Optometry, Pearl Vision, and others.

[Pigmentosa]

I have a theory. Although ODs have been trying to expand their field into ophthalmology for decades, it is now that they have begun to see significant legislation. I feel that a great deal of this radical movement is sponsored by Pearl Vision (and the equivalents).

Pearl Vision (and others) knows that the future of glasses is shrinking and that Lasik is the way to go. I think that they are planning in the long run to use ODs and their surgical rights to sell Lasik procedures in malls. If they dont invest in legislation these companies are going to collapse.

What do you guys think???

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[Ben Chudner]

What do you guys think???

 

[JR]

Oh man, not another thread

 

[qwopty99]

i think pearle vision is interested in selling glasses.

never got the sense they care for optometrists per se.

i don't see how pearle vision would make LASIK profitable.

 

[PBEA]

I have a theory. Although ODs have been trying to expand their field into ophthalmology for decades, it is now that they have begun to see significant legislation. I feel that a great deal of this radical movement is sponsored by Pearl Vision (and the equivalents).

Pearl Vision (and others) knows that the future of glasses is shrinking and that Lasik is the way to go. I think that they are planning in the long run to use ODs and their surgical rights to sell Lasik procedures in malls. If they dont invest in legislation these companies are going to collapse.

What do you guys think???

Did you come up with that all by yourself?

 

[rubensan]

Did you come up with that all by yourself?

i agree with the posts from our frequent OD guests to this forum. lenscrafters and pearl vision have less of an interest in becoming refractive surgical centers and more of an interest in obtaining as much market share as they can for prescribing and dispensing glasses. now, wal-mart is a different beast who has had in-house optometrists and optical schops for a long time and is now experimenting with providing urgent care services in their stores.

http://www.firstcoastnews.com/news/local/news-article.aspx?storyid=46080

if any coorporation has the ability, resources and infrastructure to make in-house LASIK centers geared to the masses porfitable, i would put my money on Wal-Mart.

 

[AwesomeSauce]

Nah, Pearl has no intrest in helping optometrists. The optometrists are just an expensive inconveniance to them. If opticians suddenly were allowed to refract they would lay off all of their expensive ODs and hire a bunch of cheap opticians.

 

[KHE]

I have a theory. Although ODs have been trying to expand their field into ophthalmology for decades, it is now that they have begun to see significant legislation. I feel that a great deal of this radical movement is sponsored by Pearl Vision (and the equivalents).

Pearl Vision (and others) knows that the future of glasses is shrinking and that Lasik is the way to go. I think that they are planning in the long run to use ODs and their surgical rights to sell Lasik procedures in malls. If they dont invest in legislation these companies are going to collapse.

What do you guys think???

I really don't think so.

I have run a refractive surgery center so I think that I have a pretty decent sense as to how much it costs. I don't think that Pearle is interested in doing that. Pearle is owned by Luxottica which is essentially a frame distribution company. LASIK is not their primary business. In fact, they likely view LASIK as a threat.

I also don't think that LASIK (or any refractive surgery) is going to be viable in the long term. It is my belief that what you will see as the primary mode of refractive correction in the future is contact lenses that are substantially more biocompatable than even the best ones we have now. I think you are going to see CLs that will be extended wear for months. I believe that in 20 years we will look back on this era of medicine and say "wow! Can you believe that we used to slice into eyeballs with keratomes and then zap them with excimer lasers for refractive correction?? Man! Those were the caveman days." Of course, I could be wrong since no one can predict the future, but that is what I'm betting.

Regarding ODs doing LASIK, again I think its a red herring. How many of the approximately 15000 ophthalmologists in the United States are doing LASIK right now? Let's suppose its 20% or about 3000. (I'm betting its much less.) Hypothetically, lets say that ODs were granted the rights to do LASIK tomorrow. Out of the 40000 ODs out there, if even 10% of those decided to start doing LASIK that would put out an additional 4000 providers doing this surgery. The demand for LASIK stays the same but the supply of providers now more than doubles. What is this going to do to fees? It's going to drive down fees that are already low in the hyper-competitive refractive surgery market anyways. It's just not going to be economically viable for ODs to start buying lasers and setting up surgery centers, even if a bunch of them get together.

 

[KHE]

Nah, Pearl has no intrest in helping optometrists. The optometrists are just an expensive inconveniance to them. If opticians suddenly were allowed to refract they would lay off all of their expensive ODs and hire a bunch of cheap opticians.

In the vast majority of states, optometrists are not employed by Pearle. They lease space from them and operate their little "clinic" as a separate entity. Having the optometrists there costs Pearle nothing. In fact, they charge rent to the ODs so they make a bit of money off of them. (Though not nearly as much as they make off of selling materials from the ODs prescriptions.)

 

[orangezero]

I am amazed at how far from reality several of the posts are in relation to optometry's desires. The ODs I know are upset because they can't get on medical panels and be reimbursed for red eyes, allergic conunctivitis, dry eye, etc. If you would ever talk with optometrists, or go to meetings, or deal with them professionally you'd find surgery is about the furthest thing from their minds.

