gross anatomy and neuroscience. The other thing you have to remember, and should be obvious to you by now, is that what you hear in lecture is not the only thing you need to know, there is much to be learned by reading on your own time. This particularly true for residency, nobody is going to lecture to you, you have to read the appropriate journals and textbooks on your own time for whatever specialty you go into.

Please don't take offense, but I was a first year medical student at one point too. I know what you know. Good luck in your training.

 

[VA Hopeful Dr]

The point has sort of been lost here. It is impossible to say physicians vs optometrists are superior at refraction. It is entirely an individual thing. Some physicians intensely dislike refraction or choose not to do it. But overall, some are better than others in either field. I think the point that was trying to be made was that

1) Refraction is not the "turf" of the optometrist. If an ophthalmologist chooses to do refractions, and many do, that they are equally as qualified to do so. And, it is perfectly appropriate for them to do so.

Ok, that's fair enough. My reaction was based on the assumption that more ODs care about doing refractions than MDs. Just my experience, of course.

2) What might be considered minor procedures such as giving ocular or periocular injections and biopsying lid lesions or performing laser surgery,these have no place in optometry practice or school. These procedures constitute the practice of medicine and require medical training and a medical license which means medical school, internship, residency, USMLE 1,2,3 and boards.

Agreed

Just a quick comment to the medical student. As a first year, you really have no place to comment on what is taught in medical school with regard to the eye. You will soon learn in the next few years of your training that many diseases can have profound ocular, neurologic, and systemic effects more than you now realize.

Just to list some you may have heard of by now:
Pseudotumor Cerebri
Syphilis
Tuberculosis
Rheumatoid Arthritis
Sarcoidosis
Waegners Granulomatosis
HSV
VZV
Seronegative Spondyloarthropathies
Polyarteritis Nodosa
Bechets disease
Myotonic Dystrophy
Eaton-Lambert
Myasthenia-Gravis
Thyrotoxicosis
Neurofibromatosis
Lymphoma
Leukemia
Relapsing Polychondritis
GC and Chlamydia
Stevens-Johnsons
Pemphigoid
Sturge Weber
Cat-scratch
CNS meningiomas and gliomas
Miller-Fisher Synd/Guilon Barre
Cystinosis
Wilsons disease
Lyme disease
Toxoplasmosis
Cerebrovascular disease
Fungal septicemia
Inflammatory bowel disease
Trisomy 13
Hypertension
Diabetes
Carotid Occlusive disease
Multiple Sclerosis
Trauma affecting the facial skeleton/orbit (Lefort fractures)
Tumors involving the orbit, cavernous hemangioma, rhabdomyosarcoma, fibrous histiocytoma
Lacrimal gland tumors (pleomorphic adenoma, adenocystic carcinoma)
Tumors affecting the lids, cornea, and conjunctiva (squamous cell ca, basal cell ca, sebaceous cell Ca)
Intraocular tumors (uveal melanomas, medulloepitheliomas, retinoblastomas, hemangioblastomas, melanocytomas)
AIDS
Pagets
Sickle Cell
PXE
Sjogren
Bacterial Endocarditis
Oculopharyngeal Dystrophy
Gardner Syndrome
Refsum disease
Tay Sachs
Devic's disease
Carotid-Cavernous fistula
Fabry's disease
Giant Cell Arteritis
Meretoja Syndrome and other amyloidoses
Progressive Supranuclear Palsy and other parkinsons-like diseases
Wilm's Tumor (WAGR)
Von Hippel Lindau disease
Wernicke Encephalopathy
Neuroblastoma
Horners Syndrome (apical lung ca, paraganglioma, etc..)


Jeez, I could go on forever. And these are systemic diseases involving the eye that often are diagnosed by or managed by/with ophthalmologists. Look them up and I think you will find that what you learn in medical school is extremely pertinent to the practice of ophthalmology. And then there is the list of "primary" ocular diseases.

