Kentucky: The Latest Battleground for Optometric Scope Expansion

[Visionary]

The well-financed and well-organized optometric lobby launched a sneak attack in Kentucky last week. With the help of State Senate President David Williams and Majority Floor Leader Robert Stivers, a bill was rammed through that would significantly expand scope of optometric practice to even include YAG capsulotomy. Furthermore, the Optometric Board would be given sole authority to determine future practice scope. Because of the speed and stealth with which this bill was presented, it passed the Senate by a wide margin of 34-4 on Friday, 2/11. Discussion will be taken up by the House on Monday, 2/14. Unfortunately, it appears likely that the bill may also pass the House. I can't help but feel that the huge sums of money and organizational strength of the optometric lobby will eventually overwhelm all these attempts to halt scope expansion.

http://www.courier-journal.com/article/20110211/OPINION01/302110022/1055/opinion01/Eyeing-problem

---

Members don't see this ad.

 

[ABaverage]

I understand the concern for allowing ODs to "operate" aka perform YAG surgery. But that article is very condescending to the optometric profession.

"Still, optometrists' training fails to qualify them, however able and hard working they may be, to do things like prescribe medicine or perform surgery."

"The ability to order prescription drugs, which SB 110 would permit, is a very different matter. Physicians spend a great deal of time learning how drugs interact; the result of mixing the wrong medication can be deadly."

Ok, so the article is against optometrists performing surgery. Fine. But prescribing medicine has been done for a WHILE now by optometrists. Have we been proven to irresponsible or incapable of doing this? I don't think so. "Oh NOES! That under-qualified OD (bless his heart, he tries so hard though) prescribed doxycycline as a part of his treatment for blepharitis!!! If you want real care, please see an ophthalmologist not that shoe salesman!"


I can remove myself from the situation and say that I do not believe that optometrists are qualified to perform surgery. But this is with the standard education that they receive. Perhaps an extensive >/= 3 year residency would suffice. I have no opinion on what "training" ODs need in order to operate.

Most ODs do not desire to operate or take on the responsibility of YAG capsulotomy. If they want to do this sort of thing, they would have gone to med school and become an ophthalmologist.

With that said, please do not underestimate and think so lowly of ODs.

 

[Visionary]

I understand the concern for allowing ODs to "operate" aka perform YAG surgery. But that article is very condescending to the optometric profession.

"Still, optometrists' training fails to qualify them, however able and hard working they may be, to do things like prescribe medicine or perform surgery."

"The ability to order prescription drugs, which SB 110 would permit, is a very different matter. Physicians spend a great deal of time learning how drugs interact; the result of mixing the wrong medication can be deadly."

Ok, so the article is against optometrists performing surgery. Fine. But prescribing medicine has been done for a WHILE now by optometrists. Have we been proven to irresponsible or incapable of doing this? I don't think so. "Oh NOES! That under-qualified OD (bless his heart, he tries so hard though) prescribed doxycycline as a part of his treatment for blepharitis!!! If you want real care, please see an ophthalmologist not that shoe salesman!"


I can remove myself from the situation and say that I do not believe that optometrists are qualified to perform surgery. But this is with the standard education that they receive. Perhaps an extensive >/= 3 year residency would suffice. I have no opinion on what "training" ODs need in order to operate.

Most ODs do not desire to operate or take on the responsibility of YAG capsulotomy. If they want to do this sort of thing, they would have gone to med school and become an ophthalmologist.

With that said, please do not underestimate and think so lowly of ODs.

Fair enough. That article is pretty ridiculous. I actually meant to post this article: http://www.courier-journal.com/apps/pbcs.dll/article?AID=2011302110093

It talks about how SB110 was rushed through the legislature, even skirting the chair of the Senate Health and Welfare Committee.

Of course, an identically ridiculous article appeared in Sunday's paper from the president of the American Optometric Association, who interestingly is an optometrist in KY: http://www.courier-journal.com/apps/pbcs.dll/article?AID=2011302130038

This article veils the bill as an issue of access to care. In the same edition (of a paper which serves Louisville and the surrounding area--where there is no problem with access) a half page ad was taken out by the Kentucky Optometric Association stating "You Deserve Better Access to Quality Eye Care." It goes on to say that "Many simple eye procedures currently require referrals to an Ophthalmologist. That means more appointments, more wait time and, for most Kentuckians, more long-distance travel." It's also advertised as a means of "reduc[ing] Medicaid costs."

I do not think optometrists are stupid or poorly-trained. I've known good and bad optometrists, as well as ophthalmologists. The fact is that optometrists should not be performing procedures like YAG capsulotomies, glaucoma lasers, emergency paracenteses, and removal of lesions from the eyelids, conjunctiva, and lacrimal apparatus! This is outside their scope of training, plain and simple! The more concerning part is that, while the bill identifies a number of other procedures considered outside their scope of practice, it goes on to state that the Optometric Board will have the sole authority to determine future expansions of that scope! While there are plenty of optometrists, like yourself, who do not seek surgical privileges, there are enough that do to make such a provision inherently problematic.

 

[KHE]

Fair enough. That article is pretty ridiculous. I actually meant to post this article: http://www.courier-journal.com/apps/pbcs.dll/article?AID=2011302110093I do not think optometrists are stupid or poorly-trained. I've known good and bad optometrists, as well as ophthalmologists. The fact is that optometrists should not be performing procedures like YAG capsulotomies, glaucoma lasers, emergency paracenteses, and removal of lesions from the eyelids, conjunctiva, and lacrimal apparatus! This is outside their scope of training, plain and simple! The more concerning part is that, while the bill identifies a number of other procedures considered outside their scope of practice, it goes on to state that the Optometric Board will have the sole authority to determine future expansions of that scope! While there are plenty of optometrists, like yourself, who do not seek surgical privileges, there are enough that do to make such a provision inherently problematic.

I fear this thread will go down "that road" again but let's try to keep it rational.

Optometry boards SHOULD be the ones who determine scope of optometric practice. Optometry should not have to grovel to any other "body" other than the legislatures to determine what is and isn't "optometry."

Now....I can hear all the screaming now. But I would respectfully submit that ophthalmology has brought a large amount of that upon themselves.

We've all seen the videos of ophthalmologists in committee hearings waving around bottles of tropicamide declaring that it can kill you.

We've all experienced and or read about ophthalmologists trying to roll back scope of practice by restricting things like foreign body removal in New York State despite the fact that ODs have safely and prudently done that for years.

In our own state of CT, we had to have a big stupid battle over Latisse. Cmon.

We had to have a battle concerning contact lenses that contain medication.

Cmon.

I've said this dozens of times on here. No optometrist wants to do YAGs. (Well, I'm sure there's a couple renegades out there) Trust me, we understand that it's not viable. We don't see enough of them to justify a laser. The number of patients I sent out for a YAG last year was probably half a dozen. Modern surigal techniques don't even necessitate it that often anyways.

And no, optometrists don't want to do LASIK either.

Here I say again......there are 45000 optometrists in the USA. There are something like 15000 ophthalmologists right?

I don't have hard numbers but let's assume that 10% of ophthalmologists perform lasik. I'm sure it's much more than that. But that would make 1500 providers of LASIK out there.

Let's say 2% of optometrists want to do LASIK. That's 900 ODs.

That would mean that we would increase the supply of LASIK providers by 60%, and leave demand EXACTLY THE SAME. Does anyone not think that we don't understand that? We would be looking back at the days of the $299 per eye billboard on the side of the highway as the golden age of LASIK. WE GET THAT.

Optometrists are not interested in performing surgery. We want to be able to not have to grovel everytime there's a new beta blocker or topical anti-histamine on the market.

And yea, yea, yea.....go to medical school. I can hear that one coming too. I wonder how dentists somehow manage to provide all kinds of invaside procedures and prescribe all sorts of powerful narcotics without the benefit of allopathic medical eduation? Somehow they manage though.

Ok....flame suit on.

 

[Visionary]

I fear this thread will go down "that road" again but let's try to keep it rational.