For the students here, you should realize that a good deal of your cataract surgeries, strab referals, glc surgeries, etc are going to be from optometry offices. You will be catering to optometrists for referrals, might as well learn they are human and care about patients also.

I would guess 99.7% of optometrists became optometrists to have a general practice, not to hopefully one day perform lasik, and certainly not in a mall. what a horrible business model to get in anyway, although I once saw a lasik center in a shopping mall with huge TV screens showing sample procedures.

KHE, I think you are about dead on.

 

[KHE]

For the students here, you should realize that a good deal of your cataract surgeries, strab referals, glc surgeries, etc are going to be from optometry offices. You will be catering to optometrists for referrals, might as well learn they are human and care about patients also.

KHE, I think you are about dead on.

What percentage of patients seen in an average, private, general ophthalmology practice do you think come from optometric sources?

 

[IndianaOD]

I am amazed at how far from reality several of the posts are in relation to optometry's desires. The ODs I know are upset because they can't get on medical panels and be reimbursed for red eyes, allergic conunctivitis, dry eye, etc. If you would ever talk with optometrists, or go to meetings, or deal with them professionally you'd find surgery is about the furthest thing from their minds.

For the students here, you should realize that a good deal of your cataract surgeries, strab referals, glc surgeries, etc are going to be from optometry offices. You will be catering to optometrists for referrals, might as well learn they are human and care about patients also.

I would guess 99.7% of optometrists became optometrists to have a general practice, not to hopefully one day perform lasik, and certainly not in a mall. what a horrible business model to get in anyway, although I once saw a lasik center in a shopping mall with huge TV screens showing sample procedures.

KHE, I think you are about dead on.

I completely agree with this post. I had med school offers, but turned them down once I saw the difference between ophthalmolgy and optometry. The fields cannot exist without each other as currently established. You can't be a good surgeon if you spend 80% of your time in primary care. On topic, LASIK has already been commercialized. Eyeglass World owns and operates Laser Vision Institutes (I think that's the name). A refractive surgeon I comanage with says they fly in an ophthalmologist for a couple of days at a time to knock out a hundred or so procedures. They even do the old bait and switch by advertising $300/eye. The surgeon I refer to charges $2700 an eye. I already hate all commercial practices, now OMDs have a reason to hate the company as well.

 

[VA Hopeful Dr]

Dude, who would get LASIK in a mall?

People who perceive it as being a better bargain.

 

[MR1]

I am amazed at how far from reality several of the posts are in relation to optometry's desires. The ODs I know are upset because they can't get on medical panels and be reimbursed for red eyes, allergic conunctivitis, dry eye, etc. If you would ever talk with optometrists, or go to meetings, or deal with them professionally you'd find surgery is about the furthest thing from their minds.

For the students here, you should realize that a good deal of your cataract surgeries, strab referals, glc surgeries, etc are going to be from optometry offices. You will be catering to optometrists for referrals, might as well learn they are human and care about patients also.

I would guess 99.7% of optometrists became optometrists to have a general practice, not to hopefully one day perform lasik, and certainly not in a mall. what a horrible business model to get in anyway, although I once saw a lasik center in a shopping mall with huge TV screens showing sample procedures.

KHE, I think you are about dead on.

If this is true then why do we have the problem of in some states OD's pushing for laser and surgery rights. I totally agree with you though and think we have to co-exist, there aren't enough OMD's to handle all the primary eye stuff and I think OMD residencies put out enough each year to adequately handle all the laser and surgery that is needed. I have worked for both OMDs and ODs and honestly respect the optometry profession and believe me I know as a future OMD I will depend on OD's referrels to have a practice. I just don't know, anecdotally from what I have seen in the real world, ODs and OMDs get along just fine and have never witnessed any problems.

I would say IMHO that one huge problem is the number of OD's that are graduating each year. Someone once posted here that denistry was smart and didn't open new schools or increase enrollment to avoid the oversaturation issue. How to fix this though I have no idea, just like with MD's, new schools and increasing enrollment means more $ for some people.

Lastly the comment on getting LASIK in the mall, I can totally believe people going for this, our society is numb to "cosmetic" surgery and that it is still real surgery and has risks and complications. I bet these people that get "mall lasik" are the biggest ones that complain and try to sue as well.

 

[Ben Chudner]

If this is true then why do we have the problem of in some states OD's pushing for laser and surgery rights.