Ophthalmologists require a very good foundation and broad base of medical knowledge. Then there is the surgical training and surgical knowledge. There is a reason why only the top students in any given class match in ophthalmology. Anyways, if you decide to pursue ophthalmology, you will see that you diagnose quite a lot of very interesting diseases and manage these and comanage these with other physicans in a variety of specialties. It is just too early for you to say much about what medical school teaches regarding ophthalmology based on what you learned in gross anatomy and neuroscience. The other thing you have to remember, and should be obvious to you by now, is that what you hear in lecture is not the only thing you need to know, there is much to be learned by reading on your own time. This particularly true for residency, nobody is going to lecture to you, you have to read the appropriate journals and textbooks on your own time for whatever specialty you go into.

Please don't take offense, but I was a first year medical student at one point too. I know what you know. Good luck in your training.

I'm never one to take offense when someone is offering to teach me things I don't know. Your point is well taken, and I'll gladly concede it.

 

[qwopty99]

Anyway, I know who my family and I will be seeing. It will be the most knowledgable, most highly trained and rigorously tested group of health care providers, not the opposite.

so your family member has an aniseikonia problem. who do u go to? can u design an iseikonic correction? can u speak on behalf of other OMDs? i've written a paper on aniseikona - have you?

i happen to be an OD - but I'm about the most pro-MD OD you'll ever meet. back in OD school, i was often offended by comments made by those "King and Queen" ODs who basically went around calling ODs "Doctors" and MDs "GPs" (i.e. not really good at anything). i even confronted OD professors IN LECTURE when they MD-bashed. i'm the type who likes to view both sides of the fence, so when i meet those cowboy ODs, i'll confront them as much as anyone else will.

but then i read biased posts written by people like you - the suggestion above, presumably, is that ODs aren't highly trained at anything (re: "not the opposite").
i consider myself an expert at refraction - make your case that I'm not, simply because i'm an OD and not an MD.

i'm sorry - but it's OMDs like you that galvanize optometrists like us to expand our scope without regard for your interests. in any case, the law dictates what we can and can't do - and as long as there are more and more OMDs with attitudes like u, i'll feel less and less inclined to see your side of the fence, and just take the rights to prescribe topicals and oral drugs, surgery etc. etc., rather than try to sympathize with your arguments as to how things might be done differently.

Signed:

An OD who works in a non-optometry environment medical school, who was just given topical and oral TPA rights recently in his home province.

 

[JR]

Lets keep it civil, people. I don't want to start deleting posts and closing threads.

 

[PDT4CNV]

but then i read biased posts written by people like you - the suggestion above, presumably, is that ODs aren't highly trained at anything (re: "not the opposite").
i consider myself an expert at refraction - make your case that I'm not, simply because i'm an OD and not an MD.

B]

Signed:

An OD who works in a non-optometry environment medical school, who was just given topical and oral TPA rights recently in his home province.

Dont take things out of context. There is no suggestion as to that. Please dont put words in my mouth. As I said in my last post, the point was getting lost in bickering, and now your getting personal. I specifically remarked on this issue in my previous post that it is NOT appropriate to say a physician versus an optometrist is superior at refraction. This is a generalization that cannot be made.

I will admit that I may be biased, because I see who is making waves. These issues are being discussed so vigorously not because of any agenda that physicians have, but because of the agenda of a small group of optometrists. And while, as you say about yourself, most optometrists do not agree with this agenda, they continue to support it by remaining members of their national academy and through monetary donations to support political lobbying.

I have no specific dislike for optometrists in general or the field. But medicine and optometry are two different fields, with a small amount of overlap.

There are areas of optometry that I will say most optometrists probably have more experience than most physicians and these are things such as low vision, contact lens, orthoptics, orthokeratology.

Remember why this thread was started, the optometry national academy declared war on ophthalmology and all of organized medicine. Keep in mind who is attacking and who is on the defensive. And remember, nobody claimed that physicians were superior at refraction, the claim was that physicians are NOT as well trained at refractions or "primary care" and should not be doing it. This is simply not true. So, please keep the appropriate perspective and do not get personal when responding to posts.


Have a nice weekend.