Optometry boards SHOULD be the ones who determine scope of optometric practice. Optometry should not have to grovel to any other "body" other than the legislatures to determine what is and isn't "optometry."

Now....I can hear all the screaming now. But I would respectfully submit that ophthalmology has brought a large amount of that upon themselves.

We've all seen the videos of ophthalmologists in committee hearings waving around bottles of tropicamide declaring that it can kill you.

We've all experienced and or read about ophthalmologists trying to roll back scope of practice by restricting things like foreign body removal in New York State despite the fact that ODs have safely and prudently done that for years.

In our own state of CT, we had to have a big stupid battle over Latisse. Cmon.

We had to have a battle concerning contact lenses that contain medication.

Cmon.

I've said this dozens of times on here. No optometrist wants to do YAGs. (Well, I'm sure there's a couple renegades out there) Trust me, we understand that it's not viable. We don't see enough of them to justify a laser. The number of patients I sent out for a YAG last year was probably half a dozen. Modern surigal techniques don't even necessitate it that often anyways.

And no, optometrists don't want to do LASIK either.

Here I say again......there are 45000 optometrists in the USA. There are something like 15000 ophthalmologists right?

I don't have hard numbers but let's assume that 10% of ophthalmologists perform lasik. I'm sure it's much more than that. But that would make 1500 providers of LASIK out there.

Let's say 2% of optometrists want to do LASIK. That's 900 ODs.

That would mean that we would increase the supply of LASIK providers by 60%, and leave demand EXACTLY THE SAME. Does anyone not think that we don't understand that? We would be looking back at the days of the $299 per eye billboard on the side of the highway as the golden age of LASIK. WE GET THAT.

Optometrists are not interested in performing surgery. We want to be able to not have to grovel everytime there's a new beta blocker or topical anti-histamine on the market.

And yea, yea, yea.....go to medical school. I can hear that one coming too. I wonder how dentists somehow manage to provide all kinds of invaside procedures and prescribe all sorts of powerful narcotics without the benefit of allopathic medical eduation? Somehow they manage though.

Ok....flame suit on.

No flaming, KHE. In my eyes, you're one of the most respected and rational posters on this board--even if you are an optometrist! I completely understand the desire to determine your own scope of practice. Many of the examples you cite are, indeed, ridiculous. Latisse, when you already prescribe Lumigan? Yeah, that's just stupid. If that was the point, I wouldn't have a problem.

My issue is you are still stating that optometrists don't want to do surgery, when the president of your national organization has pushed a KY bill that emphasizes exactly that. The bill didn't only propose to allow the Optometric Board to determine scope of practice. It specifically identified the aforementioned surgical procedures. Can you understand why, to us ophthalmologists, this doesn't seem like only "a couple renegades?"

As far as dentists go, they are already fully trained to do what they do. Those that seek more extensive surgical privileges actually spend time in medical school (usually only 2 years) and then complete OMFS residency training. What is the Optometric Board's plan to provide the necessary training for these surgical procedures they seek? A residency? How long? With whom? How will it determine competency? Are there even optometrists doing these procedures that can provide adequate training? Perhaps in OK? Maybe they will employ ophthalmologists to assist. I'm sure there are some who would do so, for the right price. None of this is even laid out in the bill. It was rushed through and passed the State Senate by a huge margin. Not enough questions were asked. Nearly half a million in political donations to the KY Legislature in the past year. I'm sorry, KHE, but the whole thing stinks to high heaven.

 

[speyeder]

I understand the concern for allowing ODs to "operate" aka perform YAG surgery. But that article is very condescending to the optometric profession.

"Still, optometrists' training fails to qualify them, however able and hard working they may be, to do things like prescribe medicine or perform surgery."

"The ability to order prescription drugs, which SB 110 would permit, is a very different matter. Physicians spend a great deal of time learning how drugs interact; the result of mixing the wrong medication can be deadly."

Ok, so the article is against optometrists performing surgery. Fine. But prescribing medicine has been done for a WHILE now by optometrists. Have we been proven to irresponsible or incapable of doing this? I don't think so. "Oh NOES! That under-qualified OD (bless his heart, he tries so hard though) prescribed doxycycline as a part of his treatment for blepharitis!!! If you want real care, please see an ophthalmologist not that shoe salesman!"


I can remove myself from the situation and say that I do not believe that optometrists are qualified to perform surgery. But this is with the standard education that they receive. Perhaps an extensive >/= 3 year residency would suffice. I have no opinion on what "training" ODs need in order to operate.

Most ODs do not desire to operate or take on the responsibility of YAG capsulotomy. If they want to do this sort of thing, they would have gone to med school and become an ophthalmologist.

With that said, please do not underestimate and think so lowly of ODs.

I keep hearing that the overwhelming majority of optometrists have no interest in performing eye surgery. If this is true, and I have no reason to believe otherwise, then why does optometry keep lobbying for surgical rights? Why does the optometric profession allow a small minority to hijack their political agenda? It would seem that optometry has more important concerns to address such as the oversupply of optometrists and the recent expansion of optometry schools.

 

[eyerat]

It would seem that optometry has more important concerns to address such as the oversupply of optometrists and the recent expansion of optometry schools.

But isn't this exactly what they're doing in Kentucky?!

 

[Visionary]

But isn't this exactly what they're doing in Kentucky?!

Here's a link to the whole bill and the amendments:

http://www.lrc.ky.gov/record/11RS/sb110.htm

It forbids an individual from practicing optometry without board certification, so that gives the Optometric Board some control over who can call himself/herself an optometrist. There is no mention of optometry schools, however. You could make a case for that being a very minor aspect of the bill.

 

[eyerat]

But isn't this exactly what they're doing in Kentucky?!

I was being sarcastic. What I meant to say:

PROBLEM: oversupply of optometrists + recent expansion of optometry schools
Optometry Board's SOLUTION: Expansion of scope

To keep things in perspective:

1. The term "optometry" comes from the Greek words ὄψις (opsis), meaning sight, and μέτρον (metron), meaning measurement.
2. The word ophthalmology comes from the Greek roots ophthalmos meaning eye and logos meaning word, thought, or discourse; ophthalmology literally means "the science of eyes".

 

[Visionary]

I was being sarcastic. What I meant to say:

PROBLEM: oversupply of optometrists + recent expansion of optometry schools
Optometry Board's SOLUTION: Expansion of scope

To keep things in perspective:

1. The term "optometry" comes from the Greek words ὄψις (opsis), meaning sight, and μέτρον (metron), meaning measurement.
2. The word ophthalmology comes from the Greek roots ophthalmos meaning eye and logos meaning word, thought, or discourse; ophthalmology literally means "the science of eyes".

What? They don't mean the same thing?

 

[KHE]

My issue is you are still stating that optometrists don't want to do surgery, when the president of your national organization has pushed a KY bill that emphasizes exactly that. The bill didn't only propose to allow the Optometric Board to determine scope of practice. It specifically identified the aforementioned surgical procedures. Can you understand why, to us ophthalmologists, this doesn't seem like only "a couple renegades?"

Yes, I understand. I do think it's unwise to delineate specific procedures in most cases. However, the problem is that optometrists do in fact perform certain surgical procedures, the most common being foreign body removals, epilations, and D&Is.

Rightly or wrongly, these are classified as surgical procedures under CPT terminology. So when optometrists fight for "surgical rights" that's what we're trying to accomplish. Unfortunately, we've seen in New York, a state in which I hold a license a constant back and forth between yes ODs CAN remove a foreign body vs NO, an OD can NOT. It's ridiculous.

As far as dentists go, they are already fully trained to do what they do. Those that seek more extensive surgical privileges actually spend time in medical school (usually only 2 years) and then complete OMFS residency training. What is the Optometric Board's plan to provide the necessary training for these surgical procedures they seek? A residency? How long? With whom? How will it determine competency?