This seems to be a recurring question that several of the OD's on this forum (myself included) have tried to answer for the OMD's. I think the reason you can't understand what is going on in our profession has to do with the fact that most OMD's are united in their fight against scope expansion by OD's. You assume that since you all strongly agree with (or at least do not disagree with) what your political leaders are doing, we must be the same. As someone who has been very involved in optometry on a state level, I can tell you that this is not true for us. First of all, the majority of OD's that want to participate in the legislative committees are the ones that want to push for scope expansion. In my experience they do it as more of an ego boost, ie they want to be able to say they were responsible for their state being able to prescibe oral antibiotics. These "fringe" OD's do not represent the majority of OD's, just the majority of the OD's you see fighting for scope expansion. This is a very small group, but because they are who your profession has to fight against, it appears that all OD's are like this. Second of all, money that goes towards our legislative efforts is not earmarked for specific fights. For example, when a state is threatened with the loss of glaucoma meds, the OD's in the state cannot donate money and instruct the lobbyist to only use that money to fight for glaucoma meds. The vast majority of us donate to our PAC's to not only protect the current scope we have, but also to fight against cuts in Medicare, fight for any willing provider laws, fight against ERISA, etc. Unfortunately, that money also goes to fight for surgical rights in some cases, but not because we wanted it to, but because our political leaders wanted it to. The reality of the situation is that most of us are too busy with our practices to want to take on the legislative battles, so we leave it to those that are more interested - those "fringe" OD's. I guess we could change the way things are done, but I don't believe most of us don't care whether or not we get surgical rights and as long as pushing forward prevents us from falling backward, we are happy.

 

[IndianaOD]

This seems to be a recurring question that several of the OD's on this forum (myself included) have tried to answer for the OMD's. I think the reason you can't understand what is going on in our profession has to do with the fact that most OMD's are united in their fight against scope expansion by OD's. You assume that since you all strongly agree with (or at least do not disagree with) what your political leaders are doing, we must be the same. As someone who has been very involved in optometry on a state level, I can tell you that this is not true for us. First of all, the majority of OD's that want to participate in the legislative committees are the ones that want to push for scope expansion. In my experience they do it as more of an ego boost, ie they want to be able to say they were responsible for their state being able to prescibe oral antibiotics. These "fringe" OD's do not represent the majority of OD's, just the majority of the OD's you see fighting for scope expansion. This is a very small group, but because they are who your profession has to fight against, it appears that all OD's are like this. Second of all, money that goes towards our legislative efforts is not earmarked for specific fights. For example, when a state is threatened with the loss of glaucoma meds, the OD's in the state cannot donate money and instruct the lobbyist to only use that money to fight for glaucoma meds. The vast majority of us donate to our PAC's to not only protect the current scope we have, but also to fight against cuts in Medicare, fight for any willing provider laws, fight against ERISA, etc. Unfortunately, that money also goes to fight for surgical rights in some cases, but not because we wanted it to, but because our political leaders wanted it to. The reality of the situation is that most of us are too busy with our practices to want to take on the legislative battles, so we leave it to those that are more interested - those "fringe" OD's. I guess we could change the way things are done, but I don't believe most of us don't care whether or not we get surgical rights and as long as pushing forward prevents us from falling backward, we are happy.

IMHO those fringe ODs, as any other, should be able to complete a 3 year or so post OD surgical residency. Similar to dentristry/podiatry. This would end all the trouble. I think a lot of misunderstanding also occurs because it is a state issue. With 50 states, scope expansion might be coming up in the news but it just might be 1 state that lags behind the others greatly. It doesn't mean all 40,000 or whatever ODs are trying to do cataract surgery. Unlike the 4 year medical degree that inferrs nearly unilimited scope throughout the US, the 4 year optometry degree inferrs a limited scope in each of the 50 states differently. Thus there is a 50x greater chance of hearing a scope battle then if it was national.

 

[jcresbo]

First, Luxoticca (owner of LensCrafters, Cole Vision, Pearl Vision, D.O.C. and many others) cannot fund these battles, it's against the rules. Now DelVeccio (Lux CEO and founder) could dip into his own pocket. However, most are right, they don't care that much about ODs. I will say, that Lux and Walmart are looking into ways to make it feasible to provide medical care, this only serves to increase traffic in the store, which is the real goal.

As far as professional images and LASIK in malls, medical professional always say, "Would you get LASIK in a mall?" You can insert ANY non-medically necessary procedure in for LASIK and the answer from the GENERAL PUBLIC is a resounding yes. If you don't believe me, graduate and open a LASIK center in a mall, if you're like many of the centers around me (that will do just about any two eyes that walk through the door, which is why my patients drive 60 miles for theirs) you'll do fine. Most people see health care less and less professionally.


KHE said,

"What percentage of patients seen in an average, private, general ophthalmology practice do you think come from optometric sources?"

Not sure of the percentage, but I will say that most ophthalmologists in my area complain that there's too much primary eye care coming through their office. I'm not a surgeon, but if I were, I'd want to spend as much time in the surgical suite as I could.

The real difficulty will present with Minute Clinics. Those PAs and MDs working inside WalMart will do more to legitimize "medical in a store" than ODs ever have. As much as I hate it, the general public still sees ODs as nothing more that glasses peddlers, so the general public doesn't see the irony in getting eye care next to 16 crates of toilet paper. What happens when MDs and PAs start shelling out Rxs for Amoxicillin for little Johnny while mommy buys her 12 pack of beer and a carton of smokes? Then the AMA and all it's current adversaries may finally be united in saving the profession image of the ENTIRE medical community.