 

[Hines302]

Remember why this thread was started, the optometry national academy declared war on ophthalmology and all of organized medicine.

We still have no evidence to support this! No online documentation or links to specific articles. Such a bold statement like this from the AOA would have be mentioned someplace else right?? so where is it?

This "statement" from the AOA never even was discussed on ODwire.org. Did 4,000 ODs miss this and choose not to discuss it... or is it propaganda from a couple OMDs??

I also feel OD's have no place performing surgery. However they can do a lot more than refractions. The most successful OMD practices have already realized this, and use ODs to treat minor medical conditions, and manage ocular diseases. This year the University of Kentucky Hospital - Ophthalmology Department as added residency spots for ODs in ocular disease… GASP!

 

[PDT4CNV]

We still have no evidence to support this! No online documentation or links to specific articles. Such a bold statement like this from the AOA would have be mentioned someplace else right?? so where is it?

This "statement" from the AOA never even was discussed on ODwire.org. Did 4,000 ODs miss this and choose not to discuss it... or is it propaganda from a couple OMDs??

I've seen the article, and copy of it was emailed to ophthalmology academy members via the academy's online newsletter, so it has been widely distributed. Why you cannot seem to find it, well, that I cant answer.

 

[blazenmadison]

Remember why this thread was started, the optometry national academy declared war on ophthalmology and all of organized medicine.

*Facepalms*

 

[VA Hopeful Dr]

I've seen the article, and copy of it was emailed to ophthalmology academy members via the academy's online newsletter, so it has been widely distributed. Why you cannot seem to find it, well, that I cant answer.

I don't doubt the existence of said article. I even think its doing optometry a disservice. But, I'm not sure its a genuine reflection of the AOA's current goals. I would suggest that its merely an attempt to get more money from members. Professional scare tactics can work wonders.

As a side note, just for information purposes: there are 2 different national OD groups. The AOA (optometric association) is the political arm, the AAO (academy) is the research/clinical one.

 

[Mirror Form]

I specifically remarked on this issue in my previous post that it is NOT appropriate to say a physician versus an optometrist is superior at refraction. This is a generalization that cannot be made.

The fact is that while ophthalmologists are definitely qualified to refract, *in general* we don't spend nearly as much time (upon finishing residency) refracting as OD's do. Therefore, *in general* we're probably not going to be as good. Perhaps I'm wrong, but I think it's a logical conclusion.

As far as my scleral buckle example being ridiculous, it's really not. You just have a misunderstanding of the concept of what "turf" is. It doesn't necessarily correlate to training or competence. As I mentioned earlier, plenty of retinal surgeons do far more cataracts in training then many general ophthalmologists. But after training they stop doing them b/c it's not their turf anymore, regardless of competence. Likewise, OMD's are qualified to spend all day prescribing glasses, but right now that is more the OD's turf and we should let them have it. Otherwise you're just asking for OD's to try and seek new turf.

Now don't get me wrong, I'm not saying the OMD's should never ever do any refracting. I'm just saying that they shouldn't make glasses prescriptions a significant part of their business.

 

[PDT4CNV]

The fact is that while ophthalmologists are definitely qualified to refract, *in general* we don't spend nearly as much time (upon finishing residency) refracting as OD's do. Therefore, *in general* we're probably not going to be as good. Perhaps I'm wrong, but I think it's a logical conclusion.

As far as my scleral buckle example being ridiculous, it's really not. You just have a misunderstanding of the concept of what "turf" is. It doesn't necessarily correlate to training or competence. As I mentioned earlier, plenty of retinal surgeons do far more cataracts in training then many general ophthalmologists. But after training they stop doing them b/c it's not their turf anymore, regardless of competence. Likewise, OMD's are qualified to spend all day prescribing glasses, but right now that is more the OD's turf and we should let them have it. Otherwise you're just asking for OD's to try and seek new turf.

Well, all I can say is that I do understand what you are saying, but just completely disagree. Sorry.

 

[John_Doe]

I don't doubt the existence of said article. I even think its doing optometry a disservice. But, I'm not sure its a genuine reflection of the AOA's current goals. I would suggest that its merely an attempt to get more money from members. Professional scare tactics can work wonders.