The point I was trying to make there is that sometimes we hear arguments that ODs shouldn't even be prescribing patanol or removing eyelashes. I simply point to dentists as another profession that does very invasive procedures and prescribes powerful medications without the benefit of allopathic medical education. I wasn't trying to say that because dentists do surgery that ODs should too. Dentistry is largely a procedure driven field where optometry largely isn't. That's neither good nor bad. Sorry if I didn't make that point clearly.

Are there even optometrists doing these procedures that can provide adequate training? Perhaps in OK? Maybe they will employ ophthalmologists to assist. I'm sure there are some who would do so, for the right price. None of this is even laid out in the bill. It was rushed through and passed the State Senate by a huge margin. Not enough questions were asked. Nearly half a million in political donations to the KY Legislature in the past year. I'm sorry, KHE, but the whole thing stinks to high heaven.

I know nothing of the politics of that situation but politics usually is very stinky on both sides of this issue. I did not read the article and I will attempt too but in general I would agree with you, optometrists should not be doing these procedures for a whole host of reasons but I would also disagree with you in the sense that I think that this whole issue is not about "those procedures."

 

[Visionary]

Yes, I understand. I do think it's unwise to delineate specific procedures in most cases. However, the problem is that optometrists do in fact perform certain surgical procedures, the most common being foreign body removals, epilations, and D&Is.

Rightly or wrongly, these are classified as surgical procedures under CPT terminology. So when optometrists fight for "surgical rights" that's what we're trying to accomplish. Unfortunately, we've seen in New York, a state in which I hold a license a constant back and forth between yes ODs CAN remove a foreign body vs NO, an OD can NOT. It's ridiculous.



The point I was trying to make there is that sometimes we hear arguments that ODs shouldn't even be prescribing patanol or removing eyelashes. I simply point to dentists as another profession that does very invasive procedures and prescribes powerful medications without the benefit of allopathic medical education. I wasn't trying to say that because dentists do surgery that ODs should too. Dentistry is largely a procedure driven field where optometry largely isn't. That's neither good nor bad. Sorry if I didn't make that point clearly.



I know nothing of the politics of that situation but politics usually is very stinky on both sides of this issue. I did not read the article and I will attempt too but in general I would agree with you, optometrists should not be doing these procedures for a whole host of reasons but I would also disagree with you in the sense that I think that this whole issue is not about "those procedures."

I think we, in principle, agree. Appreciate your input, KHE, as always.

 

[eyerat]

in general I would agree with you, optometrists should not be doing these procedures for a whole host of reasons but I would also disagree with you in the sense that I think that this whole issue is not about "those procedures."

The point is that the Optometry Board thinks that optometrists should do be allowed to do these procedures. If that bill passes, I would not want to be an ophthalmologist in Kentucky.

Oklahoma passed a similar bill a few years ago. Let's have a look at the job listings for ophthalmologists at the AAO website. Out of hundreds of listings there is only ONE in Oklahoma. Coincidence???

 

[socal2014]

The well-financed and well-organized optometric lobby launched a sneak attack in Kentucky last week. With the help of State Senate President David Williams and Majority Floor Leader Robert Stivers, a bill was rammed through that would significantly expand scope of optometric practice to even include YAG capsulotomy. Furthermore, the Optometric Board would be given sole authority to determine future practice scope. Because of the speed and stealth with which this bill was presented, it passed the Senate by a wide margin of 34-4 on Friday, 2/11. Discussion will be taken up by the House on Monday, 2/14. Unfortunately, it appears likely that the bill may also pass the House. I can't help but feel that the huge sums of money and organizational strength of the optometric lobby will eventually overwhelm all these attempts to halt scope expansion.

http://www.courier-journal.com/article/20110211/OPINION01/302110022/1055/opinion01/Eyeing-problem

Why are you use language like "sneak attack."?

Do you consider OD's as your enemies?

 

[bisonrumble]

Fair enough.

I do not think optometrists are stupid or poorly-trained. I've known good and bad optometrists, as well as ophthalmologists. The fact is that optometrists should not be performing procedures like YAG capsulotomies, glaucoma lasers, emergency paracenteses, and removal of lesions from the eyelids, conjunctiva, and lacrimal apparatus! This is outside their scope of training, plain and simple! The more concerning part is that, while the bill identifies a number of other procedures considered outside their scope of practice, it goes on to state that the Optometric Board will have the sole authority to determine future expansions of that scope! While there are plenty of optometrists, like yourself, who do not seek surgical privileges, there are enough that do to make such a provision inherently problematic.

As a current third year optometry student, I just wanted to let you know about my scope of training. We were taught how to perform YAG capsulotomy, subconjunctival & subcutaneous injections and removal of lid lesions. Therefore, it is not so 'plain and simple.'

 

[200UL]

As a current third year optometry student, I just wanted to let you know about my scope of training. We were taught how to perform YAG capsulotomy, subconjunctival & subcutaneous injections and removal of lid lesions. Therefore, it is not so 'plain and simple.'

I would not use this statement in your argument - especially if you are trying to convince a surgeon (I might work with lawmakers, however). First, none of your training involved actual patients. If it did, you and your school would have been breaking the law. In my opinion, training in surgery should involve actual patients.

Second, the technical aspect of many surgical procedures could be picked up by any 10 year old (the 10 year old could be trained to do a craniotomy in about 10 minutes (it would be just as good as your local brain surgeon, but our medical system has felt neurosurgeons are best able to perform craniotomies). In other words, there is more to the practice of surgery than the technical aspect - the decision making around it so much MORE important (let’s take YAG for example, we have all seen dislocated IOLs induced by YAGs, RDs induced by YAG, CME induced by YAGs, last week I saw a patient who had their entire anterior segment filled with vitreous after another surgeon performed a YAG on an in the bag PCIOL). Does your training tell you how to avoid/deal with these complications?

Third, I will never respect any optometric bill that mentions lid lesions "lid lesions." There is a video from the state of OK from the meetings several years ago among lawmakers, optometry, and ophthalmology (not sure if anyone else has seen this). I have never seen anything like it. It was obvious that optometrist must have been a better speaker than an eyecare provider. The ophthalmology group provided several clinical cases with pictures and basically asked if they were things that optometry would be able to handle/remove with the new surgical scope they were looking for. The ophthalmology provided cases were supposed to prove to the lawmakers that lid lesions can be serious. One of the pictures was a basal cell carcinoma (classic could have been in a textbook – any first year optometry student or ophthalmology student would have known this was a basal cell carcinoma). The optometrist speaking was convinced that this was benign and that he had the training to remove it in his office (really – as someone who has participated in three orbital exenteration cases due to basal cell carcinoma metastasizing to the orbit, I found this just a little concerning). Then there was a case of sebaceous cell carcinoma - very concerning from the history alone (again any first year optometry or ophthalmology resident would have known this). The optometrist went on to say this was also benign and that he felt very comfortable managing it. I am not sure if the optometrist answering the questions was simply lying to impress the lawmakers or if he was just that ignorant. It was hard to watch because it was obvious that this optometrist was just so in over his head (I realize this is only one doctor, but this is who optometry chose to represent them?). I know most lid lesions are benign, but again, there is more to the technical aspects of removing a lid lesion. However, this example shows knowledge/what is the best thing for the public means nothing in front of a bunch of lawmakers who can never be expected to truly understand all the things they are legislating.

Fourth, when you are learning “subconjunctival and subcutaneous injections,” do your teachers given you examples of when you will actually use these skills in your daily practice? Please be specific, because I am always trying to learn new things.

Lastly, I work with optometry on a daily basis. I respect what they do and I could never imagine an eyecare delivery system in the country without optometry, but some of these bills are ridiculous.

 

[Meibomian SxN]

I would not use this statement in your argument - especially if you are trying to convince a surgeon (I might work with lawmakers, however). First, none of your training involved actual patients. If it did, you and your school would have been breaking the law. In my opinion, training in surgery should involve actual patients.

