Expanded Scope of Practice in KY (close to becoming a reality)

[JaggerPlate]

Ever thought more people are choosing optometry school now over medical school even though they would have gained admission to both? A lot of my peers ever since Day 1 in undergrad were always like MED SCHOOL, MED SCHOOL, MED SCHOOL, without even researching other options. They just do it because everyone else does it.

Now I'll throw out some maybes too lol

Maybe eyes are what people are set on during undergrad.

Maybe people don't want to spend 4 years of medical school learning extraneous information like how to do a prostate exam. (And trust me a lot of my friends in med school are complaining they aren't really learning anything useful at this point) Like with organic chemistry (that we can all relate to), which surgeon remembers the details of an SN1 reaction by the time they are doing appendectomies for example.

Maybe specialists like ophthalmologists are going to get owned by obamacare.

Are matriculants to med school intelligent? Yes, very.
Is med school harder? Yes.
Should ophthalmologists bash and keep optometrists down even though they want to learn more and help patients in more diverse ways that have low-risk of injury with the advent of new technology? No.

Your points and arguments are starting to make less and less sense as time goes on.

No - any reasonable hospital would not let me perform whipples and bypasses and knee replacements.

However, when you want to do your first YAG or SLT, sight path (or whatever it is called) will come running to assist- I can tell you if you give them the $100 dollar click fee per YAG, they will tell you that you are the best surgeon around (too bad there will only be about $80 left over for you).

I personally believe that if optometry has access to YAGs, SLT, ALT it would likely drive down the payments of these procedures. This point has been made before, but there will be without a doubt more utilization (some appropriate use, some perhaps inappropriate). As a procedure is coded for more often, medicare typically will pay less each year (ie intravitreal injections and OCT have taken major hits recently - injections could become money losers if this trend continues - they are definately money losers now if even one of your patients does not pay for the lucentis). Therefore, be careful what you ask for in future bills - before you pick up the skills needed for the surgery, it may be a money loser. Just something to think about....

KHE ... I started typing out a response, but 200 essentially made the point well enough.

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[200UL]

Ever thought more people are choosing optometry school now over medical school even though they would have gained admission to both? A lot of my peers ever since Day 1 in undergrad were always like MED SCHOOL, MED SCHOOL, MED SCHOOL, without even researching other options. They just do it because everyone else does it.

Now I'll throw out some maybes too lol

Maybe eyes are what people are set on during undergrad.

Maybe people don't want to spend 4 years of medical school learning extraneous information like how to do a prostate exam. (And trust me a lot of my friends in med school are complaining they aren't really learning anything useful at this point) Like with organic chemistry (that we can all relate to), which surgeon remembers the details of an SN1 reaction by the time they are doing appendectomies for example.

Maybe specialists like ophthalmologists are going to get owned by obamacare.

Are matriculants to med school intelligent? Yes, very.
Is med school harder? Yes.
Should ophthalmologists bash and keep optometrists down even though they want to learn more and help patients in more diverse ways that have low-risk of injury with the advent of new technology? No.

The difference between you and me is that you would never be able to talk in an intelligent manner to the urologist about any of your patient's health problems.

The difference between you and me is that you will have no clue on how to talk to a cardiologist about your parient's cardiac arrhythmia or if it is safe to stop aspirin or comadin in preparation for your upcoming surgery (Do you understand the risks associated with stopping aspirin or coumadin in a patient in afib? Is that safe or not? Maybe I am a slow learner, but it took actual patient care for me to gain this).

I would also love to see you talk to a patient's family after the 1 gm of solumedrol you gave to the patient with optic neuritis put them into a psychotic state. I would love to see you after the 80 mg of prednisone gave your 80 year old patient with giant cell arteritis a GI ulcer and she bled out and died.

I do not regret learning the "extraneous" information you describe- it helps me take care of my current patients at a level you will never obtain.

