Proposed Optometry Bills for Scope of Practice Expansion

[Meibomian SxN]

Three More States Look to Expand Optometrists' Scope of Practice


Nebraska Legislative Bill No. 316: http://nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB316.pdf

Texas Senate Bill No. 1056: http://www.capitol.state.tx.us/tlodocs/82r/billtext/pdf/sb01056I.pdf

South Carolina Bill No. 503:http://www.scstatehouse.gov/sess119_2011-2012/bills/503.htm

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[q1we3]

That's great news! Lets hope they get passed!

 

[VA Hopeful Dr]

That's great news! Lets hope they get passed!

I'd be very surprised if the SC one passes. Medicine is very strong down here.

 

[200UL]

Here we go again....

I find every one of these bills interesting. All ask for slightly different things. Can you not standardize your surgical curriculum? Can you not standardize what and optometrist is? What schools are the schools that give the big surgical training - would this training be available to medical doctors?

In summary, it looks like “Optometry is the practice of…. Whatever you can convince your local lawmaker it is." Also, I like how some of the bills want to make sure, and optometrists is an "optometric physician." Are optometry schools really providing MD and DO degrees now?

As always, the bills are incredibly vague.

As always, there are contradictions within each individual bill. A common theme is, "optometrists can do surgery if a laser is used, but optometrists may not be able to do surgery if a blade is used."

As always, the details of the training (that do not exist now) will be worked out by the local optometric surgeons – you know the optometric surgery board.

As always, there is the potential for zero complications if an optometrist does eye surgery (it is those poorly trained ophthalmologist who train with actual patients and not their wallets who get complications). Yes, ophthalmologists admit to complications.

Then again, why would you actually want to learn medicine and surgery with actual patients during your time in school or residency – that is so old-school. The 21st century optometry curriculum is involves PAC contributions and every attempt to dilute clinical experience (ie a new optometry school popping every other year). Are there any online optometry schools yet? - don't laugh, I can see it happening and so can you.

Start ponying up the cash - it is time to buy off some lawmakers. Texas looks like a nice place to start. If the lawmakers there are even half as dumb as Rick Perry, you might even be able to include language that implies “optometry involves the practice lunar space exploration”. Seriously, Rick Perry makes George Bush look like a member of mensa.

Prove equivalent training and develope an equivalent curriculum that involves human beings. Until then your rogue leaders will always be liars and frauds (think ben gaddie - the greatest eye surgeon on the planet - he at least is quick to point out that he has never had a complication with thousands of procedures - this does make him the greatest if it is true.).

 

[thiaeyemd]

Is this being done essentially because of oversupply of optometrists so they want to expand to ophthalmology surgery? Maybe there isn't enough work because of oversupply thus people are desperate to expand their practice to do other things..

It just doesn't make sense...would be like me trying to neurosurgery (even though I am allowed to by law). I do orbital surgery and it would be easy for me do things on the other side of the frontal sinus or cribiform plate but it would be foolish of me to even try. Just wasnt trained in it...and no course or wet lab would ever replace a residency..never has and never will. I know that for the growth of optometry, optometrists want to do it but it just doesn't make sense to me. You don't see neurologists trying to do invasive procedures..they let the neurosurgeons do that. This is no different if opticians told you they could do a course and then refract on their own and examine patients. If you can justify that to me then the expansion for optometry would appropriately make sense. To me it sounds like the people behind this want to water down and destroy ophthalmology which anyway you cut it..is not cool. You wouldn't want that done to optometry, can you blame an ophthalmologist for wanting to protect their profession?

 

[JaggerPlate]

I wonder how much it will cost this time??? Here's to hoping it fails (though I'm 99% sure it'll pass).

 

[Meibomian SxN]

I know that for the growth of optometry, optometrists want to do it but it just doesn't make sense to me. You don't see neurologists trying to do invasive procedures..they let the neurosurgeons do that.

Which lasers do you use that are invasive? The expansion in the scope is all for NON-invasive procedures. Do you not know the difference between trabeculoplasty vs trabeculectomy?

 

[sanityonleave]

EDIT: On second thought... I'm really not qualified to weigh in on this debate. But it should be a good'n.

Cheers!

 

[thiaeyemd]

Hi Meibomian Sxn. If you think lasers aren't invasive how about I take an argon laser and blast it across the surface of your cornea. I appreciate the highly inflammatory response and come to expect it from you but in all seriousness lasers are invasive. To say they are not is just foolish. Lasers being put into a "non invasive" category is just absurd. If you are physically altering live tissue by action it is invasive by definition. I use a CO2 laser to open tissue and dissect which is a common practice in eyelid, lacrimal and orbital surgery. I open tissue with lasers. I control bleeding with lasers. When someone does Lasik, that is also an invasive procedure. Even a YAG or ALT is invasive.