Second, the technical aspect of many surgical procedures could be picked up by any 10 year old (the 10 year old could be trained to do a craniotomy in about 10 minutes (it would be just as good as your local brain surgeon, but our medical system has felt neurosurgeons are best able to perform craniotomies). In other words, there is more to the practice of surgery than the technical aspect - the decision making around it so much MORE important (let’s take YAG for example, we have all seen dislocated IOLs induced by YAGs, RDs induced by YAG, CME induced by YAGs, last week I saw a patient who had their entire anterior segment filled with vitreous after another surgeon performed a YAG on an in the bag PCIOL). Does your training tell you how to avoid/deal with these complications?

Third, I will never respect any optometric bill that mentions lid lesions "lid lesions." There is a video from the state of OK from the meetings several years ago among lawmakers, optometry, and ophthalmology (not sure if anyone else has seen this). I have never seen anything like it. It was obvious that optometrist must have been a better speaker than an eyecare provider. The ophthalmology group provided several clinical cases with pictures and basically asked if they were things that optometry would be able to handle/remove with the new surgical scope they were looking for. The ophthalmology provided cases were supposed to prove to the lawmakers that lid lesions can be serious. One of the pictures was a basal cell carcinoma (classic could have been in a textbook – any first year optometry student or ophthalmology student would have known this was a basal cell carcinoma). The optometrist speaking was convinced that this was benign and that he had the training to remove it in his office (really – as someone who has participated in three orbital exenteration cases due to basal cell carcinoma metastasizing to the orbit, I found this just a little concerning). Then there was a case of sebaceous cell carcinoma - very concerning from the history alone (again any first year optometry or ophthalmology resident would have known this). The optometrist went on to say this was also benign and that he felt very comfortable managing it. I am not sure if the optometrist answering the questions was simply lying to impress the lawmakers or if he was just that ignorant. It was hard to watch because it was obvious that this optometrist was just so in over his head (I realize this is only one doctor, but this is who optometry chose to represent them?). I know most lid lesions are benign, but again, there is more to the technical aspects of removing a lid lesion. However, this example shows knowledge/what is the best thing for the public means nothing in front of a bunch of lawmakers who can never be expected to truly understand all the things they are legislating.

Fourth, when you are learning “subconjunctival and subcutaneous injections,” do your teachers given you examples of when you will actually use these skills in your daily practice? Please be specific, because I am always trying to learn new things.

Lastly, I work with optometry on a daily basis. I respect what they do and I could never imagine an eyecare delivery system in the country without optometry, but some of these bills are ridiculous.

Get over yourself! Do you know how many fouled up surgeries & post-ops I have seen MDs make? Are you a pathologist? NO! The OD would have excised the lesion and sent it in for testing, found out it was cancerous and went from there! End of story.

Do residents learn on dummies & cow eyes? Who created all the LASIK ectasias? Are ophthalmologists trained enough in facial aesthetic surgeries and complications?

Are all general ophthalmologists competent enough to give Avastin/Lucentis injections without having completed a retina FELLOWSHIP (not rotation)?

Lastly, what do you YOU yourself do when you drop a piece of lens cortex into the vitreous? Run call retina or handle it yourself?

Get over yourself. Many ODs are qualified to perform many surgical procedures. Not ALL, but some should be allowed.

Reading the comments to that article, it sounds like the public knows when MDs and the AMA are using scare tactics...

 

[200UL]

Meibomian SxN
You are right - I am not sure why ophthalmology exists.

Why would anyone want their eye surgeon to have completed medical training or actually perform surgery on patients during their training? Seems like a lot of extra work.

If those darn legislators realize what a waste of time medical school was....

 

[geronamo26]

Don't you all have better things to do than worrying about what other people are doing?

 

[Meibomian SxN]

Meibomian SxN
You are right - I am not sure why ophthalmology exists.

Why would anyone want their eye surgeon to have completed medical training or actually perform surgery on patients during their training? Seems like a lot of extra work.

If those darn legislators realize what a waste of time medical school was....

Seems like the same legislators realized that nurse practitioners should get the same reimbursement for vaginal births, irrespective of medical vs. nursing education...

You and I both know that legislators do not have the public's best interest in mind. No organization or profession would push for something they are not trained for.

 

[orbitsurgMD]

Get over yourself! Do you know how many fouled up surgeries & post-ops I have seen MDs make? Are you a pathologist? NO! The OD would have excised the lesion and sent it in for testing, found out it was cancerous and went from there! End of story.

Do residents learn on dummies & cow eyes? Who created all the LASIK ectasias? Are ophthalmologists trained enough in facial aesthetic surgeries and complications?

Are all general ophthalmologists competent enough to give Avastin/Lucentis injections without having completed a retina FELLOWSHIP (not rotation)?

Lastly, what do you YOU yourself do when you drop a piece of lens cortex into the vitreous? Run call retina or handle it yourself?

Get over yourself. Many ODs are qualified to perform many surgical procedures. Not ALL, but some should be allowed.

Reading the comments to that article, it sounds like the public knows when MDs and the AMA are using scare tactics...

[Bolds mine]

Why? Because you want to? Because you are best qualified to? Because the law doesn't say you can't?

In order for me to be allowed to do "some surgical procedures" I had to show every credentials committee at every institution I ever worked at that I was actually trained to do those procedures I was requesting the privileges to do. I had to show how many cases of each kind I did before they would approve of me. Even for the procedures I do in my office, I have to at least show my malpractice carrier I am qualified by virtue of my training. I did a general surgery internship, an ophthalmology residency and an oculoplastic surgery fellowship.

Tell me, will your profession be willing to do the same? And if not, why not?

My take on optometric surgery privileges (and "laser" privileges) is that the optometric profession wants the business of surgical practice without having to do the training expected of ophthalmologists. And it isn't about doing a YAG (please, you will spend $20K for a laser and do how many procedures?) What it is is about wresting control of the refractive surgery market.

I generally get along very well with my local optometrists. I am respectful of them and treat them collegially. But I also know how some (not the majority, mind you) have grossly overused diagnostic modalities like fundus photography and OCT--telling patients they need the images for "future reference" even when no pathology exists and having them sign ABNs for the studies and collecting cash--running an Olan Mills side business in imaging to no one's benefit but the doctor's. YAG has been a progressively less frequent intervention with better techniques and implants; will that continue when YAG privileges are granted to practitioners who are not trained as surgeons but who have to justify their $20K investment?

 

[Meibomian SxN]

[Bolds mine]

Tell me, will your profession be willing to do the same? And if not, why not?

Yes, I would assume they would; the same as you did. ODs in Oklahoma have permission by the state to use lasers already, so obviously the education and training was adequate! And if a new procedure or laser becomes available, one is simply educated about it, trained and certified, just like MDs do!!! No need to break out a CV on what you've been "qualified by virtue" to perform...

[Bolds mine]
My take on optometric surgery privileges (and "laser" privileges) is that the optometric profession wants the business of surgical practice without having to do the training expected of ophthalmologists. And it isn't about doing a YAG (please, you will spend $20K for a laser and do how many procedures?) What it is is about wresting control of the refractive surgery market.

ODs have the frame work through their education to perform certain surgeries. Its more about progression. ODs today are 360 degrees different than 50yrs ago. The same can be said in all professions.

Everyone may not feel comfortable with every procedure, and that is fine. But stop acting like unless you go to medical school you can not progress your profession!

[Bolds mine]
I generally get along very well with my local optometrists. I am respectful of them and treat them collegially. But I also know how some (not the majority, mind you) have grossly overused diagnostic modalities like fundus photography and OCT--telling patients they need the images for "future reference" even when no pathology exists and having them sign ABNs for the studies and collecting cash--running an Olan Mills side business in imaging to no one's benefit but the doctor's. YAG has been a progressively less frequent intervention with better techniques and implants; will that continue when YAG privileges are granted to practitioners who are not trained as surgeons but who have to justify their $20K investment?

And you have never seen an MD do the same? Actually I just received a solicitation from one of your colleagues about the Foresee PHP Macular Degeneration field machine! Go figure....

 

[orbitsurgMD]

Yes, I would assume they would; the same as you did. ODs in Oklahoma have permission by the state to use lasers already, so obviously the education and training was adequate!