I am sorry, but your logic will never win out (I don't see GI doctors, cardiologist, neurologists... going to 4 year post undergraduate programs). Some of us actually want to have a clue about what we are doing when it comes to medicine - I believe patients actually like it too. If it was only as easy as they describe in optometry school.

 

[ODduck]

Here's a story for you:

One of my 4th year rotations earlier this year was at a hospital where optometry and ophthalmology worked side-by-side. At this particular hospital optometry was primarily relied upon to follow patients for diabetic eye exams, glasses, and non-surgical glaucoma.

There was a patient seen in the optometry clinic who had bilateral optic disc edema and peripapillary hemorrhages. Intraocular pressures were 13mmHg OU and cup-to-disc ratios were 0.2 and stable for the past 3 years. The optometry clinic sent them down the hall to ophthalmology for an opinion where the patient was seen by an ophthalmology PGY-1. They sent the patient back to optometry with the diagnosis of glaucoma .

I am not a doctor yet, and I fully understand that an optometrist is not a "doctor" in the same sense as an MD/DO is. However even I, a lowly 4th year optometry student, knew that this "diagnosis" is absurd. However since the ophthalmology resident has the almighty MD next to their name they can sign off on anything.

My point: MD's do crap that they aren't trained to do all the freaking time (like refractions and contact lenses) and a first year ophthalmology resident has much less knowledge of the eye than a 4th year optometry student. The bottom line is that ophthalmologists gain experience and become excellent at medical/surgical eye care. It's not like ophthalmology residents are scrubbing in and phacoing 4+ brunescent marbles on their first day. In the same way, OD's in Kentucky aren't going to go on a YAG rampage on every patient in their sights starting tomorrow at 8am.

Here is what a patient living in say Newport, Oregon has to go through in right now to get a freaking YAG capsulotomy (which lets face it, is a SIMPLE SIMPLE SIMPLE procedure to perform):

1. Go to their run of the mill primary care OD...OD sees PCO, refers patient to a comanagement site.

2. Patient has to wait at least a month and then drive 2 hours and 40 minutes to Portland (nearest OMD) where they are assessed by another OD...fancy that, the patient STILL has a PCO.

3. If the patient was lucky enough to score a same day surgery date, then they get their PCO taken care of that day. However most don't have such luck. So they have to wait another 1-4 weeks until there is a opening.

4. Drive another 5+ hours round-trip to have PCO taken care of. Patient is given a prophylactic drop of Alphagan and if the procedure takes more shots than expected, a bottle of Pred Forte. They are sent home and in the MINISCULE event of RD or dislocated IOL, they make another 5+ hour round-trip.

P.S.--This is actually much better access to care than many states (i.e. rural Kentucky).

Here is what hypothetically happens if the patient instead lives in rural western Oklahoma:

1. Patient goes to their OD...OD sees PCO...OD shoots PCO and HAS THE SAME POST-OPERATIVE COURSE AS ANY OPHTHALMOLOGIST. In the MINISCULE event of RD or dislocated IOL, the patient makes ONE long round-trip (as opposed to three) to see the ophthalmologist.

If the optometrist has the proper training (like they do in Oklahoma), how on God's green earth does this not make sense?

 

[200UL]

Access to care is always an issue in rural america - should the optometrist deliver the patient's grand-daughter's baby too because there are no ob/gyns in the same town?

Also, I have taken care of 4 patients with an RD after conservative YAG capsulotomies. I quote my own patients 1:1000 risk of RD.

Finally in your clinical scenario, is it raining on the 5 hour trip to portland - the time of year may influence my opinion on this because of weather issues.

 

[ODduck]

Access to care is always an issue in rural america - should the optometrist deliver the patient's grand-daughter's baby too because there are no ob/gyns in the same town?

Also, I have taken care of 4 patients with an RD after conservative YAG capsulotomies. I quote my own patients 1:1000 risk of RD.

Finally in your clinical scenario, is it raining on the 5 hour trip to portland - the time of year may influence my opinion on this because of weather issues.

