Optometry, Pearl Vision, and others.

[Pigmentosa]

I am reposting this issue because we did not talk about it...

About quality control:

Who should define how many glaucoma patients, and complications you have to see and treat before being able to manage glaucoma. How many glaucoma/ retina, glaucoma/ocular genetic disease, glaucoma/pediatric, glaucoma/systemic combinations, glaucoma/surgery do you have to see before being competent at managing glaucoma? I guess Eye MDs have one number and ODs have another. The clinical exposure that ODs have is minimal compared to the Eye MDs. But, I guess progressive ODs think they are competent. I guess quality control will never happen because ODs will always be pushing for more.

As for surgery rights. Anybody can operate. Even a monkey. Anybody can give glaucoma drops also. The dilemma is: when to do and when not to do... Only when you have the full breath of pathologic management that you aquire in medical school and residency can you begin to understand how to make "good" medical decisions... Even then MDs can make mistakes...

I ask again, who should be the Board of Eye Diseases??? Subspecialized Expert ophthalmologists or optometrists??? You always want the experts making the most important decisions. Right now the experts in Eye Diseases are called politicians... And that is very pleasing ...

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[rubensan]

I ask again, who should be the Board of Eye Diseases??? Subspecialized Expert ophthalmologists or optometrists??? You always want the experts making the most important decisions. Right now the experts in Eye Diseases are called politicians... And that is very pleasing ...

i think it should be you. i used to think that being a "leader and thinker" in the field of ophthalmology meant finding the next cure for a certain ophthalmic disease. while that is certainly very important to the advancement of our field, now, more than ever we need young, vibrant, intelligent individuals to represent and protect the interests of ophthalmology on a political leves OUTSIDE OF THIS FORUM. i am not just talking about "surgery by surgeons," i am talking about medicare, HMO reimbursement and scope of practice issues at large. i still maintain that we have a lot to learn from the way optometrists operate. the way they have organized themselves is incredible. the way that they have cozied up to politicians and become politicians themselves is very smart.

aside from posting in this very heated and at times, entertaining forum, what will you (not just pigmentosa, but myself and all other ophthalmologists, ophthalmology residents and ophtho-bound medical students) do to protect the interests of ophthalmology in the future?

 

[KHE]

i think it should be you. i used to think that being a "leader and thinker" in the field of ophthalmology meant finding the next cure for a certain ophthalmic disease. while that is certainly very important to the advancement of our field, now, more than ever we need young, vibrant, intelligent individuals to represent and protect the interests of ophthalmology on a political leves OUTSIDE OF THIS FORUM. i am not just talking about "surgery by surgeons," i am talking about medicare, HMO reimbursement and scope of practice issues at large. i still maintain that we have a lot to learn from the way optometrists operate. the way they have organized themselves is incredible. the way that they have cozied up to politicians and become politicians themselves is very smart.

aside from posting in this very heated and at times, entertaining forum, what will you (not just pigmentosa, but myself and all other ophthalmologists, ophthalmology residents and ophtho-bound medical students) do to protect the interests of ophthalmology in the future?

It should be pointed out that the interestes of ophthalmology and optometry are not mutually exclusive. There are PLENTY of areas that we could be working together on. Medicare/medicaid - insurance reimbursement - malpractice issues and on and on and on. Unfortunately, this whole thing has turned into a situation almost like Washington. Republicans will disagree with EVERYTHING democrats say and/or do and vice versa even if something makes sense and could benefit both parties. Kind of a shame really.

 

[Pigmentosa]

I guess first of all you have to give money to the Academy (in regards to the political strategy) Also, start training more Eye MDs (residency spots) in order to politically compete with the amounts of ODs being trained.

But there are important points that must be discussed like uniformity in quality care when you have ODs and Eye MDs performing the same procedure but different AMOUNT of cinical exposure and different amount of procedure repetition... Who decides what is enough clinical exposure?

The problem is that we have two profesionals in the market performing the same procedures, but their training is very different in regards to clinical exposure and scientific knowledge. Even non-surgical management of glaucoma is very different in terms of the amount of exposure you get in ophthalmology residency...

It hard for me to believe an OD can go an nail an OKAP exam when I know many residents of ophthalmology (which I are the cream of the crop in Medical school) do bad on them. Just as I think an Eye MD could get nailed by low vision, contacts, and tunnel vision questions...

The problem is that there is no uniformity in education, and no way in regulating centrally the quality. Like a Board of Eye Diseases...

Since their is no regulation of quality,ofthalmologists manytimes say to patients that OD are unqualified to treat diseases. Regulation now is on the hands of patients (and eveybody knows how uninformed are they)

 

[DiveMD]

Wow, it so hard to keep up with you guys! I stop reading for a day and suddenly there is an extra page in this thread. I think we all need an SDN break and maybe work a little more.