[emphasis mine]

Non sequitur.

The fact that a pliable state legislature--not a professionally qualified group to judge anything, mind you--approved something means absolutely nothing more than that they voted to approve optometric practice expansion. It does not mean they voted for practice expansion because optometrists were any more qualified than in the past. It proves nothing except that legislators can be influenced. No one said they had to be influenced by reason.

And if a new procedure or laser becomes available, one is simply educated about it, trained and certified, just like MDs do!!! No need to break out a CV on what you've been "qualified by virtue" to perform...

If you want to paraphrase my post, don't misquote me and then pretend to make a point with your distorted paraphrasing.

I wrote: "by virtue of my training." My training carries very specific requirements as to the type and quality of surgical experience I must have in order to satisfy the ACGME requirements to be qualified as a graduate resident and to be eligible to sit for my board exams. I cannot just learn about surgeries, I am required to demonstrate competence and minimum first surgeon volumes for surgical procedures, including laser procedures. I am not allowed to make those numbers by going to an underdeveloped country to do surgery, and I cannot count assisting at surgery among my cases.

When new techniques are developed and introduced, I would be expected to seek some training and possibly preceptorship for those new techniques. Obviously, a resident graduate does not return to residency to learn a new machine or technique, but the expectation of any kind of post-residency training is that it is built on a substantial and current surgical experience base. You are suggesting that some technical equivalent of competence can be conferred by mini-courses on a practitioner whose training and experience up to that point was not as a surgeon. I suggest that either you don't know what you don't know or that you are indifferent to the consequences of doing surgery without more than a mini course and the blessings of your state lawmakers.

ODs have the frame work through their education to perform certain surgeries. Its more about progression. ODs today are 360 degrees different than 50yrs ago. The same can be said in all professions.

Everyone may not feel comfortable with every procedure, and that is fine. But stop acting like unless you go to medical school you can not progress your profession!

Unlike, say Podiatry, which really has established itself at the professional school level as a surgical discipline, much as has Dentistry, I do not see how Optometry has done anything similar. Saying that optometric education is different than it was 50 years ago really does not make the case that it is an education that prepares a graduate for surgery.

Without a substantial foundation in surgery, what optometry lacks in this pursuit is credibility. The motivation without credibility becomes suspect, as it should be. And unless your profession is going to require surgical residencies of substantial length--years, not days or weeks--then the claim that optometrists are trained to do surgery and should be allowed to do so on terms equal to any established surgical profession rests on nothing more than greed.

And you have never seen an MD do the same? Actually I just received a solicitation from one of your colleagues about the Foresee PHP Macular Degeneration field machine! Go figure....

The only people around me that have things like that are optometrists. Most of them get their patients to sign ABNs and pay cash for the study, because they "might need it for future reference" (is there any other kind?)

 

[Meibomian SxN]

Without a substantial foundation in surgery, what optometry lacks in this pursuit is credibility. The motivation without credibility becomes suspect, as it should be. And unless your profession is going to require surgical residencies of substantial length--years, not days or weeks--then the claim that optometrists are trained to do surgery and should be allowed to do so on terms equal to any established surgical profession rests on nothing more than greed.

Again, the credibility has to be built up, it takes time. Some people do not even know an optometrist can write medication Rx's. It does not happen over night.

And please stop it! Residency in order to use a laser for a FEW procedures? Podiatrists perform invasive surgery, therefore a residency only makes sense; in order to increase exposure and mastery of that skill. An MD graduates with NO SPECIALIZATION, therefore it would only make common sense that they have a residency in a specialty.

As was said before, the OD has the educational background necessary to manage some surgical procedures and any complications that may occur. It is only logical that certification courses with "preceptorship" would be set up, etc.

IMHO, this is just another case of an MD feeling their arrogant grip loosen. I'm just glad you're not the smear campaign type though.

 

[VA Hopeful Dr]

Again, the credibility has to be built up, it takes time. Some people do not even know an optometrist can write medication Rx's. It does not happen over night.

And please stop it! Residency in order to use a laser for a FEW procedures? Podiatrists perform invasive surgery, therefore a residency only makes sense; in order to increase exposure and mastery of that skill. An MD graduates with NO SPECIALIZATION, therefore it would only make common sense that they have a residency in a specialty.

As was said before, the OD has the educational background necessary to manage some surgical procedures and any complications that may occur. It is only logical that certification courses with "preceptorship" would be set up, etc.

IMHO, this is just another case of an MD feeling their arrogant grip loosen. I'm just glad you're not the smear campaign type though.

Before I jump in on this, let me just ask you one thing. How many laser procedures did you perform on live patients during optometry school? Or, how many of said procedures do current OD students perform?

Then conversely, how many of each type of laser procedure is an ophthalmologist required to get at minimum before being eligible for board certification?

If there is a large gap between those two answers, should OD schooling raise their numbers to catch up to ophtho training?

 

[200UL]

It is hard to argue with the logic of VA Hopeful Doctor or orbitalsurgMD.

I am sorry Meibomian SxN - this has nothing to do with MD arrogance. The issue at hand here is, proof of competency.

There are two distinct paths that are occurring in recent years….

Organized optometry has attempted to show competence with its excellent up to date training that is just as good as medical school + ophthalmology residency +/- ophthalmology fellowship. Their ability to prescribe systemic medications (that’s right, nearly half of the scope of practice bills introduced ask for expanded systemic medication use, including the always impressive “narcotics.” Now if this were to happen, it would really save the eyecare system in this country) involves classroom instruction (no actual patients) and simulated surgical senarios (no actual time in the OR).

Ophthalmology has taken a very different path in recent years. We actually get to prescribe medications and watch their effects on actual patients during our training. Additionally we must perform high numbers of a variety of surgical procedures on actual patients before anyone says we can perform surgery on our own.

For a residency program to graduate an ophthalmologist in 2011, one must be competent in the clinic and must be a competent surgeon. The days of graduating a medical ophthalmologist are over (while not every graduate will choose to perform every surgical procedure or any at all, they were deemed competent by their training program at the time of graduation). As stated above, before we can ever perform surgical procedures at a new location, surgical logs are examined and calls are made to our training programs. This is not ophthalmology specific - this is the practice in all areas of Medicine.

Meibomian SxN, don’t you find it interesting that ophthalmology and the rest of medicine is making it harder and harder obtain privileges for all of its graduates when optometry feels a lecture and a pig eye is all that is needed?

Finally, I am a big believer of that you are only as good as both your knowledge and experiences. I find it hard to believe that optometry school will ever be able to simulate the experiences of the average ophthalmology resident (medical school, internship, residency, +/- fellowship). Please correct me if I am wrong about this.

 

[Meibomian SxN]

It is hard to argue with the logic of VA Hopeful Doctor or orbitalsurgMD.

I am sorry Meibomian SxN - this has nothing to do with MD arrogance. The issue at hand here is, proof of competency.

There are two distinct paths that are occurring in recent years….

Organized optometry has attempted to show competence with its excellent up to date training that is just as good as medical school + ophthalmology residency +/- ophthalmology fellowship. Their ability to prescribe systemic medications (that's right, nearly half of the scope of practice bills introduced ask for expanded systemic medication use, including the always impressive "narcotics." Now if this were to happen, it would really save the eyecare system in this country) involves classroom instruction (no actual patients) and simulated surgical senarios (no actual time in the OR).

Ophthalmology has taken a very different path in recent years. We actually get to prescribe medications and watch their effects on actual patients during our training. Additionally we must perform high numbers of a variety of surgical procedures on actual patients before anyone says we can perform surgery on our own.

For a residency program to graduate an ophthalmologist in 2011, one must be competent in the clinic and must be a competent surgeon. The days of graduating a medical ophthalmologist are over (while not every graduate will choose to perform every surgical procedure or any at all, they were deemed competent by their training program at the time of graduation). As stated above, before we can ever perform surgical procedures at a new location, surgical logs are examined and calls are made to our training programs. This is not ophthalmology specific - this is the practice in all areas of Medicine.