It's Portland...of course it's raining

 

[JaggerPlate]

1. I agree that the argument/assumptions that knowledge learned outside of the eye in medical school is worthless/not important to an Ophthalmologist is absolutely absurd.

2. ODduck,

Of course this is the argument - increasing access to 'underserved and rural individuals.' However, I've still never really seen any conclusive arguments that OD are more likely to set up surgical sites in these rural areas. It seems to me that there are simply more ODs in these areas ... because there are more ODs than Ophthalmologists in general - however, I also keep hearing (repeatedly) on these boards that not all ODs are going to do this ... so, is the rural OD in Oklahoma who sees 90% medicare patients in a small town really going to fork over 100k for a laser?

Furthermore, like 200 said, is it simply a matter of just getting lasers into the areas and getting the procedures done, or does it reach a point where quality is an issue - ie is the patient described above better off spending 2 months driving around and then undergoing the surgery with a residency trained Ophthalmologist at a University medical center somewhere further away, or by an OD in a rural little practice who is obviously more covenant, but possibly not as practiced/set up to do so??? Obviously a lot of hyperbole in the example, but you probably get my point.

Additionally, earlier this week, an OD posted a video featuring a discussion between some ODs and MDs about the recent expansion in Kentucky. One of the ODs in the discussion, who was hailed by the individual posting the video, actually practices laser surgery in Oklahoma (the state everyone claims needed the bump for rural care), but it turns out he practices in a huge city with sufficient access to Ophthalmologists, and is also now opening satellite practices in several other large, well populated, well represented cities. Doesn't seem like this is really helping out rural patients whatsoever to me. Granted, n = 1 example, but I have a 'hunch' you'll see FAR more of this than you will ODs opening up shops in the unsettled west.

 

[KHE]

No - any reasonable hospital would not let me perform whipples and bypasses and knee replacements.

But it's technically legal. Those are obviously major surgeries but you could easily set up your own outpatient surgery center and "legally" do minor outpatient procedures that are outside the scope of ophthalmology. It's "technically legal." I probably overstated the case by mentioning Whipples and knee replacements.

However, when you want to do your first YAG or SLT, sight path (or whatever it is called) will come running to assist- I can tell you if you give them the $100 dollar click fee per YAG, they will tell you that you are the best surgeon around (too bad there will only be about $80 left over for you).

I personally believe that if optometry has access to YAGs, SLT, ALT it would likely drive down the payments of these procedures. This point has been made before, but there will be without a doubt more utilization (some appropriate use, some perhaps inappropriate). As a procedure is coded for more often, medicare typically will pay less each year (ie intravitreal injections and OCT have taken major hits recently - injections could become money losers if this trend continues - they are definately money losers now if even one of your patients does not pay for the lucentis). Therefore, be careful what you ask for in future bills - before you pick up the skills needed for the surgery, it may be a money loser. Just something to think about....

I'M THE ONE WHO'S MADE THAT POINT COUNTLESS TIMES!!! That's why I keep telling you guys that none of this is about surgery!

 

[IndianaOD]

The facts are facts.

Every time optometry has expanded scope there has been demonstrated exceptional competence and safety. The incidence of poor outcomes has been at least as good (if not better) than the established norms. Everything else is just rhetoric.

Believe me, if this was not the case the outcry would be enormous.

Congrats to Kentucky on a well deserved change.

Oh, BTW on some of the comments above. Every ophthalmologist I have worked with clears the patient for surgery from the PCP if there are any doubts. This is how it should be and ODs would be no different. The very minor (bloodless) laser procedures we are talking bout have very few systemic medical risks.

Also, ODs have been able to Rx oral prednisone for years in most states. Haven't seen a huge increase in ruptured gastric ulcers. Any OD or OMD worth a crap would clear this with the PCP beforehand anyways. That is what the PCP is for as they know the patients medical status the best.

 

[200UL]

My only point is that the eyes do not occur in a vacuum. People who criticize medical education (if they have not gone to medical school or hung out in a hospital or operating room) have no right unless you have actually gone to school.

An MD sees problems at a different level.