 

[speyeder]

It should be pointed out that the interestes of ophthalmology and optometry are not mutually exclusive. There are PLENTY of areas that we could be working together on. Medicare/medicaid - insurance reimbursement - malpractice issues and on and on and on. Unfortunately, this whole thing has turned into a situation almost like Washington. Republicans will disagree with EVERYTHING democrats say and/or do and vice versa even if something makes sense and could benefit both parties. Kind of a shame really.

I agree.

 

[KHE]

I agree.

Good. And this is why I think that there should be a summit between "respected elders" of each of the two fields so as to try to bridge some of these gaps and work out some of these issues. The people who attend this summit should be people who do NOT have a long history of PAC activity and involvement.

I think, as I have said before that optometrists as a whole do not really have a good appreciation of the hellish training that ophthalmologists go through and why that training is important for what they do.

I think it is fair to say however that ophthalmologists as a whole really have no clue what modern optometric training encompases and most of them simply parrot what they were told by their attendingings in medical school and/or ophthalmology residency: optometry = incompetent blathering idiots

In spite of that, I see no reason why a reasonable dialogue can't be held.

 

[Pigmentosa]

most of them simply parrot what they were told by their attendingings in medical school and/or ophthalmology residency: optometry = incompetent blathering idiots

In spite of that, I see no reason why a reasonable dialogue can't be held.

I agree somewhat with this. However, when OD say they are having new technology in their education, does that includes technology that is basically taken from Ophthalmology or do you guys develop new low vision aids, new contact lens technology and so on??? ODs scope expansion in education is basically trying to get as much into Ophtha and Eye Diseases and less into the traditional Optometry role. This is seen in the fellowships that OD offers that parallels the ones that Ophtha has always had. I dont think that any Ophthalmologist would protest if ODs develop new prisms, contacts, lenses, etc. I think that at this point everybody knows that the goal of progressive OD PAC leaders is to make Optometry equal to Ophthalmology and that this battle will not stop until then.

 

[IndianaOD]

As a resident in vision therapy, under what context have you spent "significant time with OMDs of several specialties?"

Not a resident in vision therapy for starters. I spent time in the OR and clinic with OMDs during my residency. A lot of our fourth year rotations are with OMDs so several there. I've spent time with both retina, cornea, and peds. Only been around a neuro OMD a couple of times.

 

[IndianaOD]

I agree somewhat with this. However, when OD say they are having new technology in their education, does that includes technology that is basically taken from Ophthalmology or do you guys develop new low vision aids, new contact lens technology and so on??? ODs scope expansion in education is basically trying to get as much into Ophtha and Eye Diseases and less into the traditional Optometry role. This is seen in the fellowships that OD offers that parallels the ones that Ophtha has always had. I dont think that any Ophthalmologist would protest if ODs develop new prisms, contacts, lenses, etc. I think that at this point everybody knows that the goal of progressive OD PAC leaders is to make Optometry equal to Ophthalmology and that this battle will not stop until then.

I'm not sure if I understand the question but I'll give it a try. A LOT of the advanced optics used in Ophthalmology was developed at schools of optometry. More recently the adaptation of higher order aberrations. Researchers at the IU school of optometry were instrumental in developing aberrometry. This may sound more familiar as custom LASIK and aspheric IOLs. There is continuing to be more and more high quality research from optometry schools, especially as more PhDs in vision science are obtained from such schools. While in OD school I carried out research related to drug penetration of the corneal endothelium. Loved the trips to the slaughter houses!

 

[IndianaOD]

me too. perhaps my experience today touches on your sentiments.

very pleaseant female patient who originally presented with:

Va
OD: 20/200 NIPH


SLE

K: nasal pterygium encroaching pupillary margin OD.

2 months after bilateral pterygium excision

OD: 20/60 20/25 with PH


nice woman who loves her optometrist, happy with the results and I referred her back to her OD. i guess he got my number off of an old Rx for predforte but he wanted me to understand how much he really appreciated that i referred the patient back.

is this what you meant?

I believe that if this was the usual transaction there would not be so much animosity. ODs would be happy that their patients were taken care of and not experienced to anti-OD slander and the MDs should be happy because they get to do the surgery and make the big bucks without the primary care headaches.

Unfortunately, this is not very common. My last two referals come to mind. After confiming my assesment and agreeing with my plan the OMD refered the patient for routine care with a pediatric ophthalmologist. The patient didn't understand why and after the OMD recieved a letter from yours truly they are happily back with me. That was absolutely absurd.