Meibomian SxN, don't you find it interesting that ophthalmology and the rest of medicine is making it harder and harder obtain privileges for all of its graduates when optometry feels a lecture and a pig eye is all that is needed?

Finally, I am a big believer of that you are only as good as both your knowledge and experiences. I find it hard to believe that optometry school will ever be able to simulate the experiences of the average ophthalmology resident (medical school, internship, residency, +/- fellowship). Please correct me if I am wrong about this.

How many is enough? Again, I could not possibly believe that anyone would allow any doctor to perform something they have never been educated on, and have practiced on.

Before any procedure, I would assume practice is done on a non-living being; am I correct? Did you start training with an argon laser on humans first? Or were you educated, practiced and then did the real thing?

Optometrists do not and will not ever see the volume of patients ophthalmology residents see. But that does not mean that they are not competent enough to examine a patient.

I can only speak for myself, if I wanted to do cataract surgery then I would have went to medical school. All I ask is that I be allowed to treat my patients to the best that I was trained to do. That's all.

The next 5-10 years will only show progression, it is better to just accept it and adapt. The same can be said for other fields of medicine....(nursing, PCPs, PAs, nurse anesthesiologists etc).

 

[VA Hopeful Dr]

How many is enough? Again, I could not possibly believe that anyone would allow any doctor to perform something they have never been educated on, and have practiced on.

Before any procedure, I would assume practice is done on a non-living being; am I correct? Did you start training with an argon laser on humans first? Or were you educated, practiced and then did the real thing?

Optometrists do not and will not ever see the volume of patients ophthalmology residents see. But that does not mean that they are not competent enough to examine a patient.

I can only speak for myself, if I wanted to do cataract surgery then I would have went to medical school. All I ask is that I be allowed to treat my patients to the best that I was trained to do. That's all.

The next 5-10 years will only show progression, it is better to just accept it and adapt. The same can be said for other fields of medicine....(nursing, PCPs, PAs, nurse anesthesiologists etc).

So how many live patients do you practice on during school?

 

[chalazion]

Both the Senate & the House in Kentucky violated their procedures (see below) in their handling of SB 110.

Any vote on this bill needs to be delayed so that it can be considered by the appropriate committee:

House
http://www.lrc.ky.gov/record/11RS/HR1.htm
In this link click on HR1:

Senate
http://www.lrc.ky.gov/record/11RS/SR2.htm
In this link click on SR2:

In assigning this bill both in the senate and the house to the licensing and occupations committee rather than health and welfare committee, they have violated their own rules.

Rule 40. Jurisdiction of Standing Committees. The Committee on Committees shall refer each bill to the Committee with control over the subject matter. All bills and resolutions on the same subject matter shall be referred to the same committee. The general jurisdiction of the several standing committees shall be:

7. Health and Welfare: matters pertaining to human development, health, and welfare; delivery of health services; support of dependents; public assistance; child welfare; adoptions; children's homes; disabled persons; family welfare; aid to the blind; commitment and care of children; mental health; substance abuse; health, medical and dental scholarships; local health units and officers; vital statistics; communicable diseases; hospitals, clinics, and long-term care facilities; health professions;physicians, osteopaths and podiatrists; chiropractors; dentists and dental specialists; nurses; pharmacists; embalmers and funeral directors; psychologists; optometrists,ophthalmic dispensers; physical therapists; senior citizens; eliminating age discrimination; non-public sector retirement; problems of aging; violent acts against the elderly.

10. Licensing and Occupations: matters pertaining to professional licensing not assigned specifically to another committee; racing; prize fighting and wrestling; places of entertainment; alcoholic beverage control; private corporations; cooperative corporations and marketing associations; religious, charitable and educational societies; nonprofit corporations; professional service corporations; cemeteries; barbers and cosmetologists; professional engineers and land surveyors; architects; real estate brokers and agents public accountants; detection of deception examiners; auctioneers; business schools; warehouses; partnerships; trade practices.

 

[Meibomian SxN]

So how many live patients do you practice on during school?

I do not remember exact numbers because I am not a new grad; but after graduation they gave us a binded book of every patient encounter we saw, including ICD-9 codes. But to give you an example, we started observing patient care for 1.4yrs, and then started seeing live patients in the school's eye clinic under an attending or resident for for another 1yr. The last 2 years were called externships, in which the student chooses and that is for 2yrs. After graduating, the optometrist has an option to do a residency in varying fields or just practice what they know under state laws.

 

[Meibomian SxN]

Before I jump in on this, let me just ask you one thing. How many laser procedures did you perform on live patients during optometry school? Or, how many of said procedures do current OD students perform?

Then conversely, how many of each type of laser procedure is an ophthalmologist required to get at minimum before being eligible for board certification?

If there is a large gap between those two answers, should OD schooling raise their numbers to catch up to ophtho training?

http://www.wsaz.com/news/headlines/Senate_Bill_110_Optometrists_vs_Ophthalmologists_116431974.html

This article showed a very good and compelling argument by a competent optometrist, and a pathetic response by an ophthalmologist loosing that "arrogant grip".

If the patient 'hemorrhages behind the eye', what would the OD do? Hell, what would the ophthalmologist do? What would 'OrbitsurgMD' do???.....

Exactly the same thing the anyone else would do! Refer it out to retina stat!
I hope it passes, good for them for much needed progression!

 

[cme2c]

Before any procedure, I would assume practice is done on a non-living being; am I correct? Did you start training with an argon laser on humans first? Or were you educated, practiced and then did the real thing?

Just curious how many of the EyeMDs out there trained using argon on a "non-living" being?

In our program which is like most, we observed multiple patients with an attending physician who themselves had done hundreds of lasers. Then with them watching us through an observer scope we were stepwise allowed to perform various parts of the procedure while they watched our every move. I can't even imagine trying to use laser on a "non-living" being, it just won't work well with the poor view, etc. Sure we use pig/cow eyes to practice suturing, etc, but all that real does is get you used to working under a microscope, the real training happens on real patients. Surgery is not something you can go to a conference, practice on a pig eye and get a certificate.

 

[Frumps]

OrbitsurgMD, your posts are always spot on. You should be testifying at these hearings!

 

[cme2c]

http://www.wsaz.com/news/headlines/Senate_Bill_110_Optometrists_vs_Ophthalmologists_116431974.html

This article showed a very good and compelling argument by a competent optometrist, and a pathetic response by an ophthalmologist loosing that "arrogant grip".

If the patient 'hemorrhages behind the eye', what would the OD do? Hell, what would the ophthalmologist do? What would 'OrbitsurgMD' do???.....

Exactly the same thing the anyone else would do! Refer it out to retina stat!
I hope it passes, good for them for much needed progression!

Thank you for showing the level or your training. If someone hemorrhaghes during a blepharoplasty why would you send them to retina? That is STUPID!!! If they have a retrobulbar hemorrhage from a bleph and is losing vision you need to decompress their orbit by doing a lateral canthotomy and cantholysis, NOW!!!!!!!!!! (Ironically that is probably what OrbitsurgMD is a specialist in, so you better get a pretty big retractor to pull that foot out of your mouth) It has absolutely nothing to do with retina. This is a basic procedure that every ophthalmologist has performed in their residency. This is why we have broad exposure to all areas. Now how often does a doc have to do an urgent canthotomy and cantholysis, not very. But that's the beauty of how our medical training works. When I saw my first lateral tarsal strip, I learned how to do this procedure. Nothing can replace the feel of strumming across that lateral canthal tendon on a patient and then cutting acrossed it and knowing that you got it released.

 

[JaggerPlate]

Another example of senseless expansion based solely upon what a certain group feels they are "entitled to." No dedication to further training, no promise to demonstrate competency on the level of a board certified DO/MD, no honest plea to the public as to why this should be done; simply a sense of entitlement mixed with shady politics and a lobbying group.

It's a shame that patient safety, understanding, and transparency is what truly suffers in the end. I really hope this gets squashed.