When I was a resident an optometrist in Oklahoma god knows where lasered a patient who had neovascularization and had a closed angle because he thought he had angle closure glaucoma and needed a PI. Well...the iris bled and IOP went up to 50 for three days and his son flew him to DC to be seen after he had an anterior chamber washout by an ophthalmologist there. The optometrist wanted to send him to a big optometry referral center so the patient could be "comananged". The son refused. So don't tell me that lasers are non-invasive. The patient had a significant arcuate defect after that. I am not sure why I am telling you this because your desire to expand priveleges goes way beyond caring for that patient's story. What if that was your mom or dad? How pissed would you be? And the fact is that to YAG an iris with neo is a mistake that at the most a 1yr resident would make and that is stretching it.

The fact that you read up on trabeculoplasty and trabeculectomy is great but you need to read some more. The fact you don't even realize that ophthalmologists use lasers that are highly invasive is scary.

By the way...I read the old posts where you didn't even know the proper treatment for a retrobulbar hemorrhage...call a retina specialist? Are you serious? It is an embarrassment..have some decency man. For someone so vocal on this board and inflammatory you sure should be spending your time doing other things...like reading up your knowledge.

 

[200UL]

thiaeyemd - you must have a bad memory. Oklahoma optometrists have "zero history of complications." There have been "no complaints before the state optometry board." There have been "zero lawsuits." In other words, it must have been an MD that screwed up in your scenario. After all, only those poorly trained MDs actually have complications with eye surgery. The 21st century optometry curriculm creates the more superior optometric "physician" (No optometrists are not physicians - they are doctors). Patients and surgical training are not needed.

In all seriousness, thiaeyemd saw as much pathology in 2 weeks of residency as the average optometrist sees in their entire residency. The authors/supporters of these bills are ignorant and unethical liars.

For example, I would love to have the average optometrist read and explain the entire recent kentucky law to me. Most would not even grasp the granted priveledges. It is beyond my scope of practice in many respects and I actually did eye surgery on thousands of humans during my residency.

If I was an optometrist, I would be using my PAC money to limit the number of new optometry schools (new schools with more spots every year). Soon your experiences during training will be so watered down, that even the easy-to-be-bought-off politicians will not listen to Ben Gaddie's lies. In other words, try to maintain some level of training with humans.

 

[speyeder]

I'm not going to get into a debate about the merits of these recent bills, as this issue has been rehashed endlessly already. But 200UL does raise some good points. Wouldn't the AOA serve its members and the profession of optometry better by trying to limit the opening of new schools and the influx of optometry students into a field that is already saturated? And isn't there a concern that the clinical experience of optometry students will be diluted? I mean, we all know there is not an endless supply of patients. Ophthalmology residents already have a huge advantage over optometry students in terms of the number of patients and breadth of pathology seen during training. This gap will only widen unless organized optometry does something to limit the number of newly minted ODs.

 

[Eyes Only]

If I was an optometrist, I would be using my PAC money to limit the number of new optometry schools (new schools with more spots every year).

That would violate anti-trust laws, which is illegal in this country.

 

[speyeder]

Which lasers do you use that are invasive?

Wow. You should really do some research before you ask that question.

 

[east]

The attempt at OD scope expansion is inevitable. Ophthalmology will continue to fight it, which they should, both for legitimate reasons and to protect their income. But all these new ODs poppin' out will just make it worse. I don't know how to stop it, it's screwing all of us. Any suggestions?

 

[east]

by the way....did fake doctor and pathological liar Ben Gaddie bully 200UL in grade school or something? Relax a little and enjoy life, your probably a successful ophthalmologist. Tone down the rancor a little and have some fun.

 

[Jason K]

Wouldn't the AOA serve its members and the profession of optometry better by trying to limit the opening of new schools and the influx of optometry students into a field that is already saturated? And isn't there a concern that the clinical experience of optometry students will be diluted? I mean, we all know there is not an endless supply of patients. Ophthalmology residents already have a huge advantage over optometry students in terms of the number of patients and breadth of pathology seen during training. This gap will only widen unless organized optometry does something to limit the number of newly minted ODs.

I think this post is dead on. I’ve said before that optometry, as a profession, is like a teenager who doesn’t really know what’s best to do for himself in the long-term. It just does whatever seems “cool” at the moment. Turning OD offices into a starwars show sounds like a great idea, right? We’re expanding the practice rights of the profession, what could be more important? Well, everything could be more important, at least right now. What good does it do to have ODs expanding our scope to include laser procedures if 80% of us will be glorified refracting opticians in 10 years? Great, we’ll have a few dozen ODs out there “saving the world” while the other 60,000 in the country turn dials at EyeMart.

I know of very few practicing ODs who would actually consider adding laser procedures to their practice even if they could so why is this such a big issue right now? The cost of the equipment is prohibitive and the return would be hard to justify the expense based on reimbursement levels which are sure to drop anyway once we start doing them widespread. The people who are fascinated by this idea are a few optometric "renegades" and pre-optometry / optometry students. Most practicing ODs I know are saying “Whatever, I have no interest in doing any of that stuff in my office.”