 

[speyeder]

IMHO those fringe ODs, as any other, should be able to complete a 3 year or so post OD surgical residency. Similar to dentristry/podiatry. This would end all the trouble. I think a lot of misunderstanding also occurs because it is a state issue. With 50 states, scope expansion might be coming up in the news but it just might be 1 state that lags behind the others greatly. It doesn't mean all 40,000 or whatever ODs are trying to do cataract surgery. Unlike the 4 year medical degree that inferrs nearly unilimited scope throughout the US, the 4 year optometry degree inferrs a limited scope in each of the 50 states differently. Thus there is a 50x greater chance of hearing a scope battle then if it was national.

Again, why create a second track for ophthalmic surgery? The one that exists is called getting your MD degree + finishing ophthalmology residency.

We don't see this in other professions. Should we create a separate track for paralegals to practice law without attending law school?

 

[IndianaOD]

Again, why create a second track for ophthalmic surgery? The one that exists is called getting your MD degree + finishing ophthalmology residency.

We don't see this in other professions. Should we create a separate track for paralegals to practice law without attending law school?

I was hoping this thread wouldn't turn this way but once provoked why not?

We could just say cut out the middle man (med-school) and learn about the eye and vision right from the start. Lets start beating the dead horse...dentists, podiatrists, nurse anesthetists. I think that ophthalmology is not far off from critical volume. (Except neuro, retina, and peds). I get at least 2-3 mailings per week for lasik. A South Bend Ophthalmologist just got shut down with the feds and state from fraud. Why is it so crazy that someone who was interested in eyecare got started in OD school then thought surgery looked interesting? I see posts all the time where OMD decided ophthalmology at the last second. A lot of surgeons out there had no interest in surgery until soon before they matched.

Why should someone retake a lot of the same classes over again?

 

[IndianaOD]

I was hoping this thread wouldn't turn this way but once provoked why not?

We could just say cut out the middle man (med-school) and learn about the eye and vision right from the start. Lets start beating the dead horse...dentists, podiatrists, nurse anesthetists. I think that ophthalmology is not far off from critical volume. (Except neuro, retina, and peds). I get at least 2-3 mailings per week for lasik. A South Bend Ophthalmologist just got shut down with the feds and state from fraud. Why is it so crazy that someone who was interested in eyecare got started in OD school then thought surgery looked interesting? I see posts all the time where OMD decided ophthalmology at the last second. A lot of surgeons out there had no interest in surgery until soon before they matched.

Why should someone retake a lot of the same classes over again?

You're comparing an associates degree to a professional degree. Yeah, that's exactly comparable.

The only time I thought it would be great to be able to do cataract surgery was on a missions trip to Honduras. The people are exstatic about glasses, but there are a lot of LP hypermature cataracts and pterygium there. The only regional OMD is terrible and half the patients develope enophthalmitis. Since no one is available to help those people I would love to help them. They can't get a US OMD to go down there.

 

[orbitsurgMD]

I have a theory. Although ODs have been trying to expand their field into ophthalmology for decades, it is now that they have begun to see significant legislation. I feel that a great deal of this radical movement is sponsored by Pearl Vision (and the equivalents).

Pearl Vision (and others) knows that the future of glasses is shrinking and that Lasik is the way to go. I think that they are planning in the long run to use ODs and their surgical rights to sell Lasik procedures in malls. If they dont invest in legislation these companies are going to collapse.

What do you guys think???

I doubt it.

Pearle makes money on selling glasses and contacts in volume. They do business with many of the nationally-prominent vision plans. Their professionals--optometrists--are simply a business necessity to Pearle to generate prescriptions that can be filled. Despite their advertising, eyecare is not Pearle's primary business, retail eyewear and contact lenses is their business. If it were possible to dispense using a technician and an Epic and no on-site optometrist, Pearle would do that. Most of the optometrists they have take jobs there right out of school to make a little money since a startup with no patients is difficult and expensive. Once most have a census of patients that they feel confident taking out on their own, they leave and launch their own independent practices. The exam rate paid and the necessary production to make a good living is not competitive with a well-run independent practice.

As for LASIK, that simply competes with the core business. It isn't in the interests of Pearle any more than it is in the interests of independent optometrists to be heavy promoters of LASIK. Long-term, LASIK is a profit draining enterprise to an optometrist. Sure, it is nice to get a check from a LASIK center for co-management, but successful LASIK patients are no longer a source of either long-term repeat retail business or current word-of-mouth referral. For the patient who desperately wants to be free of eyeglasses or contacts, it is a useful service, but for the optometrist wanting to have a loyal returning patient base, LASIK is not the way to go.
And the same is even more true for Pearle.

The novelty of shopping-mall LASIK is over. That was 1999, not 2007. LASIK is maturing, and the simple fact is that there are many people who do not want LASIK, or are happy enough with their glasses and contacts. Those are the customers Pearle wants and wants to have come back.

 

[orbitsurgMD]

.

 

[speyeder]

I was hoping this thread wouldn't turn this way but once provoked why not?

We could just say cut out the middle man (med-school) and learn about the eye and vision right from the start. Lets start beating the dead horse...dentists, podiatrists, nurse anesthetists. I think that ophthalmology is not far off from critical volume. (Except neuro, retina, and peds). I get at least 2-3 mailings per week for lasik. A South Bend Ophthalmologist just got shut down with the feds and state from fraud. Why is it so crazy that someone who was interested in eyecare got started in OD school then thought surgery looked interesting? I see posts all the time where OMD decided ophthalmology at the last second. A lot of surgeons out there had no interest in surgery until soon before they matched.