The second one, again after I did all the hard work and testing and made the correct diagnosis. I wanted to be sure since it was a rare genetic condition so I sought a second opinion from a retinal OMD. After completely agreeing and confiming my assessment and plan and that there was absolutely no Tx available, he scheduled the patient in 6 months for monitoring. To monitor what? I can look at an incurable macular dystrophy just as good as him. Plus we can actually offer help with low vision services and monitor the patient better with ERGs that he doesn't have access to.

I deal with some OMDs who do a great job like you did of returning the patient, but far too often they are stolen away. I'm sure sometimes with some anti-optometry rhetoric. Needless to say, the referral chain has been broken with them. I don't understand the motivation for such tactics.

The patients will go back and get 90% of the exam by a tech, 5 minutes with the OMD and out the door.

 

[KHE]

Not a resident in vision therapy for starters. I spent time in the OR and clinic with OMDs during my residency. A lot of our fourth year rotations are with OMDs so several there. I've spent time with both retina, cornea, and peds. Only been around a neuro OMD a couple of times.

What is your residency in?

 

[Ben Chudner]

I deal with some OMDs who do a great job like you did of returning the patient, but far too often they are stolen away. I'm sure sometimes with some anti-optometry rhetoric. Needless to say, the referral chain has been broken with them. I don't understand the motivation for such tactics.

When I worked for an OMD practice, I saw plenty of patients that did not want to return to the OD that referred them in. It's easy to blame the OMD for this, but most OMD's I have worked with realize it makes good business sense to ensure patients return to their original doctor. I am not saying this is what happened in your two cases, but I know it happens a lot and most often it's because of something the OD office did and not what the OMD says.

 

[IndianaOD]

What is your residency in?

Sniffing out B.S.

 

[KHE]

I agree somewhat with this. However, when OD say they are having new technology in their education, does that includes technology that is basically taken from Ophthalmology or do you guys develop new low vision aids, new contact lens technology and so on??? ODs scope expansion in education is basically trying to get as much into Ophtha and Eye Diseases and less into the traditional Optometry role. This is seen in the fellowships that OD offers that parallels the ones that Ophtha has always had. I dont think that any Ophthalmologist would protest if ODs develop new prisms, contacts, lenses, etc. I think that at this point everybody knows that the goal of progressive OD PAC leaders is to make Optometry equal to Ophthalmology and that this battle will not stop until then.

Optometry has a long history of advancing low vision and CL technologies. Many of the senior researchers designing and implementing new technologies for the major CL manufacturers are ODs and OD/PhDs.

I am not sure what "fellowships" you are referring to that parallel ophthalmology.

Regarding research....historically most of the research generated on "disease" were studies relating to contact lens complications that were primarily funded by private foundations and vision companies like B&L and Alcon. As such, much of the early education in "disease" was piggybacked on from research and advancements from ophthalmology. For the longest time, ODs were NOT ELIGIBLE to receive NIH or NEI funding to conduct large scale clinical trials. Only MDs or PhDs were allowed to do that. That has changed so I think that in the future you will see more and more well designed and large scale clinical trials and research conducted by ODs, which will enhance optometry's contribution to the eyecare knowledgebase.

 

[rubensan]

i always maintain that my patients will get a better pair of glasses if they go to an optometrist. that being said, i know that optometrists are capable of MUCH more that fitting glasses. how much more? i do not know. i do not pretend to be an expert on the quantity or quality of OD education. i think we should be careful making claims like "we do low vision just as well as ODs" or "we follow macular dystrophies just as well as a retinal specialist." one of the most important points that has been made in this dynamic thread is that one field has no clue what the other is capable of. this is and always has been about the bottom line: $. if we can agree that this is about $ and not patient care, i maintain that there are bigger causes that are worth fighting for that require the unity of both fields. just look at how some of our 2008 presidential hopefuls feel about medicare and healthcare and you may begin to see why. unfortunately, as long as ODs feel that MDs do not play fair and as long ODs continue to push for surgical rights, lines will be drawn and legislation will be passed. millions of dollars will be spent. will either field be better off in 10 years after a state-by-state, blow-by-blow battle?

I believe that if this was the usual transaction there would not be so much animosity. ODs would be happy that their patients were taken care of and not experienced to anti-OD slander and the MDs should be happy because they get to do the surgery and make the big bucks without the primary care headaches.

 

[KHE]

one of the most important points that has been made in this dynamic thread is that one field has no clue what the other is capable of. this is and always has been about the bottom line: $. if we can agree that this is about $ and not patient care, i maintain that there are bigger causes that are worth fighting for that require the unity of both fields. just look at how some of our 2008 presidential hopefuls feel about medicare and healthcare and you may begin to see why. unfortunately, as long as ODs feel that MDs do not play fair and as long ODs continue to push for surgical rights, lines will be drawn and legislation will be passed. millions of dollars will be spent. will either field be better off in 10 years after a state-by-state, blow-by-blow battle?