Personally, I don’t think true surgery has any place in the OD scope given our current training model, but I know that’s not the popular opinion on this forum, at least from the OD side. We just don’t have the ability to provide the patient volume necessary to make it practical. If you want to be an eye surgeon, don’t go to optometry school. Go get a medical degree, do a residency that provides you with thousands upon thousands of surgical patients to “practice” on, and then have at it. There are other ODs out there who've made that choice and now they're well-trained surgeons. Trying to create “insta-surgeons” with weekend training courses that involve as few as one single human patient is absolutely insane. It makes us look like desperate “wannabees.” Sorry, but it’s true.

I know a lot of people on this forum will find my views on this topic to be tantamount to blasphemy, but as anyone who’s read my posts knows, I think there are far more pressing issues to deal with for the profession. Instead of trying to “snap our fingers” and wake up the next day as well-trained surgeons, we should be trying to repair the damaged profession we currently have. Maybe after addressing the issues we have, we can start worrying about laying the foundations that need to be in place before proceeding with scope expansion that includes surgery. Until then, I think our focus should be elsewhere.

 

[east]

i think this post is dead on. I’ve said before that optometry, as a profession, is like a teenager who doesn’t really know what’s best to do for himself in the long-term. It just does whatever seems “cool” at the moment. Turning od offices into a starwars show sounds like a great idea, right? We’re expanding the practice rights of the profession, what could be more important? Well, everything could be more important, at least right now. What good does it do to have ods expanding our scope to include laser procedures if 80% of us will be glorified refracting opticians in 10 years? Great, we’ll have a few dozen ods out there “saving the world” while the other 60,000 in the country turn dials at eyemart.

I know of very few practicing ods who would actually consider adding laser procedures to their practice even if they could so why is this such a big issue right now? The cost of the equipment is prohibitive and the return would be hard to justify the expense based on reimbursement levels which are sure to drop anyway once we start doing them widespread. The people who are fascinated by this idea are a few optometric "renegades" and pre-optometry / optometry students. Most practicing ods i know are saying “whatever, i have no interest in doing any of that stuff in my office.”

personally, i don’t think true surgery has any place in the od scope given our current training model, but i know that’s not the popular opinion on this forum, at least from the od side. We just don’t have the ability to provide the patient volume necessary to make it practical. If you want to be an eye surgeon, don’t go to optometry school. Go get a medical degree, do a residency that provides you with thousands upon thousands of surgical patients to “practice” on, and then have at it. There are other ods out there who've made that choice and now they're well-trained surgeons. Trying to create “insta-surgeons” with weekend training courses that involve as few as one single human patient is absolutely insane. It makes us look like desperate “wannabees.” sorry, but it’s true.

I know a lot of people on this forum will find my views on this topic to be tantamount to blasphemy, but as anyone who’s read my posts knows, i think there are far more pressing issues to deal with for the profession. Instead of trying to “snap our fingers” and wake up the next day as well-trained surgeons, we should be trying to repair the damaged profession we currently have. Maybe after addressing the issues we have, we can start worrying about laying the foundations that need to be in place before proceeding with scope expansion that includes surgery. Until then, i think our focus should be elsewhere.

+1

 

[sanityonleave]

Jason K --

Kudos for a very well thought out post. While I'm certainly coming from a biased perspective, I think your analysis is on the money.

I don't think there's anyone who wants to see the optometry profession marginalized, but based on what others on this board have posted that's a scary possibility if the leadership doesn't get their **** together.

That would violate anti-trust laws, which is illegal in this country.

Forgive my ignorance, but how exactly do medical schools pull this off, then? Couldn't the accrediting body for optometry schools raise standards (e.g. make it so that each optometry student must have x # of patient encounters per year in 3rd and 4th year or something) and thus dramatically raise the barriers to entry for a new OD school? Perhaps I'm missing something, but a lot of knowledgeable ODs on this board have pointed to reducing the # of graduates as the first step to preserving the quality of the education, quality of students and the field as a whole.

 

[Tippytoe]

i think this post is dead on. I’ve said before that optometry, as a profession, is like a teenager who doesn’t really know what’s best to do for himself in the long-term. It just does whatever seems “cool” at the moment. Turning od offices into a starwars show sounds like a great idea, right? We’re expanding the practice rights of the profession, what could be more important? Well, everything could be more important, at least right now. What good does it do to have ods expanding our scope to include laser procedures if 80% of us will be glorified refracting opticians in 10 years? Great, we’ll have a few dozen ods out there “saving the world” while the other 60,000 in the country turn dials at eyemart.

I know of very few practicing ods who would actually consider adding laser procedures to their practice even if they could so why is this such a big issue right now? The cost of the equipment is prohibitive and the return would be hard to justify the expense based on reimbursement levels which are sure to drop anyway once we start doing them widespread. The people who are fascinated by this idea are a few optometric "renegades" and pre-optometry / optometry students. Most practicing ods i know are saying “whatever, i have no interest in doing any of that stuff in my office.”

personally, i don’t think true surgery has any place in the od scope given our current training model, but i know that’s not the popular opinion on this forum, at least from the od side. We just don’t have the ability to provide the patient volume necessary to make it practical. If you want to be an eye surgeon, don’t go to optometry school. Go get a medical degree, do a residency that provides you with thousands upon thousands of surgical patients to “practice” on, and then have at it. There are other ods out there who've made that choice and now they're well-trained surgeons. Trying to create “insta-surgeons” with weekend training courses that involve as few as one single human patient is absolutely insane. It makes us look like desperate “wannabees.” sorry, but it’s true.