Why should someone retake a lot of the same classes over again?

So your reason for creating a separate track is 'why not'? Yeah that's a good reason.

Let's just ignore the fact that the current system for training eye surgeons is working fine. Let's just ignore the fact that there's currently no shortage of ophthalmologists.

But let's create an alternate pathway just to satisfy the few hundred or so optometrists who want to perform eye surgery without going through medical school.

Sure why not?

Let's create a short track for all professions. That way anyone can become anything they want.

 

[IndianaOD]

So you reason for creating a separate track is 'why not'? Yeah that's a good reason.

Let's just ignore the fact that the current system for training eye surgeons is working fine. Let's just ignore the fact that there's currently no shortage of ophthalmologists.

But let's create an alternate pathway just to satisfy the few hundred or so optometrists who want to perform eye surgery without going through medical school.

Sure why not?

Let's create a short track for all professions. That way anyone can become anything they want.

Can't argue with someone who is clueless. I'm sorry you think 4 years of med school teaches you more about the eye than 4 years of eye-specific professional education. Med-school isn't some golden ticket to infinite knowledge, maybe you'll find this out sometime.

 

[JR]

Hmmm, they did teach me how to spell endophthalmitis .

Can't argue with someone who is clueless. I'm sorry you think 4 years of med school teaches you more about the eye than 4 years of eye-specific professional education. Med-school isn't some golden ticket to infinite knowledge, maybe you'll find this out sometime.

 

[speyeder]

Can't argue with someone who is clueless. I'm sorry you think 4 years of med school teaches you more about the eye than 4 years of eye-specific professional education. Med-school isn't some golden ticket to infinite knowledge, maybe you'll find this out sometime.

Nice comeback.

 

[rubensan]

for reasons still unclear to me, i think that you and some of your colleagues love coming onto this forum to argue and become "provoked." we can go on and on and on and on and on and on and on and on and on. in the name of "defending optometry and clarifying misconceptions about ODs," this thread will degenerate and become shut down, PMs will be sent to moderators, complaints will surface on the optometry forum about all of us and at the end of the day all you will have learned was that you were preaching to the wrong choir my friend. right or wrong, the audience here will never think that a separate route to ophthalmic surgery will be a good idea. please, save us the flame war that you are inching ever so close to igniting.

quoted by IndianaOD:
Can't argue with someone who is clueless. I'm sorry you think 4 years of med school teaches you more about the eye than 4 years of eye-specific professional education. Med-school isn't some golden ticket to infinite knowledge, maybe you'll find this out sometime.

 

[IndianaOD]

for reasons still unclear to me, i think that you and some of your colleagues love coming onto this forum to argue and become "provoked." we can go on and on and on and on and on and on and on and on and on. in the name of "defending optometry and clarifying misconceptions about ODs," this thread will degenerate and become shut down, PMs will be sent to moderators, complaints will surface on the optometry forum about all of us and at the end of the day all you will have learned was that you were preaching to the wrong choir my friend. right or wrong, the audience here will never think that a separate route to ophthalmic surgery will be a good idea. please, save us the flame war that you are inching ever so close to igniting.

quoted by IndianaOD:
Can't argue with someone who is clueless. I'm sorry you think 4 years of med school teaches you more about the eye than 4 years of eye-specific professional education. Med-school isn't some golden ticket to infinite knowledge, maybe you'll find this out sometime.

If you look above, the flaming was started by speyeder. Then some goober states I put a wrong letter in a word. You call that a constructive post? The problem is that if I start to post actual facts and studies in rebuttal to the senseless attacks on what is the real profession of eye doctors the thread gets shut down. I'll be back in a couple of weeks to see the latest round of greed induced "go to medical school" posts. Nothing like some of these posts to get ODs and OD students fired up and headed to the legislature.

Any spelling mistakes in there to get ya all hot and bothered?

 

[speyeder]

If you look above, the flaming was started by speyeder. Then some goober states I put a wrong letter in a word. You call that a constructive post? The problem is that if I start to post actual facts and studies in rebuttal to the senseless attacks on what is the real profession of eye doctors the thread gets shut down. I'll be back in a couple of weeks to see the latest round of greed induced "go to medical school" posts. Nothing like some of these posts to get ODs and OD students fired up and headed to the legislature.

Any spelling mistakes in there to get ya all hot and bothered?

I questioned why there should be an alternate path to training eye surgeons & you called me clueless.

Yet somehow I started the flaming war.

Right.

I guess asking legitimate questions somehow 'provokes' you.

 

[rubensan]

If you look above, the flaming was started by speyeder. Then some goober states I put a wrong letter in a word. You call that a constructive post? The problem is that if I start to post actual facts and studies in rebuttal to the senseless attacks on what is the real profession of eye doctors the thread gets shut down. I'll be back in a couple of weeks to see the latest round of greed induced "go to medical school" posts. Nothing like some of these posts to get ODs and OD students fired up and headed to the legislature.