As a side note, just for information purposes: there are 2 different national OD groups. The AOA (optometric association) is the political arm, the AAO (academy) is the research/clinical one.

If you just perform a basic web search you can find articles including this one, http://www.aao.org/aao/news/washington/article3_20060427.cfm. I am not a member of AOA and did not attend the summit meeting, so I cannot give any direct evidence, but trust that I have reliable information.

I do not agree with any attacks on the messenger, just disagree with the message. I have friends and colleagues who are optometrists, and know that there are both competent and less competent ophthalmologists as well as optometrists. The key is to continue with and find better ways to work together.

I gave these posts so that people are aware of some of the issues that they will face. And believe that without personal involvement in advocacy, the delivery of health care will be controlled by others. I also believe at the forefront of all this are the various local, state, and national organizations like AAO and AOA. And contributing time and money to the respective PACs is a form of political insurance for your future - just like life, health, malpractice, etc insurance. And I have contributed to the Surgical Scope Fund as well as OPHTHPAC.

Really, one of the big issues now that will affect everyone in health care are the upcoming cuts in Medicare - this is definitely something that ophthalmology, optometry, and others in health care can fight together.

They propose to cut Medicare by almost 5% 2007, and by 34% over the next nine years. Ophthalmology patients are 60% medicare, and reimbursement rates for all carriers are based on medicare rates. Imagine you are in practice and your overhead is about 80%, and your overall revenue falls just 5% (even while you might be working longer hours and see more patients). After paying off overhead, you are left with 25% less overall profit.

Medicare wants to reduce payments by 34% over nine years - and this does not include the basic core inflation rate (which causes compounded depreciation of the dollar) or the increase in the costs of practice (which may rise 22% over the next 5-10 years).

I guess I am going off on a tangent.

 

[HOLLYWOOD]

no you are not . these are the issues we should be discussing.

 

[smiegal]

Refraction is not the "turf" of the optometrist. If an ophthalmologist chooses to do refractions, and many do, that they are equally as qualified to do so. And, it is perfectly appropriate for them to do so.

Pseudotumor Cerebri
Syphilis
Tuberculosis
Rheumatoid Arthritis
Sarcoidosis
Waegners Granulomatosis
HSV
VZV
Seronegative Spondyloarthropathies
Polyarteritis Nodosa
Bechets disease
Myotonic Dystrophy
Eaton-Lambert
Myasthenia-Gravis
Thyrotoxicosis
Neurofibromatosis
Lymphoma
Leukemia
Relapsing Polychondritis
GC and Chlamydia
Stevens-Johnsons
Pemphigoid
Sturge Weber
Cat-scratch
CNS meningiomas and gliomas
Miller-Fisher Synd/Guilon Barre
Cystinosis
Wilsons disease
Lyme disease
Toxoplasmosis
Cerebrovascular disease
Fungal septicemia
Inflammatory bowel disease
Trisomy 13
Hypertension
Diabetes
Carotid Occlusive disease
Multiple Sclerosis
Trauma affecting the facial skeleton/orbit (Lefort fractures)
Tumors involving the orbit, cavernous hemangioma, rhabdomyosarcoma, fibrous histiocytoma
Lacrimal gland tumors (pleomorphic adenoma, adenocystic carcinoma)
Tumors affecting the lids, cornea, and conjunctiva (squamous cell ca, basal cell ca, sebaceous cell Ca)
Intraocular tumors (uveal melanomas, medulloepitheliomas, retinoblastomas, hemangioblastomas, melanocytomas)
AIDS
Pagets
Sickle Cell
PXE
Sjogren
Bacterial Endocarditis
Oculopharyngeal Dystrophy
Gardner Syndrome
Refsum disease
Tay Sachs
Devic's disease
Carotid-Cavernous fistula
Fabry's disease
Giant Cell Arteritis
Meretoja Syndrome and other amyloidoses
Progressive Supranuclear Palsy and other parkinsons-like diseases
Wilm's Tumor (WAGR)
Von Hippel Lindau disease
Wernicke Encephalopathy
Neuroblastoma
Horners Syndrome (apical lung ca, paraganglioma, etc.