I know a lot of people on this forum will find my views on this topic to be tantamount to blasphemy, but as anyone who’s read my posts knows, i think there are far more pressing issues to deal with for the profession. Instead of trying to “snap our fingers” and wake up the next day as well-trained surgeons, we should be trying to repair the damaged profession we currently have. Maybe after addressing the issues we have, we can start worrying about laying the foundations that need to be in place before proceeding with scope expansion that includes surgery. Until then, i think our focus should be elsewhere.

+2

 

[speyeder]

I think this post is dead on. I’ve said before that optometry, as a profession, is like a teenager who doesn’t really know what’s best to do for himself in the long-term. It just does whatever seems “cool” at the moment. Turning OD offices into a starwars show sounds like a great idea, right? We’re expanding the practice rights of the profession, what could be more important? Well, everything could be more important, at least right now. What good does it do to have ODs expanding our scope to include laser procedures if 80% of us will be glorified refracting opticians in 10 years? Great, we’ll have a few dozen ODs out there “saving the world” while the other 60,000 in the country turn dials at EyeMart.

I know of very few practicing ODs who would actually consider adding laser procedures to their practice even if they could so why is this such a big issue right now? The cost of the equipment is prohibitive and the return would be hard to justify the expense based on reimbursement levels which are sure to drop anyway once we start doing them widespread. The people who are fascinated by this idea are a few optometric "renegades" and pre-optometry / optometry students. Most practicing ODs I know are saying “Whatever, I have no interest in doing any of that stuff in my office.”

Personally, I don’t think true surgery has any place in the OD scope given our current training model, but I know that’s not the popular opinion on this forum, at least from the OD side. We just don’t have the ability to provide the patient volume necessary to make it practical. If you want to be an eye surgeon, don’t go to optometry school. Go get a medical degree, do a residency that provides you with thousands upon thousands of surgical patients to “practice” on, and then have at it. There are other ODs out there who've made that choice and now they're well-trained surgeons. Trying to create “insta-surgeons” with weekend training courses that involve as few as one single human patient is absolutely insane. It makes us look like desperate “wannabees.” Sorry, but it’s true.

I know a lot of people on this forum will find my views on this topic to be tantamount to blasphemy, but as anyone who’s read my posts knows, I think there are far more pressing issues to deal with for the profession. Instead of trying to “snap our fingers” and wake up the next day as well-trained surgeons, we should be trying to repair the damaged profession we currently have. Maybe after addressing the issues we have, we can start worrying about laying the foundations that need to be in place before proceeding with scope expansion that includes surgery. Until then, I think our focus should be elsewhere.

Jason, thanks for being a voice of reason in this often contentious debate. I, for one, support optometry and want to see your profession survive and do well. I think the state of optometry would be in a better place if people like you and Tippytoe were in charge of the AOA.

 

[thiaeyemd]

Not actively participating in practice expansion and passively allowing others to try to do sketchy things and idly standing by are not too different.

First they came for the communists, and I did not speak out—because I was not a communist;
Then they came for the socialists, and I did not speak out—because I was not a socialist;
Then they came for the trade unionists, and I did not speak out—because I was not a trade unionist;
Then they came for the Jews, and I did not speak out—because I was not a Jew;
Then they came for me—and there was no one left to speak out.

Jason K...great post..I just wish your profession gets its political wing under control or at the end everyone now..ophthalmologists and current optometrists will get screwed.

I have heard at the American College of Surgeons meetings people talking about medicine politically supporting opticians to refract on their own to cut the legs under optometry. If that happens it would be a huge blow for optometry.

 

[Jason K]

I think the state of optometry would be in a better place if people like you and Tippytoe were in charge of the AOA.

Ha! Move over Dori Carlson, there's two new sherrifs in town!

(PS: I made the mistake of listening to Dori's inauguration speech. I wish I hadn't as I believe it to have put me at significant risk for a brain hemorrhage and possibly early-onset Alzheimer's. I feel so warmly reassured with the knowledge that she and her esteemed colleagues will leave optometry "a little better than they found it.")

Watch at your own risk: http://www.youtube.com/watch?v=hkpaQj4ybTk

 

[Jason K]

I have heard at the American College of Surgeons meetings people talking about medicine politically supporting opticians to refract on their own to cut the legs under optometry. If that happens it would be a huge blow for optometry.

This prospect has terrified me for some time. The minute refracting opticians get widespread refracting rights, there will be thousands of ODs wandering around saying "Hey, how come my earning potential just got cut in half?" Every commercial OD in the US has good reason to be concerned. I don't think many newly-minted ODs realize that optometrists employed or contracted in commercial settings are not there to provide primary eye care or any eye care, for that matter. They're there for the sole purpose of providing refractions to drive the sale of spectacles and contact lenses - that's it! Anything beyond that is extraneous. If an optician can do the "same job" for half or better yet, a third of the price, it'll be a short transition period. I fear that many ODs will be paying for/have paid for a very expensive refracting optician's certificate, hence my vocal position on this site. I can't even say I'd blame ophthalmology for taking this route if they end up succeeding. The nonsense that we're pushing is no better.