Any spelling mistakes in there to get ya all hot and bothered?

that is not what gets threads shut down. i shut threads down when the quality of the arguments degenerates into calling people "clueless" or "goobers." this is an open forum, so please post what you want without using derrogatory qualifiers. i just caution you that this forum may be the wrong audience for your claims that optometry education plus an OD-sponsored ophthalmic surgery residency is equivalent to a traditional ophthalmology residency.

perhaps the most poignant comment that you made was alluding to how all of this will play out in the legislature. many here are looking forward to this just as much as you enjoyed writing it.

 

[KHE]

that is not what gets threads shut down. i shut threads down when the quality of the arguments degenerates into calling people "clueless" or "goobers." this is an open forum, so please post what you want without using derrogatory qualifiers. i just caution you that this forum may be the wrong audience for your claims that optometry education plus an OD-sponsored ophthalmic surgery residency is equivalent to a traditional ophthalmology residency.

I think that these threads just serve to underscore the fact that neither side has a clue as to what the training and/or education of the other side involves.

Optometry students can not appreciate the dedication and suffering involved in completing medical school and ophthalmology residency. All the anecdotes of "Yeah well I have a brother who went to med school" or "yeah well my best friend went to med school" blah blah blah really mean nothing.

On the other hand, I think most physicians have no clue as to what training modern optometrists receive and I think this is due in large part to the fact that medical students will, through the course of their training interact with every other health care provider with the exception of optometry. It's really no different for residents. Their interaction with optometry is scant at best and usually its only from some strange referal from an outside source. Some ophthalmology programs may have an OD or two here and there doing contact lenses and low vision but they have little clue what those ODs are truly capable of because they don't get to see it.

The question as to why the need for an alternate path to eye surgery is very legitmate and one that on the whole I agree with. There is really NO need to have that alternate path. But most ODs don't want to go down that path anyways. They just want to be able to perform and get paid for the simple procedures and examinations that they are already more than adequately trained for.

 

[DrEyeBall]

I think another thing sthat needs to be examined is why someone will go through optometry school and then decide they want to do surgery when they could have decided earlier to go through med school and residency.

I suspect some people make a decision on optometry school before they are certain what they want to do. Many people choose med school and then sample each of the fields before deciding that ophthalmology is for them.

I can appreciate that someone may go through optometry school and then realize that they want to do more than what traditional optometry allows them to do. A seperate track is not the answer in my opinion. I can also appreciate that a decision to go deeper in debt to go back through medical school is very tough. However, people do it.

Maybe the answer is for some of the credits earned in optometry school to be applied in med school so that it could be done in less than 4 years?

 

[UABopt]

I can appreciate that someone may go through optometry school and then realize that they want to do more than what traditional optometry allows them to do. A seperate track is not the answer in my opinion. I can also appreciate that a decision to go deeper in debt to go back through medical school is very tough. However, people do it.

Maybe the answer is for some of the credits earned in optometry school to be applied in med school so that it could be done in less than 4 years?

What you describe though is exactly that, an alternate track. This is exactly how it works to become an OMFS. After dental school you take the USMLE after taking some didactic that you may have missed in Dental school, and then go on to complete 3rd and 4th year rotations, and then going on to the residency.

The problem people see with going back to medical school from square one is not only the cost and the time, but also that after 4 years of medical school you still have no guarantee that you will match into ophthalmology.

You have to understand that optometrists have no intention of performing surgery when they start school, but the future in impossible to predict, and ambitions sometimes change. Optometry is the only career that I can think of where, in order to take the next logical step, you have to start all over again.

 

[UABopt]

I can appreciate that someone may go through optometry school and then realize that they want to do more than what traditional optometry allows them to do. A seperate track is not the answer in my opinion. I can also appreciate that a decision to go deeper in debt to go back through medical school is very tough. However, people do it.

Maybe the answer is for some of the credits earned in optometry school to be applied in med school so that it could be done in less than 4 years?

What you describe though is exactly that, an alternate track. This is exactly how it works to become an OMFS. After dental school you take the USMLE after taking some extra didactic that you may have missed in Dental school, and then go on to complete 3rd and 4th year rotations, and then going on to the residency.

The problem people see with going back to medical school from square one is not only the cost and the time, but also that after 4 years of medical school you still have no guarantee that you will match into ophthalmology.

You have to understand that optometrists have no intention of performing surgery when they start school, but the future in impossible to predict, and ambitions sometimes change. Optometry is the only career that I can think of where, in order to take the next logical step, you have to start all over again.

 

[VA Hopeful Dr]

What you describe though is exactly that, an alternate track. This is exactly how it works to become an OMFS. After dental school you take the USMLE after taking some didactic that you may have missed in Dental school, and then go on to complete 3rd and 4th year rotations, and then going on to the residency.

The problem people see with going back to medical school from square one is not only the cost and the time, but also that after 4 years of medical school you still have no guarantee that you will match into ophthalmology.

You have to understand that optometrists have no intention of performing surgery when they start school, but the future in impossible to predict, and ambitions sometimes change. Optometry is the only career that I can think of where, in order to take the next logical step, you have to start all over again.