I would never say any of the things in optometry school are worthless – I do feel it should be extended if you want the abilities to do the things you list in bills. This is what dentistry does?

 

[IndianaOD]

My only point is that the eyes do not occur in a vacuum. People who criticize medical education (if they have not gone to medical school or hung out in a hospital or operating room) have no right unless you have actually gone to school.

An MD sees problems at a different level.

I would never say any of the things in optometry school are worthless – I do feel it should be extended if you want the abilities to do the things you list in bills. This is what dentistry does?

Wow, I hope that sounded good coming out.

Do you really want to go down the road of MD misdiagnosis? Get over it.

 

[JaggerPlate]

Wow, I hope that sounded good coming out.

Do you really want to go down the road of MD misdiagnosis? Get over it.

Eh, it really doesn't have so much to do with MD 'misdiagnosis,' because that's just a natural part of the game, it has more to do with the fact that the MD is trained and qualified to make the diagnosis, even if the condition is unpredictable and the conclusion is sometimes proven otherwise.

As numerous ODs have stated in this thread, Optometry school doesn't 'waste' it's time with all the 'unnecessary,' stuff that's unrelated to the eye, so when a medical emergency hits, even if the MD gets it wrong ... he/she was still trained to make the diagnosis of something happening that is NOT directly related to the eye procedure, whereas (from what I've personally been told in this thread) an OD is not. Making an educated, informed decision and possibly missing the mark in an emergent situation >>> having someone make the call who's never trained/dealt with this type of situation.

 

[qcy07]

"As numerous ODs have stated in this thread, Optometry school doesn't 'waste' it's time with all the 'unnecessary,' stuff that's unrelated to the eye, so when a medical emergency hits, even if the MD gets it wrong ... he/she was still trained to make the diagnosis of something happening that is NOT directly related to the eye procedure, whereas (from what I've personally been told in this thread) an OD is not." JaggerPlate


Regardless of my feelings on scope expansion, I don't think we should be using the posts of a few ODs on "student/doctor network" as the definitive source with respect to the education and training of optometrists.

 

[JaggerPlate]

Well, it looks like the expansion train has no intent of stopping its quest to 'serve the rural communities' of America:

http://www.osteopathic.org/inside-a...aily-report-blog/Lists/Posts/Post.aspx?ID=598

 

[IndianaOD]

Well, it looks like the expansion train has no intent of stopping its quest to 'serve the rural communities' of America:

http://www.osteopathic.org/inside-a...aily-report-blog/Lists/Posts/Post.aspx?ID=598

Funny how MDs used to say the same things about DO s.

 

[IndianaOD]

Eh, it really doesn't have so much to do with MD 'misdiagnosis,' because that's just a natural part of the game, it has more to do with the fact that the MD is trained and qualified to make the diagnosis, even if the condition is unpredictable and the conclusion is sometimes proven otherwise.

As numerous ODs have stated in this thread, Optometry school doesn't 'waste' it's time with all the 'unnecessary,' stuff that's unrelated to the eye, so when a medical emergency hits, even if the MD gets it wrong ... he/she was still trained to make the diagnosis of something happening that is NOT directly related to the eye procedure, whereas (from what I've personally been told in this thread) an OD is not. Making an educated, informed decision and possibly missing the mark in an emergent situation >>> having someone make the call who's never trained/dealt with this type of situation.

What systemic emergency is SLT going to cause that we are not trained to handle? ODs have already shown they can safely prescribe orals for years.

 

[JaggerPlate]

Funny how MDs used to say the same things about DO s.

This is by far the weakest argument I've heard (numerous) times during this discussion. Frankly, it's completely unrelated and sounds extremely immature.

To put it in some sort of relatedness ...

100 years ago, women couldn't vote; does that mean that every time a woman discusses politics in 2011, I should turn around and laugh in her face because her great, great grandmother was shown the same discrimination from men?

Don't denigrate the discussion with these types of responses.