 

[JaggerPlate]

I think this post is dead on. I’ve said before that optometry, as a profession, is like a teenager who doesn’t really know what’s best to do for himself in the long-term. It just does whatever seems “cool” at the moment. Turning OD offices into a starwars show sounds like a great idea, right? We’re expanding the practice rights of the profession, what could be more important? Well, everything could be more important, at least right now. What good does it do to have ODs expanding our scope to include laser procedures if 80% of us will be glorified refracting opticians in 10 years? Great, we’ll have a few dozen ODs out there “saving the world” while the other 60,000 in the country turn dials at EyeMart.

I know of very few practicing ODs who would actually consider adding laser procedures to their practice even if they could so why is this such a big issue right now? The cost of the equipment is prohibitive and the return would be hard to justify the expense based on reimbursement levels which are sure to drop anyway once we start doing them widespread. The people who are fascinated by this idea are a few optometric "renegades" and pre-optometry / optometry students. Most practicing ODs I know are saying “Whatever, I have no interest in doing any of that stuff in my office.”

Personally, I don’t think true surgery has any place in the OD scope given our current training model, but I know that’s not the popular opinion on this forum, at least from the OD side. We just don’t have the ability to provide the patient volume necessary to make it practical. If you want to be an eye surgeon, don’t go to optometry school. Go get a medical degree, do a residency that provides you with thousands upon thousands of surgical patients to “practice” on, and then have at it. There are other ODs out there who've made that choice and now they're well-trained surgeons. Trying to create “insta-surgeons” with weekend training courses that involve as few as one single human patient is absolutely insane. It makes us look like desperate “wannabees.” Sorry, but it’s true.

I know a lot of people on this forum will find my views on this topic to be tantamount to blasphemy, but as anyone who’s read my posts knows, I think there are far more pressing issues to deal with for the profession. Instead of trying to “snap our fingers” and wake up the next day as well-trained surgeons, we should be trying to repair the damaged profession we currently have. Maybe after addressing the issues we have, we can start worrying about laying the foundations that need to be in place before proceeding with scope expansion that includes surgery. Until then, I think our focus should be elsewhere.

 

[Eyes Only]

Forgive my ignorance, but how exactly do medical schools pull this off, then? Couldn't the accrediting body for optometry schools raise standards (e.g. make it so that each optometry student must have x # of patient encounters per year in 3rd and 4th year or something) and thus dramatically raise the barriers to entry for a new OD school? Perhaps I'm missing something, but a lot of knowledgeable ODs on this board have pointed to reducing the # of graduates as the first step to preserving the quality of the education, quality of students and the field as a whole.

The key is the standards for accreditation. As long as a school meets the minimum standard, they get accreditation.

I suppose you are right, the standards would have to change.

 

[Tippytoe]

I have heard at the American College of Surgeons meetings people talking about medicine politically supporting opticians to refract on their own to cut the legs under optometry. If that happens it would be a huge blow for optometry.

I do not think this is too far-fetched. With emerging technology, it would not be too difficult for a high-school grad optician to refract in Walmart.......and take a very high resolution retinal image and anterior seg image to be 'reviewed' off-site by an ophthalmolgist (or ophthalmic tech) for disease. It won't be long before a better "Optos" instrument comes around- one capable of a full and high resolution retinal image.

From there, the optician refraction is done, the ocular health is reviewed and the store gets to sell glasses. Anyone not correctable to 20/20 or any questionable health concerns gets referred to the ophthalmologist for examination.

In this scenerio, everyone-- the store, the optician, the ophthalmologist and the patients (via lower prices) WINS!!

The only loser is the now unemployed optometrists. Sucks for them/us but it probably is a better and more efficient way to do it.

 

[hello07]

Jason k- I could not agree more with your post! It saddens me that instead of the AOA putting a stop to the potential 2 new schools one in Mass and the other in Virginia that want to open up; they are more concerned with expending surgical privileges which 90% of us ODs have no interest it.
We, doctors of optometry are our worse enemy if you can believe me. We are divided amongst ourselves. Few years ago, 2 new boards enacted went at each other and ended up in court.
I love Optometry but we have become a disgrace lately.
Knowing what I know know after so many yes of practice, I wouldn't encourage anyone in their rout mind to become an optometrist.
My 2 cents

 

[speyeder]

I do not think this is too far-fetched. With emerging technology, it would not be too difficult for a high-school grad optician to refract in Walmart.......and take a very high resolution retinal image and anterior seg image to be 'reviewed' off-site by an ophthalmolgist (or ophthalmic tech) for disease. It won't be long before a better "Optos" instrument comes around- one capable of a full and high resolution retinal image.

From there, the optician refraction is done, the ocular health is reviewed and the store gets to sell glasses. Anyone not correctable to 20/20 or any questionable health concerns gets referred to the ophthalmologist for examination.

In this scenerio, everyone-- the store, the optician, the ophthalmologist and the patients (via lower prices) WINS!!