Oh I think everyone will freely admit that it's about money. I admit it. But its not about short term money or trying to make money by doing a few LASIK patients or a few YAGs, or snipping off a few lid papillomas or scooping about a chalazion here and there.

As I have said before, it makes no economic sense for ODs to be involved in surgical care, even refractive surgery. No OD that I know sees enough patients in year who could benefit from a PI or a YAG unless they work in an ophthalmology clinic. So in the case where an OD would be MOST likely to have the volume needed, it would make the LEAST sense for them to perform the procedure because there's an ophthalmolgist around.

Same thing with LASIK... I've already said on here more than once that if ODs were suddenly granted permission to perform LASIK in every state tomorrow, almost no one would do it because it makes no sense. The supply of providers triples over night and the demand stays the same. What does that do to LASIK fees that are already under extreme pressure? How does an OD afford a laser? How does an OD afford the buildout for the room to put the laser in? Even if a bunch of ODs got together and shared a facility, it still would not make sense.

All this business is about money but it's not about money from performing procedures. It is about who is going to control the long term fate of the optometric profession. As technology and medicine advances, are ODs going to have to go grovel before the medical society, begging for permission to do something every time a new eye drop comes on the market, or every time a new technique is developed?

This is why I advocate the idea of a summit between respected elders of the two professions to hash out some of these issues because while we all bicker about this crap in the 50 states, it takes away precious time and resources from both sides which could be used towards furthering the common interests of the two professions. And I maintain that we have a lot more interests in common than not.

 

[Pigmentosa]

I have a deal.

Eye MDs are the only ones permitted to Rx and surgery...

OD are the only ones permitted to refract patients and give them an Rx for glasses or contacts... Rx from ODs only for Emergencies

Who thinks this is a good deal???

 

[AwesomeSauce]

I have a deal.

Eye MDs are the only ones permitted to Rx and surgery...

OD are the only ones permitted to refract patients and give them an Rx for glasses or contacts... Rx from ODs only for Emergencies

Who thinks this is a good deal???

That's a terrible deal, ODs wont give up prescriptive authority without one hell of a fight.

If it was possible to "make a deal" you could probably get ODs to agree to stay away from surgery If the OMDs would agree to stop trying to reduce optometric scope. (and by surgery I mean actual surgery, not forgien body removal etc etc) I don't think that most ODs feel threatend by OMDs refracting, so you can keep that.

 

[Ben Chudner]

I have a deal.

Eye MDs are the only ones permitted to Rx and surgery...

OD are the only ones permitted to refract patients and give them an Rx for glasses or contacts... Rx from ODs only for Emergencies

Who thinks this is a good deal???

I hope this post is not serious. There needs to be a realistic compromise between the two professions. This means that both OD's and OMD's have to give something up. Just as it is ridiculous to ask OMD's to give in on cataract surgery, the same goes for OD's giving up topical and most eye related oral meds.

 

[MR1]

I hope this post is not serious. There needs to be a realistic compromise between the two professions. This means that both OD's and OMD's have to give something up. Just as it is ridiculous to ask OMD's to give in on cataract surgery, the same goes for OD's giving up topical and most eye related oral meds.

How about this: ODs stop trying to get surgical rights (anything that goes into or around the eye, this includes injections and lasers) obviously foreign bodies and puncta plugs are fine. Also ODs can use Rx eye drops, as far as oral meds I really don't know on this one since I haven't started my residency yet. Now OMDs will help protect ODs from opticians trying to refract and hopefully will also refer back patients after the surgery and post op period is over.

So everyone gets along and does what they are trained to do, and in the end I think this is best for the patient.

 

[DiveMD]

OMD’s and OD’s need to sit down and share a beer pitcher on the regular basis. This might not solve the scope expansion situation but will take care of the animosities.

 

[eyestrain]

OMD’s and OD’s need to sit down and share a beer pitcher on the regular basis. This might not solve the scope expansion situation but will take care of the animosities.

This is a great idea, but it might take more than one pitcher.

 

[Ben Chudner]

How about this: ODs stop trying to get surgical rights (anything that goes into or around the eye, this includes injections and lasers) obviously foreign bodies and puncta plugs are fine. Also ODs can use Rx eye drops, as far as oral meds I really don't know on this one since I haven't started my residency yet. Now OMDs will help protect ODs from opticians trying to refract and hopefully will also refer back patients after the surgery and post op period is over.

So everyone gets along and does what they are trained to do, and in the end I think this is best for the patient.

It's a step in the right direction. I would want to get more specific on procedures rather than use broad terms like "anything that goes into or around the eye". I would also want to have agreed upon policies for new procedures so that they can be included in OD scope if appropriate.