Furthermore, it's further removed because when the MDs expressed this bias against DOs many, many years ago ... they were correct to do so. DO education in the pre-clinical and clinical model was not on par with MD education. DOs saw what they wanted and what they needed to do to get there, so they revamped curriculum, embraced evidence based training, and PROVED themselves, and ... wouldn't you know it - they are allowed to sit for the USMLE and complete ACGME residencies today.

What systemic emergency is SLT going to cause that we are not trained to handle? ODs have already shown they can safely prescribe orals for years.

Why do you keep coming back to this similar point about an oral medication. Do patients take oral medications with you watching in the office? Have you ever had to handle an adverse reaction to this drug RIGHT after it was administered in your office?

As I've stated before ... this isn't even the same universe as surgery, and you know this. It's a complete different level, a complete new set of risk factors, and a complete different type of reasoning and reaction that would be involved with the treatment of an emergent situation.

Like I said before, ODs have continually reminded the DO/MDs in this thread that the majority of this training is unnecessary in treating the eye (which includes surgical treatment), and I've also discussed how, in the Ophthalmology threads, residents and attending physicians essentially told an OD that they way he described the reaction to a hypothetical emergency/complication during one of the newly legal surgeries would have resulted in blinding the patient (to which he responded that he didn't know this and thanked the physicians for the clarification).

 

[JaggerPlate]

What systemic emergency is SLT going to cause

That's why it's called an emergency ... if it was predictable, comprehensive, and mundane, it would be called an event, not an emergency. Unless I dust off my crystal ball, I can't predict what could go wrong during one of these procedures. I've literally seen a patient come into an ED for stitches from a small cut on his hand that occurred when cooking, receive the stitches, stand up, pass out, smash his head against the counter, and require emergency treatment and admission to the hospital for days.

If you'd asked me 'what type of systemic emergency is 4 stitches on a hand going to cause,' I probably wouldn't have guessed what occurred either.

 

[PBEA]

That's why it's called an emergency ... if it was predictable, comprehensive, and mundane, it would be called an event, not an emergency. Unless I dust off my crystal ball, I can't predict what could go wrong during one of these procedures. I've literally seen a patient come into an ED for stitches from a small cut on his hand that occurred when cooking, receive the stitches, stand up, pass out, smash his head against the counter, and require emergency treatment and admission to the hospital for days.

If you'd asked me 'what type of systemic emergency is 4 stitches on a hand going to cause,' I probably wouldn't have guessed what occurred either.

while I understand the point you are making, the example is lacking. You can't say that an OD should be able to handle every single emergency that presents during the course of their careers, no matter what procedure they are doing, because NO ONE can make that claim. If there is an RD s/p yag then guess what the general ophtho does? yeah, he calls retina also, just like the OD would. Not saying that as any kind of justification for OD surgery, just saying that argument is kind of a non-starter.

A few years ago, while doing gonio on someone, they passed out cold, hit their head on some equipment and slumped to the floor (vasovagal). Luckily, a an ammonia capsule was all that was needed, because if she was crashing, she most likely would have died, because aside from calling 911 and doing some basic CPR, that's about all I could offer. When discussing this with a few different ophtho's, as with any in office procedure, this too was all they could offer.

 

[PBEA]

Furthermore, it's further removed because when the MDs expressed this bias against DOs many, many years ago ... they were correct to do so. DO education in the pre-clinical and clinical model was not on par with MD education. DOs saw what they wanted and what they needed to do to get there, so they revamped curriculum, embraced evidence based training, and PROVED themselves, and ... wouldn't you know it - they are allowed to sit for the USMLE and complete ACGME residencies today.

With regard to DO's and their earlier struggles, I think it's a matter of the chicken or the egg. If ODs are going to revamp their curriculum and prove themsleves, they would have to have legal standing to do so. HENCE legislation. I'm sure the DO's had to have legal standing before their schools just started doing procedures, dispensing medications, etc. Not sure why this is so hard to fathom.