The only loser is the now unemployed optometrists. Sucks for them/us but it probably is a better and more efficient way to do it.

You are right that this scenario is not out of the realm of possibility. Where I trained, third year residents reviewed thousands of fundus photos taken by offsite techs at other VA hospitals. Those patients with abnormal findings were made appointments to be examined at our facilities, bypassing the need for onsite ophthalmologists and optometrists.

 

[PBEA]

You are right that this scenario is not out of the realm of possibility. Where I trained, third year residents reviewed thousands of fundus photos taken by offsite techs at other VA hospitals. Those patients with abnormal findings were made appointments to be examined at our facilities, bypassing the need for onsite ophthalmologists and optometrists.

I guess it could....that is if you ignore all of the other eye problems that don't show up in a picture of the posterior pole . I'm sure medicine will line up to support retinal cameras in walmarts. It's not better pt care, but what the hell, if it means cutting ODs out then all the better, right?

 

[sanityonleave]

I guess it could....that is if you ignore all of the other eye problems that don't show up in a picture of the posterior pole . I'm sure medicine will line up to support retinal cameras in walmarts. It's not better pt care, but what the hell, if it means cutting ODs out then all the better, right?

I don't think that was his point at all. Nobody here wants to "cut" ODs -- but rather, he was pointing out that if there wasn't strong centralized professional leadership that ODs being marginalized in such a way was possible.

 

[speyeder]

I guess it could....that is if you ignore all of the other eye problems that don't show up in a picture of the posterior pole . I'm sure medicine will line up to support retinal cameras in walmarts. It's not better pt care, but what the hell, if it means cutting ODs out then all the better, right?

Why do you assume that? That is not what I wrote. Clearly examining a patient with a slit lamp and performing an indirect BIO exam is superior to fundus photos alone. That system was implemented out of a need to provide eyecare services in VAs without an optometry or ophthalmology presence, not out of some sinister plot to undermine your profession.

 

[PBEA]

I don't think that was his point at all. Nobody here wants to "cut" ODs -- but rather, he was pointing out that if there wasn't strong centralized professional leadership that ODs being marginalized in such a way was possible.

Granted I may be reading a bit too much between the lines, but let me clue you in to something now before the indoctrination seeps too deep into your psyche. There has never been a time, and there will never be a time, when ophthalmology hasn't attempted to "cut" out optometry. You may feel inclined to believe the rhetoric about "defending pt care" but no matter what the topic whether its surgery, medications, pt access, etc or for that matter ANYTHING outside of a so called "refraction", and it is always the same. Bang the war drums, fear monger, rally the troops because we gotta stop those dang ODs. And you wonder why ODs have become supposedly so adept at lobbying?...............Really?

 

[Eyes Only]

Jason k- I could not agree more with your post! It saddens me that instead of the AOA putting a stop to the potential 2 new schools one in Mass and the other in Virginia that want to open up; they are more concerned with expending surgical privileges which 90% of us ODs have no interest it.
We, doctors of optometry are our worse enemy if you can believe me. We are divided amongst ourselves. Few years ago, 2 new boards enacted went at each other and ended up in court.
I love Optometry but we have become a disgrace lately.
Knowing what I know know after so many yes of practice, I wouldn't encourage anyone in their rout mind to become an optometrist.
My 2 cents

I agree...

Post this on the pre-optometry forum and you'll be labelled a troll and a loser. After all, you practice optometry, so what could you possibly know about the profession? Everything over there is sunshine and roses. This is why we will have 2 new schools, and more on the way. There appears to be hundreds, maybe thousands of doe eyed innocent pre optometry students out there willing to go a $150,000 or more in debt to join the ranks, and nothing you or I can say will change this.

 

[PBEA]

Why do you assume that? That is not what I wrote. Clearly examining a patient with a slit lamp and performing an indirect BIO exam is superior to fundus photos alone. That system was implemented out of a need to provide eyecare services in VAs without an optometry or ophthalmology presence, not out of some sinister plot to undermine your profession.

and coming to a family practice/endo/PCP office near you. As we speak being rolled out nationwide, with ophthalmology lining up to provide photo review. Next up walmart, minute clinics, and any other closet they can find to jam a camera into. How bout self serve kiosks? Can't happen? sure it can just ask OPHTHALMOLOGY. Now thats quality I tell ya, say you wanna buy a bridge?

"defenders of patient care"

puke

 

[speyeder]

and coming to a family practice/endo/PCP office near you. As we speak being rolled out nationwide, with ophthalmology lining up to provide photo review. Next up walmart, minute clinics, and any other closet they can find to jam a camera into. How bout self serve kiosks? Can't happen? sure it can just ask OPHTHALMOLOGY. Now thats quality I tell ya, say you wanna buy a bridge?

"defenders of patient care"

puke

Sorry, can't help you with your paranoia.

 

[PBEA]

Sorry, can't help you with your paranoia.

paranoia? don't be naive, the first part of my post is the current reality and is growing, the latter parts aren't here now, but like you said under the right circumstances (like ophthalmology or gasp! optometry support) not far fetched. Be careful what you wish for. You really think those VA programs are just about access?! Get real.