 

[Visionary]

Just curious how many of the EyeMDs out there trained using argon on a "non-living" being?

In our program which is like most, we observed multiple patients with an attending physician who themselves had done hundreds of lasers. Then with them watching us through an observer scope we were stepwise allowed to perform various parts of the procedure while they watched our every move. I can't even imagine trying to use laser on a "non-living" being, it just won't work well with the poor view, etc. Sure we use pig/cow eyes to practice suturing, etc, but all that real does is get you used to working under a microscope, the real training happens on real patients. Surgery is not something you can go to a conference, practice on a pig eye and get a certificate.

Spot on. These procedures cannot be learned adequately on models or animal eyes. You must learn on real patients. Moreover, you must repeat the procedure numerous times on numerous patients to fully grasp the finer points. The view varies between patients. Patients react differently to the procedures (yes, they sometimes move!). The ocular tissues can respond differently (e.g., iris types and yag pi). No where in the Ky bill is it explained how training and competency is to be achieved. Makes me wonder if they even understand what they are asking for! Anyone know the current acgme competency minimum requirements for each of the surgical procedures? I know it's changed since I finished residency.

 

[Meibomian SxN]

Thank you for showing the level or your training. If someone hemorrhaghes during a blepharoplasty why would you send them to retina? That is STUPID!!! If they have a retrobulbar hemorrhage from a bleph and is losing vision you need to decompress their orbit by doing a lateral canthotomy and cantholysis, NOW!!!!!!!!!!

Thank you for teaching me something I did not know. And so now when I have hundreds of blephs lined up in my office I'll remember what to do.

Ok, retractor out my mouth and all; the bottom line is the law will most likely be passed. I doubt ODs start doing blephs but if so, they will be taught the complications and proper follow-ups etc the same way YOU were taught.

Just curious how many of the EyeMDs out there trained using argon on a "non-living" being?

In our program which is like most, we observed multiple patients with an attending physician who themselves had done hundreds of lasers. Then with them watching us through an observer scope we were stepwise allowed to perform various parts of the procedure while they watched our every move.

One state is already allowed to use lasers. They learned the same way you learned. Its not that difficult a concept to understand....

 

[MullerCell]

Wow, thanks for proving our point Meibomian. While you are referring to Retina, your patient just infarcted their optic nerve. I have worked with numerous optometrist at multiple academic departments. Many are personal friends of mine and they are very good at what they do. However, they are not trained to manage the majority of real pathology. They are excellent at contact lens and refraction. They can recognize and medically treat POAG, dry eye, blepharitis, ect. They can do diabetic exams. But there is a huge difference between doing a diabetic exam and performing proper PRP with an indirect laser through a 3mm pupil in a patient with 3+ NSC or determining what combination of focal laser, Avastin, and intravitreal steroids to use for advanced diabetic macular edema and chronically managing that patient. The majority of community optometrists that refer me patients have no idea what they are looking at. They call vitreous hemorrhages retinal detachments. They call shadows on their non-mydriatic cameras tumors. They don't recognize vein occlusions, CNVMs, or DME. There is obviously a different emphasis and experience during training that makes the current limitations of scope appropriate. You can't replicate the volume of pathology encountered during ophthalmology residency and fellowship.

 

[Meibomian SxN]

Wow, thanks for proving our point Meibomian. While you are referring to Retina, your patient just infarcted their optic nerve. I have worked with numerous optometrist at multiple academic departments. Many are personal friends of mine and they are very good at what they do. However, they are not trained to manage the majority of real pathology. They are excellent at contact lens and refraction. They can recognize and medically treat POAG, dry eye, blepharitis, ect. They can do diabetic exams. But there is a huge difference between doing a diabetic exam and performing proper PRP with an indirect laser through a 3mm pupil in a patient with 3+ NSC or determining what combination of focal laser, Avastin, and intravitreal steroids to use for advanced diabetic macular edema and chronically managing that patient. The majority of community optometrists that refer me patients have no idea what they are looking at. They call vitreous hemorrhages retinal detachments. They call shadows on their non-mydriatic cameras tumors. They don't recognize vein occlusions, CNVMs, or DME. There is obviously a different emphasis and experience during training that makes the current limitations of scope appropriate. You can't replicate the volume of pathology encountered during ophthalmology residency and fellowship.

You're right. All ophthalmologists are competent and never make mistakes. Never get stumped. Never over bill patients. Never sell pills & Rx pads. They are the gods that walk the earth.

And for that I'll be sending a check down to Kentucky in order to help their PAC pass their law . Maybe they can offer you an honorarium for teaching a certificate course on Blepharoplasty surgery...

 

[MullerCell]

I don't do blephs. I leave it to surgeons that are fellowship trained in oculoplastic surgery.

 

[JaggerPlate]

You're right. All ophthalmologists are competent and never make mistakes. Never get stumped. Never over bill patients. Never sell pills & Rx pads. They are the gods that walk the earth.

And for that I'll be sending a check down to Kentucky in order to help their PAC pass their law . Maybe they can offer you an honorarium for teaching a certificate course on Blepharoplasty surgery...

Wow, so you've now had 3 Ophthalmic physicians/surgeons tell you that your course of action in that situation would have been wrong and been a huge detriment toward the patient, and you still feel like the solution is to launch into an eye roll, non-sequitur about the fact that DO/MDs aren't foolproof without thinking for a SECOND about what this could mean to patients?

Furthermore, you're now going to send money to the PAC OD group to push the law further? You don't think for a second that maybe there's a reason why the MD/DO groups don't feel it's important to keep the surgical procedures within the realms of those trained in surgery? It's just all about money and ego, huh?

 

[Meibomian SxN]

Wow, so you've now had 3 Ophthalmic physicians/surgeons tell you that your course of action in that situation would have been wrong and been a huge detriment toward the patient, and you still feel like the solution is to launch into an eye roll, non-sequitur about the fact that DO/MDs aren't foolproof without thinking for a SECOND about what this could mean to patients?

I thanked him for correcting me in something I was wrong about.

Furthermore, you're now going to send money to the PAC OD group to push the law further? You don't think for a second that maybe there's a reason why the MD/DO groups don't feel it's important to keep the surgical procedures within the realms of those trained in surgery? It's just all about money and ego, huh?

Again, for the 1 millionth time: There will not be hundreds of Kentucky ODs running to buy argon lasers and applying to surgical centers to perform blephs and PRPs....Some procedures are listed as surgical and for billing purposes they need it passed!

I don't do blephs. I leave it to surgeons that are fellowship trained in oculoplastic surgery.

Good for you. Maybe now I'll refer my blephs to a plastic surgeon. Or maybe a dermatologist. Or maybe the Oral Maxillo Facial surgeon....all qualify to perform the surgery. Or did I answer that question wrong too?

I wouldn't do that though because I actually have a good relationship with our referral MD. She doesn't seem to threatened by ODs practicing what they are trained to do.

 

[speyeder]

Wow, so you've now had 3 Ophthalmic physicians/surgeons tell you that your course of action in that situation would have been wrong and been a huge detriment toward the patient, and you still feel like the solution is to launch into an eye roll, non-sequitur about the fact that DO/MDs aren't foolproof without thinking for a SECOND about what this could mean to patients?

Furthermore, you're now going to send money to the PAC OD group to push the law further? You don't think for a second that maybe there's a reason why the MD/DO groups don't feel it's important to keep the surgical procedures within the realms of those trained in surgery? It's just all about money and ego, huh?

Well said!

 

[speyeder]

http://www.wsaz.com/news/headlines/Senate_Bill_110_Optometrists_vs_Ophthalmologists_116431974.html

If the patient 'hemorrhages behind the eye', what would the OD do? Hell, what would the ophthalmologist do? What would 'OrbitsurgMD' do???.....

Exactly the same thing the anyone else would do! Refer it out to retina stat!
I hope it passes, good for them for much needed progression!

Wow...I don't even know what to say.