I think the bold part up there is key. If ODs could do well on step 1, it might be worth letting y'all enter into 3rd year and going from there.

Any thoughts on this from the MDs?

 

[rubensan]

in theory, i have no problem with what is being proposed. The creation of an alterate route to becoming an ophthalmic surgeon for optometrists that is similar to OMFS would look something like this: OD->2nd year of medical school-> USMLE I->3rd and 4th year of medical school->USMLE IICK/IICS ->PGY-1->USMLE III->ophthalmology residency->ophthalmology oral and written boards->AAO board certified ophthalmic surgeon!!!

every 6 months or so this idea gets thrown around. it comes down to supply vs. demand. does our US society need more ophthalmic surgeons? put the OK/NM epilation/foreign body/epilation debate aside here. do we need any more ophthalmic care providers performing cataract surgery, trabs, strabs and blephs in this country?

Any thoughts on this from the MDs?

 

[S Files]

OMFS (Oral Maxillofacial Surgery) is a DENTAL specialty which requires a DENTAL degree and a DENTAL license.

OMFS is a 4 year specialty program. Sure some programs (my guess is around 15%) are 6 years (these are called MD-Integrated - they take the USMLE, 2 yrs of med school, etc). But they represent the minority. The MD is not required for OMFS practice.

This comparison to OD, creating an alternate path, etc is WAY OFF BASE.

 

[DrEyeBall]

Not knowing exactly what courses are similar to the first two years of med school, it is hard to say. I would imagine the important ones to look at would be anatomy, physiology and pathology. If these are similar, then why not go into 3rd yeard of med school. If they are not, maybe there would be some way to take them and then go on to the third year.

I can understand that there would be a real issue about not knowing if you would match in ophthalmology even after you do this. Not sure how to answer that question

 

[DiveMD]

I don't understand this dilemma. Why do we need to create a path of less resistance toward eye surgery? Maybe those few OD's who want to be eye surgeons should go to medical school. This pathway was already established even before they decided to go to OD school.

 

[UABopt]

I don't understand this dilemma. Why do we need to create a path of least resistance toward eye surgery? Maybe those few OD’s who want to be eye surgeons should go to medical school. This pathway was already established even before they decided to go to OD school.

Honestly... what is there not to understand? The future is impossible to predict with 100% certainty. At this point in time the scope of optometric practice in many states is essentially at the level of ophthalmology with the exception of surgery, and has been for years. There is very little difference in the way an OD, in a disease intensive practice, would handle patients and the way and an ophthalmologist would handle the exact same patients. The big difference is that there are optometrists in many different modes of practice. The "evil" commercial settings are not going to allow ODs to take up chair time with silly things like treating disease, when they could be selling glasses and making these evil empires even bigger. This leads to confusion of both patients who think we do nothing but refract, and Ophthalmologists who get referals from commercial settings for conditions that are well within the optometric scope.

Like it or not, there is very little if any need for an optometrist to make a non-surgical referal to a general ophthalmologist, certainly sub-specialists, retina, glaucoma etc...etc are another story. Most of us are extermely content with our primary care roles, that is why we went into the field in the first place. There is however a certain small segment of the population that gets to the point of wanting to move on to the next step, and the next step is... surgery. I know, I know, there are enough qualified surgeons already why create an alternate route? well I am going to tell you.

As it stands now an optometrist would have to start out at the exact same point he was at when he graduated from college, actually a little bit worse off because he would be at minimum 4 years removed from all of the science prereqs in undergrad and if he had taken the MCAT the score would have expired. He would have to get into medical school, and then after 4 years and 150K more debt have no guarantee he would match into ophthalmology. An "alternative route" would be just that another way to get to the point of being a resident in ophthalmology. As such ophthalmology would still be able to control the number of spots available to both the traditional and this "alternative" routes. To me there are other battles that need to be fought before scope expansion i.e. ERISSA, lisence reciprocity etc. I would think that Medicine in general would be all for this "alternative route" as it would be a very good argument against the expansion of optometry as it stands. i.e. "If you want to do surgery, there is a viable way for you to become an Ophthalmologist."

The alternative is to have optometry push to the point of regulating itself. This is where I personally think optometry should be. I think ODs should be in charge of their own destiny and think that we are perfectly capable of knowing our own limitations. From the perspective of MDs this would be disastrous because then ODs would set up their own "surgical residency" programs and there would be no centralized organization for regulating the number ophthalmic surgeons, and you would have two truly redundant professions.

 

[DrEyeBall]

Your path completely bypasses medical school? How does anyone benefit from that (other than the person not having to go through 2 years of clinical rotations and internship). We continue to miss the point that an ophthalmologist is an MD that specializes in diseases of the eye. That part requires medical school training. Unless you have been through the clinical education, you really have no idea of how much it is used in the practice of ophthalmology. I am not talking about being a cataract surgeon. It seems many of these misconceptions about the need for medical school training come about because people see what the local cataract guy does and thinks extensive training in systemic diseases is not needed.