 

[speyeder]

You really think those VA programs are just about access?

Okay you got me. I'm outted. My master plan is foiled.

 

[Jason K]

I agree...

Post this on the pre-optometry forum and you'll be labelled a troll and a loser. After all, you practice optometry, so what could you possibly know about the profession? Everything over there is sunshine and roses. This is why we will have 2 new schools, and more on the way. There appears to be hundreds, maybe thousands of doe eyed innocent pre optometry students out there willing to go a $150,000 or more in debt to join the ranks, and nothing you or I can say will change this.

To me, this is what's so sad about the whole situation. If more of us actually did say something to bright-eyed "potentials," they might actually have the good sense to look things over with a fine-toothed comb before shelling out a couple of hundred thou for their "refracting optician's certificate" ..........I mean....an O.D. There's no doubt that, as EyesOnly points out, any negativity on here is usually met with flaming torches and repeated usage of the words "loser," "pathetic," "failure," or some combination thereof. God forbid someone might want to keep another person from driving off the same cliff they did. Oh well, whoever doesn't listen to the message now will just "hear" it later when they finally realize they bought into the AOA's "Optometry is Awesome" campaign.

 

[Visionary]

and coming to a family practice/endo/PCP office near you. As we speak being rolled out nationwide, with ophthalmology lining up to provide photo review. Next up walmart, minute clinics, and any other closet they can find to jam a camera into. How bout self serve kiosks? Can't happen? sure it can just ask OPHTHALMOLOGY. Now thats quality I tell ya, say you wanna buy a bridge?

"defenders of patient care"

puke

Non-mydriatic cameras, in general, are terrible. I've seen them used for screening, and the images just suck. Misses pathology and also leads to a lot of false positives. I don't disagree that some may be pushing for this, but it is definitely not good patient care. We used Optos in fellowship, but only for widefield photos and angiography in dilated patients. As far as I'm concerned, that's the only role for it.

 

[Meibomian SxN]

Hi Meibomian Sxn. If you think lasers aren't invasive how about I take an argon laser and blast it across the surface of your cornea. I appreciate the highly inflammatory response and come to expect it from you but in all seriousness lasers are invasive. To say they are not is just foolish. Lasers being put into a "non invasive" category is just absurd. If you are physically altering live tissue by action it is invasive by definition. I use a CO2 laser to open tissue and dissect which is a common practice in eyelid, lacrimal and orbital surgery. I open tissue with lasers. I control bleeding with lasers. When someone does Lasik, that is also an invasive procedure. Even a YAG or ALT is invasive.

According to who, you? Are you a physicist? Are you OSHA? I think you should look up the meaning of: invasive surgery. Seems you failed that class or just did not take it. Since you seem anal for definitions, the glaucoma lasers are considered MINIMALLY invasive. Let me guess, you're knickers are in a bunch again because I said minimally; Smh....

When I was a resident an optometrist in Oklahoma god knows where lasered a patient who had neovascularization and had a closed angle because he thought he had angle closure glaucoma and needed a PI. Well...the iris bled and IOP went up to 50 for three days and his son flew him to DC to be seen after he had an anterior chamber washout by an ophthalmologist there. The optometrist wanted to send him to a big optometry referral center so the patient could be "comananged". The son refused. So don't tell me that lasers are non-invasive. The patient had a significant arcuate defect after that. I am not sure why I am telling you this because your desire to expand priveleges goes way beyond caring for that patient's story. What if that was your mom or dad? How pissed would you be? And the fact is that to YAG an iris with neo is a mistake that at the most a 1yr resident would make and that is stretching it..

You obviously FAILED at glaucoma rounds! Is it far fetched that a Px with iris neo has a closed angle? And are you really suggesting the arcuate defect was caused by the PI??? Wow, your knowledge is pretty scary; and to think you are authorized to use CO2 lasers???

The fact that you read up on trabeculoplasty and trabeculectomy is great but you need to read some more. The fact you don't even realize that ophthalmologists use lasers that are highly invasive is scary.

I did my 1 year residency WITH a glaucoma fellowship trained ophthalmologist, not just the likes of someone who saw and performed X number of procedures to satisfy their residency requirements. So I did a little more than "read up on". As for you it seems you fell under Bush's criteria of "No egotist left behind"...

By the way...I read the old posts where you didn't even know the proper treatment for a retrobulbar hemorrhage...call a retina specialist? Are you serious? It is an embarrassment..have some decency man. For someone so vocal on this board and inflammatory you sure should be spending your time doing other things...like reading up your knowledge.

You hold me to something I quickly wrote in a post? Get off that ego of yours and come to grips that the scope is changing. Whether some ODs and MDs agree or disagree, fact remains: Lasers will become within our scope in the next decade.

 

[Visionary]

You obviously FAILED at glaucoma rounds! Is it far fetched that a Px with iris neo has a closed angle? And are you really suggesting the arcuate defect was caused by the PI??? Wow, your knowledge is pretty scary; and to think you are authorized to use CO2 lasers???