 

[200UL]

while I understand the point you are making, the example is lacking. You can't say that an OD should be able to handle every single emergency that presents during the course of their careers, no matter what procedure they are doing, because NO ONE can make that claim. If there is an RD s/p yag then guess what the general ophtho does? yeah, he calls retina also, just like the OD would. Not saying that as any kind of justification for OD surgery, just saying that argument is kind of a non-starter.

A few years ago, while doing gonio on someone, they passed out cold, hit their head on some equipment and slumped to the floor (vasovagal). Luckily, a an ammonia capsule was all that was needed, because if she was crashing, she most likely would have died, because aside from calling 911 and doing some basic CPR, that's about all I could offer. When discussing this with a few different ophtho's, as with any in office procedure, this too was all they could offer.

/

The optometry students are missing the point. I saw between 15,000 and 20,000 eye patients in my eye training alone (this does not even count the “irrelevant” trauma/ent/neurology/neurosurgery patients I saw in medical school/internship). Most were very complicated (they had seen multiple eye doctors prior to coming to the university) My guess is these patients were more complex than the average patient an optometry student sees in his /her training, but I have no proof of this so correct me if I am wrong. A senior optometrist wrote in this forum one week ago that some optometry students graduate with as few as 1,000 patient encounters and he would never hire an optometrist straight out of training because of the likelihood that they lack experience – these are not my words so do not criticize me.

Perhaps I am just a slow learner, but many of you try to argue it took me 20,000 patients to learn what you guys learn in 1,000 patients. Give me a break, if I don’t see problems at a slightly different level than you, I (and every other ophthalmologist for that matter) must be mentally challenged.

 

[PBEA]

/

The optometry students are missing the point. I saw between 15,000 and 20,000 eye patients in my eye training alone (this does not even count the “irrelevant” trauma/ent/neurology/neurosurgery patients I saw in medical school/internship). Most were very complicated (they had seen multiple eye doctors prior to coming to the university) My guess is these patients were more complex than the average patient an optometry student sees in his /her training, but I have no proof of this so correct me if I am wrong. A senior optometrist wrote in this forum one week ago that some optometry students graduate with as few as 1,000 patient encounters and he would never hire an optometrist straight out of training because of the likelihood that they lack experience – these are not my words so do not criticize me.

Perhaps I am just a slow learner, but many of you try to argue it took me 20,000 patients to learn what you guys learn in 1,000 patients. Give me a break, if I don’t see problems at a slightly different level than you, I (and every other ophthalmologist for that matter) must be mentally challenged.

I think you are overeacting, but I'll indulge you a little. Using your rationale that because you think optometry school is so pitifully lacking in just about any capacity, am I to presume that you think ODs doing anything outside of "refraction" is too much for the OD? That by virtue of an ODs inabilility to comprehend or "see things the way you do" suggests that ODs should not be allowed to provide ANY medical eye care whatsoever? That would include any and all diagnostic or therapuetic modality? If what you say is true then ODs really should not do ANY of those things, right?

 

[Frumps]

The interesting thing is that this was all about improving access to care. That is the angle the optometry community had to use to get this passed with the state legislature. Why make poor Mr. Jones drive to see an actual eye surgeon. Did anyone in the legislature listen to the ACTUAL public instead of just the optometrists. I would like to hear what the optometrists/students rational argument is for passing the current legislation based on the grounds that was proposed to the legislature (access to care).

Look at the poll. http://mycn2.com/politics/cn2-poll-optometrist-bill

The rural communities actually had a higher percentage of citizens who preferred an ophthalmologist 84 to 87%!

 

[Commando303]

The interesting thing is that this was all about improving access to care. That is the angle the optometry community had to use to get this passed with the state legislature. Why make poor Mr. Jones drive to see an actual eye surgeon. Did anyone in the legislature listen to the ACTUAL public instead of just the optometrists. I would like to hear what the optometrists/students rational argument is for passing the current legislation based on the grounds that was proposed to the legislature (access to care).