 

[JaggerPlate]

Again, for the 1 millionth time: There will not be hundreds of Kentucky ODs running to buy argon lasers and applying to surgical centers to perform blephs and PRPs....Some procedures are listed as surgical and for billing purposes they need it passed!

I understand that you're being reasonable about the situation, but the problem with the above statement is that you truthfully don't know this for fact. What if a sizable chunk of ODs sees it differently than yourself and DO start performing these surgical procedures? What if just 1 OD goes out, gets the equipment, performs the operations without undergoing additional training (as it's law now, and there's nothing saying he has to) and seriously injuries a patient?

Frankly, the only way to prevent these (admitted) hypotheticals is to not allow non-physician/surgeons to perform surgery on the eye.

 

[Meibomian SxN]

I understand that you're being reasonable about the situation, but the problem with the above statement is that you truthfully don't know this for fact. What if a sizable chunk of ODs sees it differently than yourself and DO start performing these surgical procedures? What if just 1 OD goes out, gets the equipment, performs the operations without undergoing additional training (as it's law now, and there's nothing saying he has to) and seriously injuries a patient?

Frankly, the only way to prevent these (admitted) hypotheticals is to not allow non-physician/surgeons to perform surgery on the eye.

If that truly did happen and the complication was due to negligence and incompetence, then I am pretty sure the law would get reversed and that would be the end of any future "surgery" laws getting passed.

 

[200UL]

I am sorry but the bills in like those in Kentucky would make me embarrassed if I was an optometrist. They are just so ridiculous…

In the current form optometrist will have the right to:

1. Provide all forms of anesthesia except for general: Stuff like this makes me laugh. Depending on specialty/practice, the majority of MDs (not just ophthalmologists) do not feel comfortable giving IV sedation (and all of these doctors were ACLS certified and ran many codes in there life). Why? because unpredictable things can happen with anesthesia. Is it really true that optometric training has improved so much that graduates can run codes on the day of graduation with no prior experience running a code?

2. Perform laser cataract surgery (perhaps organized optometry should start teaching the MDs this one since there are only a few ophthalmologists in the world who have used such technology. Maybe all optometry students are being trained in intraocular surgery (on humans) now. Please speak up you are at one of these programs– perhaps some ophthalmology programs would like to model this curriculum. Do optometrists realize the cataract just doesn’t get obliterated by the laser – lens material still needs to be removed. And sorry doing it on a pig eye alone is not enough in my opinion.

Organized optometry looks incredibly pathetic to an educated observer with such requests. While the “ask for the stars and hope we just get just a little approach” may be good politics, it makes your profession look very desperate. If patients/legislators truly knew what this bill was asking for, they too would lose respect. Again, as stated above, I doubt if many optometrists in practice in Kentucky truly know what the bill is asking for….

 

[JaggerPlate]

If that truly did happen and the complication was due to negligence and incompetence, then I am pretty sure the law would get reversed and that would be the end of any future "surgery" laws getting passed.

So it should be a "trial and error" type of ruling with patient wellbeing as the barometer as to whether or not it's kosher?

Sorry for the hyperbole, but as you can probably tell, these roadblocks that stand between certain health professionals and surgery exist for more complex reasons than DO/MD greed/ego in my humble opinion. Many times, I feel as if this is overlooked.

 

[200UL]

This is from the new Kentucky OD bill.

For the MDs (or ODs) reading, you may find this very entertaining. For the ODs reading ready to take the new optometry bill by the horns, please get an MD involved before you start pulliing the epinephrine out for your patient who is crashing.

Also, optometric schools should open up this high impact 6 hour pharmacology course to medical doctors (or whatever the bill is describing). This 6 hour course gives optometrists the ability to prescribe anything other than than schedule 1 or 2 meds (they choose not to go into too much depth on heroin in optometry school). With an optometric pharmacology course, I believe about 2 years could be shaved off the average medical doctors training (surgical or non-surgical).

Again, how can a profession demand respect when such smoke and mirrors are being used. Again, I doubt the average optometrist wants to be pushing the epinephrine in the clinic for a crumping patient, but this is what the OD leaders say "is in their scope of practice"

(13) The board may authorize only those persons who have qualified for use of diagnostic pharmaceutical agents as set out in subsection (12) of this section to utilize and prescribe therapeutic pharmaceutical agents in the examination or treatment of any condition of the eye or its appendages. Any therapeutically certified optometrist licensed under the provisions of this subsection shall be authorized to prescribe oral medications except controlled substances classified in Schedules I and II for any condition which an optometrist is authorized to treat under the provisions of this chapter. The[ and to] use of injections for other than treatment of the human eye and its appendages shall be limited to the administration of[administer] benadryl, epinephrine, or equivalent medication to counteract anaphylaxis or anaphylactic reaction. In a public health emergency, the Commissioner of Health may authorize therapeutically licensed optometrists to administer inoculation for systemic health reasons. The authority to prescribe a Schedule III, IV, or V controlled substance shall be limited to prescriptions for a quantity sufficient to provide treatment for up to seventy-two (72) hours. No refills of prescriptions for controlled substances shall be allowed. The utilization or prescribing of therapeutic pharmaceutical agents shall be limited to those persons who have sufficient education and professional competence as determined by the board and who have earned transcript credits of at least six (6) semester hours in a course or courses in general and ocular pathology and therapy, with particular emphasis on utilization of therapeutic pharmaceutical agents from a college or university accredited by a regional or professional accreditation organization which is recognized or approved by the council on postsecondary accreditation or by the United States Department of Education. These six (6) semester hours are in addition to the six (6) semester hours required by subsection (12) of this section, making a total of twelve (12) semester hours.

 

[JaggerPlate]

This is from the new Kentucky OD bill.

For the MDs (or ODs) reading, you may find this very entertaining. For the ODs reading ready to take the new optometry bill by the horns, please get an MD involved before you start pulliing the epinephrine out for your patient who is crashing.

Also, optometric schools should open up this high impact 6 hour pharmacology course to medical doctors (or whatever the bill is describing). This 6 hour course gives optometrists the ability to prescribe anything other than than schedule 1 or 2 meds (they choose not to go into too much depth on heroin in optometry school). With an optometric pharmacology course, I believe about 2 years could be shaved off the average medical doctors training (surgical or non-surgical).

Again, how can a profession demand respect when such smoke and mirrors are being used. Again, I doubt the average optometrist wants to be pushing the epinephrine in the clinic for a crumping patient, but this is what the OD leaders say "is in their scope of practice"

(13) The board may authorize only those persons who have qualified for use of diagnostic pharmaceutical agents as set out in subsection (12) of this section to utilize and prescribe therapeutic pharmaceutical agents in the examination or treatment of any condition of the eye or its appendages. Any therapeutically certified optometrist licensed under the provisions of this subsection shall be authorized to prescribe oral medications except controlled substances classified in Schedules I and II for any condition which an optometrist is authorized to treat under the provisions of this chapter. The[ and to] use of injections for other than treatment of the human eye and its appendages shall be limited to the administration of[administer] benadryl, epinephrine, or equivalent medication to counteract anaphylaxis or anaphylactic reaction. In a public health emergency, the Commissioner of Health may authorize therapeutically licensed optometrists to administer inoculation for systemic health reasons. The authority to prescribe a Schedule III, IV, or V controlled substance shall be limited to prescriptions for a quantity sufficient to provide treatment for up to seventy-two (72) hours. No refills of prescriptions for controlled substances shall be allowed. The utilization or prescribing of therapeutic pharmaceutical agents shall be limited to those persons who have sufficient education and professional competence as determined by the board and who have earned transcript credits of at least six (6) semester hours in a course or courses in general and ocular pathology and therapy, with particular emphasis on utilization of therapeutic pharmaceutical agents from a college or university accredited by a regional or professional accreditation organization which is recognized or approved by the council on postsecondary accreditation or by the United States Department of Education. These six (6) semester hours are in addition to the six (6) semester hours required by subsection (12) of this section, making a total of twelve (12) semester hours.

Shouldn't all this information be sent to the state medical board, AMA, Ophthal societies, etc??