I think the point was that someone with NVG has a zippered angle from neovascularization, which is not the same as traditional acute angle closure due to pupillary block. LPI in the setting of NVG in not appropriate, unless pupillary block exists. Creating a hole in the iris will not fix an angle drainage issue. It can equalize the anterior and posterior chamber pressures to relieve pupillary block, though. Because the patient in question received inappropriate treatment, the IOP remained high for too long, resulting in the arcuate defect.

 

[Meibomian SxN]

...unless pupillary block exists.

Exactly. And in this non-adherent diabetic, I'm sure that was the case....

And I still doubt the ODs actions caused the defect. Px should have followed up the next day as is protocol. Sounds more like the negligence was 100% on the patient and the son.

 

[Visionary]

Exactly. And in this non-adherent diabetic, I'm sure that was the case....

And I still doubt the ODs actions caused the defect. Px should have followed up the next day as is protocol. Sounds more like the negligence was 100% on the patient and the son.

You're sure, eh? Well, I would actually doubt pupillary block. That is uncommon with NVG. Yes, NVI at the pupillary margin can cause synechiae, which can create block, but that is the exception to the rule. Please, dazzle us with some more of your expertise.

 

[Meibomian SxN]

You're sure, eh? Well, I would actually doubt pupillary block. That is uncommon with NVG. Yes, NVI at the pupillary margin can cause synechiae, which can create block, but that is the exception to the rule....

You say its uncommon but then you say its the exception to the rule? And you do retina???....

With the contradictions you keep sharing, I think you're an excellent candidate for the GOP or the Democratic political circus

 

[Visionary]

You say its uncommon but then you say its the exception to the rule? And you do retina???....

With the contradictions you keep sharing, I think you're an excellent candidate for the GOP or the Democratic political circus

Do you know what contradiction means? What I stated was not contradictory. Read it again, genius.

 

[Meibomian SxN]

Do you know what contradiction means? What I stated was not contradictory. Read it again, genius.

So NOW you're saying that someone with NVI can't have NVG? Boy, I'd LOVE to rip you up in a grand rounds seminar....And YES, we had those in the OD curriculum as well as on rotations and residency!

I just hope you don't have the same train of thought when you're operating on that delicate pink tissue in the eye; pretty scary to think about

 

[thiaeyemd]

Meibomian Sx....your responses glaringly show your knowledge.You are what a general surgeon I trained with would call "Wrong and Strong". You are not only ignorant..you like screaming it to the world on studentdoctor.net..

You really represent your field well
Keep posting...it only proves my point...

to top it off....I love how you blame the patient and son as its their fault

laughing my ass off

 

[speyeder]

So NOW you're saying that someone with NVI can't have NVG? Boy, I'd LOVE to rip you up in a grand rounds seminar....And YES, we had those in the OD curriculum as well as on rotations and residency!

I just hope you don't have the same train of thought when you're operating on that delicate pink tissue in the eye; pretty scary to think about

I don't know which is scarier, your stunning lack of knowledge or your self-assuredness that you are right.

 

[PBEA]

Non-mydriatic cameras, in general, are terrible. I've seen them used for screening, and the images just suck. Misses pathology and also leads to a lot of false positives. I don't disagree that some may be pushing for this, but it is definitely not good patient care. We used Optos in fellowship, but only for widefield photos and angiography in dilated patients. As far as I'm concerned, that's the only role for it.

agreed, but as you said (and I have read numerous reports of) these retinacams are being put into PCPs, endo, etc for "screening photos", they keep the tech fee and the images are sent over the web to some ophtho to read the image, who in turn collects the balance of the fee. It IS bad care, but that doesn't seem to stop ophtho from doing it. Pts have NO IDEA that they aren't getting a proper eval, and will never seek out an eye doctor. I wonder who carries the liability burden on those cases.

 

[netmag]

I must say that I find this entire thread extremely entertaining. Mostly just from a social interaction standpoint. The hierarchy levels between the MDs, ODs, and Pre-ODs is very distinct. Anyone stepping out of line for any reason is immediately taken to task. There are some extremely sensitive reactions to anyone considered to be speaking out of line between the levels that expresses a bit of condescension and intense need for affirmation of status at each level. Not saying that it's wrong or unjustified. Just really interesting to see in action.

As to the original topic, while I think that the AOA should indeed discourage new schools, it is just as important (perhaps more so) for them to be involved in politics as well. A friend of mine is interested in optometry. I did a quick search on our state legislature the other week to see how much goes on pertaining to optometry. I wasn't expecting much but I was suprised to see the level of action going on here just in this year alone. They were making minor modifications to optometric legislation governing optometrist's scope from the 1980's. I assume senators and congress members in this state would not bother editing it unless they had a specific reason to do so.

While I'm certain that the MDs here probably have no ill will towards ODs on a personal level, it seems like the various professional groups at large are constantly pulling or pushing things from a legislative standpoint. If no one is paying attention on your behalf, eventually you could actually lose some things that you currently have. It may not be necessary to move into someone else's territory for the purpose of making gains, but the way things are today, it seems that you do have to be somewhat politically active to be certain that you maintain your current status.