Look at the poll. http://mycn2.com/politics/cn2-poll-optometrist-bill

The rural communities actually had a higher percentage of citizens who preferred an ophthalmologist 84 to 87%!

Here's the poll question and its given options:

A bill recently passed the legislature dealing with eye doctors. It would allow optometrists, who are professionally trained and licensed to examine the eyes and diagnose problems, to perform certain surgeries. Currently, all surgeries are performed by ophthalmologists with medical degrees that deal with the diseases of the eye. Which statement is closest to your view?

• Yes, optometrists should be allowed to perform certain surgeries
• No, any surgeries should be done by ophthalmologists with medical degrees

How would a person be likely to know what training O.D.s (or, for that matter, M.D.s) receive? "Do you find your current commute to receive eye-care from an ophthalmologist to be too lengthy?" may have yielded a response that delivers a different impression from that found through this poll.

 

[Frumps]

I'm sorry. Do you find the way the question was phrased to be false. If so, please elaborate. Not trying to be argumentative but just interested to find a rational view. Also, do you think if they presented actual training data and patient encounters that would sway the publics vote towards letting optometrists perform certain surgical procedures?

 

[qcy07]

Here's the poll question and its given options:

A bill recently passed the legislature dealing with eye doctors. It would allow optometrists, who are professionally trained and licensed to examine the eyes and diagnose problems, to perform certain surgeries. Currently, all surgeries are performed by ophthalmologists with medical degrees that deal with the diseases of the eye. Which statement is closest to your view?

• Yes, optometrists should be allowed to perform certain surgeries
• No, any surgeries should be done by ophthalmologists with medical degrees

Not trying to be argumentative here either but we all know that poll questions can be phrased to elicit pretty much any answer desired.

For example, It states in the poll that optometrists are trained to diagnose eye problems. It fails to mention the training and licensing of optometrists to treat certain eye problems. If the poll said optometrists are trained to treat certain eye conditions and left it at that, would the public assume surgery was a form of treatment? Furthermore certain surgeries are not defined in the poll. I assume and understand that this was done because it would be too difficult in a 30 second poll to explain and define these certain surgeries. Is it possible that a member of the general public (having no idea what the difference is between major invasive ocular surgery under general anesthesia, and a Yag Capsulotomy) would need to know the difference between certain surgeries to make an informed comment.

I can not be sure, but I think that when the public hears surgery, they think S U R G E R Y. I am not downplaying lasers, I understand the Ophthalmologist's point that Yag Caps is still a surgery, you know what I mean.

Again I am not even in favor of some of this bill, but polls are notoriously easy to manipulate.

What if a poll was conducted that asked:

The Kentucky State Legislature is considering a bill that would allow an untrained, uneducated, high school drop out to perform ocular surgery without a license.

Would you be in favor of this bill?

Well this just occurred today in my office. A patient came in and promptly told me that she was experiencing irritation in the left eye yesterday, and she knew she had a long history of trichiasis. She told me "I probably should have canceled my appt." I asked why? she said "because I could see two of my lower lashes rubbing my eye and I had my friend remove them with a pair of tweezers." "I feel good now"..... I took a look, no staining, no spk, no entropion, looked good.

Correction Trichiasis CPT surgical code: 67820

I told the pt. that her friend owed her $54.29 according to medicare.

 

[sunyopt]

I've read the post here and the issue seems that MD/DO's don't think optometrist will receive proper training. It looks like they will have considerable input/control on determining what constitutes necessary training (see the except from the law pasted below). Now with that solved looks like there's about 100 posts about nothing.
I actually have a KY license and have worked there. Patients travel hours just to see an OD and many can not afford to see MD's. Most MD's now require a $500 deposit if the patient doesn't have insurance. Hopefully this legislation will improve access and lower cost while maintaining the current standard of care. One curious thing that hasn't been discussed is, how is it that OD's are competent to determine when PI's and YAG's are necessary and capable to assume care immediately after the procedure but can't handle performing those simple in-office procedures? If the complications happen there is a good chance it will be in our office. As for a surgical foundation we all have to start somewhere, right? I'm sure the medical college deans on the board will ensure we are properly trained.


