General Ophthalmologists doing Medical Retina

[eyegal]

I wanted to find out your thoughts on how much medical retina is appropriate for a general ophthalmologist to do.

Do may have octs? and/or fas in their office?

Are many doing their own focal lasers?

Are many doing intravitreal injections?

Thanks

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[Olddog1]

I wanted to find out your thoughts on how much medical retina is appropriate for a general ophthalmologist to do.

Do may have octs? and/or fas in their office?

Are many doing their own focal lasers?

Are many doing intravitreal injections?

Thanks

I am a glaucoma specialist, so I do none. However, I know of 3 general ophthalmologist in more remote areas (25+ miles from me) that are doing their own focal lasers (some PRP as well). None perform FAs, all 3 have OCTs. One told me his patients were happy not to have the drive in to see a retina specialist and he provides all their eye care anyway. None of these guys do intravitreal injections, but they were also trained a few years ago, so they didn't get as much hands on experience as residents do now with injections. Of course, they are doing primary trabs, plastics, strabismus surgery, "premium" IOLs, pretty much anything non-retina related that walks in the door. I believe the trend is for the generalist doing more injections (in my area it seems to be more common in conjunction with cataract surgery), but I believe it is mostly motivated to capture more income (duh). In my opinion you should do as much as you are comfortable with. The problem will occur if there are 3 retina docs in a practice across the street, you do an IVK, get an endophthalmitis, and then a lawyer asks if you really think you were the most capable person in your area to perform the procedure. Also, if the retina practice is referring alot of cataracts your way you may find they may dry up if you are capturing alot of their medical retina business.

 

[PDT4CNV]

I do not think it is inappropriate for a comprehensive ophthalmologist to do PRP or focal laser, as long as they follow the standard of care and are well trained diagnostically and procedurally in the diseases they are treating.

I would have felt comfortable doing so coming out of my residency if I had done comprehensive ophthalmology instead of retina.

Focal laser without angiography sounds unusual to me.

 

[schistosomiasis]

There's going to be an article in next month's EyeNet (that AAO magazine) about general ophthos doing intravitreals; should be interesting to see what they say.

Maybe it's different in some parts of the country but the retina specialist I refer to doesn't do FAs before every focal; same for those in my residency (a different part of the country).

Shouldn't PDT4CNV be avastin4CNV now?

 

[orbitsurgMD]

I wanted to find out your thoughts on how much medical retina is appropriate for a general ophthalmologist to do.

Do may have octs? and/or fas in their office?

Are many doing their own focal lasers?

Are many doing intravitreal injections?

Thanks

If you are doing your own angiography and can document your indications to treat, I can't see why you shouldn't. In my area, there is ample retina support and they are the only ones doing laser and injections. They are also the only ones with OCTs around here.

I would not recommend doing any retinal intervention however unless you can document treatable disease by angiography.

 

[orbitsurgMD]

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[katieg715]

I did over 100 prps, over 50 focal grids, and probably about 30 intravitreal injections in my residency. I feel very comfortable with all 3 procedures. I will do my own PRPs, focals, and only an intravitreal injection if my patient can't get to a retina specialist (closest one is about 50 minutes drive). I also document the heck out of it that I told them they need to go to a retina specialist for this procedure and they refused to or couldn't go. We send a bunch of business to the retina guys--they don't seem to mind if I do frontline prp's/focals.