Great list - that is exactly what I was talking about, but without the legwork. The "eye training" argument (4 yr OD vs 3 yr Ophthalmology) seems to come up in these types of threads without much perspective into the role of 4 yrs of medical school training in the practice of ophthalmology.

I would, obviously, have no problem with anyone in my family getting a refraction from an OD or an MD. I'd probably send a child family member to a Peds Ophthalmologist, but otherwise would be perfectly content with anyone else.

 

[drgregory]

If you just perform a basic web search you can find articles including this one, http://www.aao.org/aao/news/washington/article3_20060427.cfm. I am not a member of AOA and did not attend the summit meeting, so I cannot give any direct evidence, but trust that I have reliable information.

I do not agree with any attacks on the messenger, just disagree with the message. I have friends and colleagues who are optometrists, and know that there are both competent and less competent ophthalmologists as well as optometrists. The key is to continue with and find better ways to work together.

I gave these posts so that people are aware of some of the issues that they will face. And believe that without personal involvement in advocacy, the delivery of health care will be controlled by others. I also believe at the forefront of all this are the various local, state, and national organizations like AAO and AOA. And contributing time and money to the respective PACs is a form of political insurance for your future - just like life, health, malpractice, etc insurance. And I have contributed to the Surgical Scope Fund as well as OPHTHPAC.

Really, one of the big issues now that will affect everyone in health care are the upcoming cuts in Medicare - this is definitely something that ophthalmology, optometry, and others in health care can fight together.

They propose to cut Medicare by almost 5% 2007, and by 34% over the next nine years. Ophthalmology patients are 60% medicare, and reimbursement rates for all carriers are based on medicare rates. Imagine you are in practice and your overhead is about 80%, and your overall revenue falls just 5% (even while you might be working longer hours and see more patients). After paying off overhead, you are left with 25% less overall profit.

Medicare wants to reduce payments by 34% over nine years - and this does not include the basic core inflation rate (which causes compounded depreciation of the dollar) or the increase in the costs of practice (which may rise 22% over the next 5-10 years).

I guess I am going off on a tangent.

now youre talking. these are exactly the things that we should be working together on. get this - for a phaco cat surgery some of the private insurers in my area pay only three times what they pay for a comprehensive exam + refraction (surgeon's reimbursement, not facility). the skill level for cataract surgery, as well as the ancillary personal required, should very much exceed three times what it takes to perform a comprehensive eye examination. im saying this as an optometrist. i work in a multispecialty group, and the surgeons, other ODs and myself had a long discussion on this. some of us were really unaware of this dwindling reimbursement. it floored me. i realize the training it takes AS WELL AS THE RISK/LIABILITY one assumes for cataract surgery. the fact that the reimbursement is going down every year is even more alarming. with ALL OF EYECARE WORKING TOGETHER, we'd have much more power. however, optometry in itself has its own problems. obviously, we have our cowboys who want to be major eye surgeons. we also have an ever growing population of corporate ODs who either dont realize or dont care that they are giving away their services for less that what it costs for a haircut. sorry for the tangents.

 

[c_mor]

I'm a resident who can't afford to donate the sums you suggested.
Is there anything else I can do to advocate consistent and safe practice in the field of eye surgery within the political spectrum?

 

[VA Hopeful Dr]

I'm a resident who can't afford to donate the sums you suggested.
Is there anything else I can do to advocate consistent and safe practice in the field of eye surgery within the political spectrum?

Call up your state's ophthalmological society, there's always things you can do and they can direct you. Writing your congressmen and your educating patients (ideally without actually degrading the abilities of ODs) are good places to start.

 

[ODhopeful]

I'm an incoming 2nd year in OD school. I am wondering if OMDs insist on doing refractions as well, then is there really a need for ODs. I am asking because I feel that optometry may begin to lose its place in the medical field and may soon become obsolete.