- Retain original provisions, except amend KRS 320.240 to separate optometry practice requirements for surgery from those for drug prescription and administration; require the optometry board and the medical board to jointly establish the educational and competence criteria necessary for an optometrist to perform laser and nonlaser surgical procedures.
HFA (4, R. Palumbo) - Retain original provisions; amend KRS 320.230 to expand the membership of the optometry board from five members to nine members; increase the number of citizen at large members from one member to two members; add the deans of the University of Kentucky College of Medicine, the University of Louisville School of Medicine, and the Pikeville College School of Osteopathic Medicine to the board; allow the three dean board members to appoint designees to serve in their place.
HFA (5, T. Riner) - Retain original provisions of the bill; add requirement for the board to require demonstrated proficiency in order to perform certain surgeries.
HFA (6, T. Riner) - Retain original provisions of the bill; add requirement for the board to require an optometrist to conduct a medical history and physical exam before performing authorized surgical procedures.
HFA (7, T. Riner) - Retain original provisions of the bill; add requirement that the board require any optometrist electing to perform laser surgery to meet additional requirements for training and continuing education before performing certain surgical procedures.

 

[Visionary]

I've read the post here and the issue seems that MD/DO's don't think optometrist will receive proper training. It looks like they will have considerable input/control on determining what constitutes necessary training (see the except from the law pasted below). Now with that solved looks like there's about 100 posts about nothing.
I actually have a KY license and have worked there. Patients travel hours just to see an OD and many can not afford to see MD's. Most MD's now require a $500 deposit if the patient doesn't have insurance. Hopefully this legislation will improve access and lower cost while maintaining the current standard of care. One curious thing that hasn't been discussed is, how is it that OD's are competent to determine when PI's and YAG's are necessary and capable to assume care immediately after the procedure but can't handle performing those simple in-office procedures? If the complications happen there is a good chance it will be in our office. As for a surgical foundation we all have to start somewhere, right? I'm sure the medical college deans on the board will ensure we are properly trained.


- Retain original provisions, except amend KRS 320.240 to separate optometry practice requirements for surgery from those for drug prescription and administration; require the optometry board and the medical board to jointly establish the educational and competence criteria necessary for an optometrist to perform laser and nonlaser surgical procedures.
HFA (4, R. Palumbo) - Retain original provisions; amend KRS 320.230 to expand the membership of the optometry board from five members to nine members; increase the number of citizen at large members from one member to two members; add the deans of the University of Kentucky College of Medicine, the University of Louisville School of Medicine, and the Pikeville College School of Osteopathic Medicine to the board; allow the three dean board members to appoint designees to serve in their place.
HFA (5, T. Riner) - Retain original provisions of the bill; add requirement for the board to require demonstrated proficiency in order to perform certain surgeries.
HFA (6, T. Riner) - Retain original provisions of the bill; add requirement for the board to require an optometrist to conduct a medical history and physical exam before performing authorized surgical procedures.
HFA (7, T. Riner) - Retain original provisions of the bill; add requirement that the board require any optometrist electing to perform laser surgery to meet additional requirements for training and continuing education before performing certain surgical procedures.

I won't get into the first part on your board. Don't want to troll. As for the amendments you listed, they were all voted down. The KY Optometry Board will consist of 4 optometrists and a private citizen, just like in OK.

 

[IndianaOD]

I won't get into the first part on your board. Don't want to troll. As for the amendments you listed, they were all voted down. The KY Optometry Board will consist of 4 optometrists and a private citizen, just like in OK.

Honestly that is how it should be. There aren't ODs, DDS, and nurse practitioners on the medical boards are there?

 

[Visionary]

Honestly that is how it should be. There aren't ODs, DDS, and nurse practitioners on the medical boards are there?

True, but they do have multiple specialities represented (not all of whom like each other), not just ophthalmology. Also, the med school deans. Dilutes things a bit.