 

[UABopt]

Your path completely bypasses medical school? How does anyone benefit from that (other than the person not having to go through 2 years of clinical rotations and internship). We continue to miss the point that an ophthalmologist is an MD that specializes in diseases of the eye. That part requires medical school training. Unless you have been through the clinical education, you really have no idea of how much it is used in the practice of ophthalmology. I am not talking about being a cataract surgeon. It seems many of these misconceptions about the need for medical school training come about because people see what the local cataract guy does and thinks extensive training in systemic diseases is not needed.

No... Had you read the previous posts in essence nothing would be skipped. Such a program would be essentially identical in structure to the 6 year OMFS MD/DDS programs. These programs include some didactic that might have been missed during optometry school in the first year along with clincal training. a the end of year 1 Passing of Step I of the USMLE grants you advanced standing as an MS-3. completion of MS-3 and MS-4 clerkships, followed 3 years of training in surgery. The result as in such OMFS program would be an MD/OD. What was skipped?

 

[PDT4CNV]

I think that if you want to practice medicine, you should go to medical school. Surgical training is not the only difference between optometry and ophthalmology, sorry to disappoint you.

 

[VA Hopeful Dr]

I think that if you want to practice medicine, you should go to medical school. Surgical training is not the only difference between optometry and ophthalmology, sorry to disappoint you.

Then what's the difference between when an OD diagnoses glaucoma and when an MD does it, if one practices medicine and one doesn't?

 

[PDT4CNV]

Then what's the difference between when an OD diagnoses glaucoma and when an MD does it, if one practices medicine and one doesn't?

When the patient doesn't have glaucoma.

 

[PBEA]

When the patient doesn't have glaucoma.

You really do have an axe to grind, dont you?

Maybe you and I can share PMs so that you might get some facts straight. Lets start publicly with how effective photodynamic therapy really is. Ill go first: photodynamic therapy 4 choroidal neovascularization suks monkey toes. Now its your turn.

 

[UABopt]

I think that if you want to practice medicine, you should go to medical school. Surgical training is not the only difference between optometry and ophthalmology, sorry to disappoint you.

Did anybody ever say that it was?

I am not at all disappointed by the fact that surgery is not the only difference in the training of an ophthalmologist and an optometrist. ODs learn far more about Optics, Physiological Optics, Ophthalmic Materials, Sports Vision, Binocular Vision, Low Vision, Contact Lenses, etc...etc...

But to say that a program that includes all 3rd and 4th year clerkships and passing the USMLE.... followed by 3 years in ophthalmology residency after having already completed optometry school is not adequate to then be an ophthalmologist is ridiculous. In such a residency program I would forsee that the ODs entering into these programs would complete residency right along side ophthalmologists completing traditional training. That is to say no new residency programs would have to be created after completion of the MS-4 rotations an MD would be granted to the former OD and at the start of the Ophthalmology residency they would be considered 100% equal with those entering the residency through the traditional route. Equal except for the fact that the new MD/OD would already be highly experienced on day 1, no need to train them how to do use the slit lamp, BIO, DFE, Refract and the list goes on and on.

 

[DiveMD]

As it stands now an optometrist would have to start out at the exact same point he was at when he graduated from college, actually a little bit worse off because he would be at minimum 4 years removed from all of the science prereqs in undergrad and if he had taken the MCAT the score would have expired. He would have to get into medical school, and then after 4 years and 150K more debt have no guarantee he would match into ophthalmology. An "alternative route" would be just that another way to get to the point of being a resident in ophthalmology. As such ophthalmology would still be able to control the number of spots available to both the traditional and this "alternative" routes. To me there are other battles that need to be fought before scope expansion i.e. ERISSA, lisence reciprocity etc. I would think that Medicine in general would be all for this "alternative route" as it would be a very good argument against the expansion of optometry as it stands. i.e. "If you want to do surgery, there is a viable way for you to become an Ophthalmologist."

As I said, the medical school-ophthalmology residency pathway was already available and "viable" when you decided to go to OD school. Sorry...

 

[VA Hopeful Dr]

When the patient doesn't have glaucoma.

I was asking a serious question, and that answer gives me nothing. I'm a medical student who is honestly interested in the political aspect of medicine. I completely agree that as the curriculums are currently, ODs have no business doing surgery. They also probably lack the full body breadth of knowledge that MDs enjoy. But that doesn't tell me how they don't practice medicine while MDs do when they are both doing the exact same thing (exams, FB removal, punctal plugs, and so on).

 

[I Surgeon]

here are a few things you need to understand...

ophthalmology match is highly competitive. Many well qualified medical students each year do not get accepted and have to end up doing other medical specialties.

tell me, how would less qualified individuals becoming ophthalmologists through an alternative route benefit society when we have enough well qualified ophthalmologists already, and who I might add, did it the "right" way.

it makes no sense to turn away a medical student who is really interested in eyes through the harder regular match and let an optom in through an easier alternative route who most likely could not make it into medical school in the first place.

sorry to be blunt, but i am sick and tired of hearing about yous people using a backdoor to practice medicine...yea ophthalmology is medicine. BTW, you can have your low vision training...