RED ALERT: Optometrists petitioning to perform ocular surgery in North Carolina

[doctortom]

Dear Colleagues,

The House Health Committee in North Carolina will be voting on the bill HB36 this Wednesday, 8th March. I have attached a copy of the bill to this post. The bill would allow optometrists to do surgeries (including intravitreal injections) with few exceptions. The bill is purposely vague in what procedures would be allowed if the bill passes. If HB 36 is killed in the Health Committee it cannot progress any further. Optometrists are currently using legislation which allows them surgical privileges in states like Oklahoma to support this petition. The only physician member of the North Carolina general assembly stated that the vote was “precariously close”.

We need to generate as many calls/e-mails to the Health Committee as possible this weekend. Please e-mail all of them! I’ve already done so.

The more opposition to the bill they hear, the more likely we are to defeat it.

In addition please enlist as many of your friends and family members as possible. I am attaching a list that has the telephone numbers and e-mails of members of the Health Committee.

Please forward this to as many physicians as possible.

Thanks for any help you can offer.

---

Members don't see this ad.

 

[snation]

On the topic, this is an interesting paper comparing Ophthalmologists vs Optoms in Oklahoma.

https://www.ncbi.nlm.nih.gov/pubmed/27467233

Could be beneficial for the representatives to read over this before making their decision.

 

[Feugmed]

Does anyone know what happened with voting for this bill??

 

[EyeDR_oo]

bump.

 

[doctortom]

bump.

The vote was delayed to March 22nd. Legislatures were inundated with emails from both ophthalmologists and optometrists. They want to hear from more patients. Please continue to contact them.

 

[Feugmed]

Thanks for the reply! Georgia is having the same issue right now with a bill that allows optometrists to do injections!

 

[kid Icarus 3]

The below article is incredibly alarming. It was one thing to hear about the potential battle about to ensue in NC... This article already shows the ground ophthalmologists are LOSING in Florida in a big way. Honestly, we CANNOT SIT AROUND AND NOT DO ANYTHING ANYMORE. I am urging anyone reading this to write your state senator (super easy to do) and contact your state ophthalmology society and ask how you can get involved. I contacted the Florida ophtho society and they informed me that there will be a hearing about this recent bill that narrowly passed in the next couple weeks and they told me they NEED ophthalmologists (residents or practitioners) to testify at these types of meetings. If we don't do something now we will continue to lose ground and all our long years of training will be considered as "equivalent" to optoms by the government and the general public. Optoms will continue to try to get access to our procedures and privileges and we need to rally. There is so much more to say but just wanted to post this quick message. Thanks for reading!

https://www.aao.org/eye-on-advocacy-article/optometry-narrowly-clears-first-hurdle-in-florida-
(Florida optometrists have taken an early lead in their brazen attempt to earn primary-care provider status for eye diseases. A legislative proposal giving optometry laser and scalpel surgery privileges passed out of a House of Representatives subcommittee this week by a razor-thin margin. The House proposal and its Senate counterpart represent a grave danger to Florida eye patients. It would result in the Florida Board of Optometry becoming the state’s sole authority for expanding optometrists’ scope, redefining optometrists as primary eye care providers. As a result, thousands of optometrists would be elevated to nearly the same scope of eye care that is currently exclusive to ophthalmologists.)

 

[EyeDR_oo]

Here is the link to the house subcommittee video that took place in Florida.

3/15/17 House Health Quality Subcommittee - The Florida Channel

For those of you that don't know the premise: A few years back optoms and ophthos reached a scope of practice agreement in FL. Not surprisingly, they have come back for the full mile. On the table is approval for SLT/ALT/YAGs/Lid procedures (and possibly LASIK as it is not on their prohibitive list, and the wording seems to allow for it) after a "weekend" course. The argument is access to care in emergency situations, and the indigent population. Have yet to see an emergency LASIK, but sure why not.

I watched the full 1.5hrs of the debacle. I strongly recommend investing the time. One committee member needed clarification for the acronym "MD". Equally amazing the committee chair, Pigman an ER physician, voted in favor of this bill to pass. The future well being of our patients are being decided by cash and street dullards.

 

[immunology89]

Here is the link to the house subcommittee video that took place in Florida.

3/15/17 House Health Quality Subcommittee - The Florida Channel

For those of you that don't know the premise: A few years back optoms and ophthos reached a scope of practice agreement in FL. Not surprisingly, they have come back for the full mile. On the table is approval for SLT/ALT/YAGs/Lid procedures (and possibly LASIK as it is not on their prohibitive list, and the wording seems to allow for it) after a "weekend" course. The argument is access to care in emergency situations, and the indigent population. Have yet to see an emergency LASIK, but sure why not.

I watched the full 1.5hrs of the debacle. I strongly recommend investing the time. One committee member needed clarification for the acronym "MD". Equally amazing the committee chair, Pigman an ER physician, voted in favor of this bill to pass. The future well being of our patients are being decided by cash and street dullards.

This was a really interesting watch. Thanks a lot for posting it. The ophthalmologists who turned out did a great job.

Is access really that bad for medicaid patients in Florida? I didn't really hear much hard evidence either way, it was just assumed that it was bad....Maybe I missed something. It seems like if we can address that access problem, the optometrists argument would be over. Other states should make sure access doesn't become such a big problem that optometrists can say well less training isn't as good as more training, but better than not getting in the door.

Also, the committee member who asked for clarification on the acronym MD voted No on the measure, so don't give him such a hard time. If you listen to his comments at the end, he shows a lot of common sense. I remember when my Dad asked one of my mentors who practices internal medicine what internal medicine is, I about fell out of my chair. Doesn't make him a dullard.

 

[LightBox]

The problem is that most Ophtahlmologists-in-training are too damn overworked and tired to worry about advocacy. They are busy seeing 50 train-wreck patients at the County/VA hospital, preparing for grand rounds, reading up on patients they are managing, and studying for the OKAP. They wrongly assume that "some other guy" will bear the banner and work things out for their future. Guess what? This complacency is exactly what some Optometrists are banking on. These ODs also hope that Ophthalmologists have a short memory and that is why they incrementally try to gain more and more privileges. Because with every privilege they gain that blurs the distinction between an Optometrist and Ophthalmologist, the easier it is to gain a subsequent privilege. It is like the practice of law and basing future court decisions on previous precedents. Many young Ophthalmologists may come out of training and not even know that ODs were not allowed to prescribe narcotics (if the law passes in Florida for example) and just accept it as the "norm." These OD leaders want you to forget.

Let's face it. If Ophthalmologists didn't worry about their OD referral network, then there would be a lot more vocal eye surgeons out there campaigning against these unnecessary scope expansion bills.

If you didn't know it already, these Optometrists really don't care about doing the hard stuff like PKPs and PVR cases. Their primary goal is being able to do LASIK (i.e. lots of $), being the primary gate-keepers of all eye care (i.e. control), and perhaps even taking the bread and butter of cataract surgery and medical retina (e.g. intravitreal injections). Let's hope some of these posts opens some of the young Ophthalmologists' eyes out there.

 

[Bronze Medal]

Dear Colleagues,

The House Health Committee in North Carolina will be voting on the bill HB36 this Wednesday, 8th March. I have attached a copy of the bill to this post. The bill would allow optometrists to do surgeries (including intravitreal injections) with few exceptions. The bill is purposely vague in what procedures would be allowed if the bill passes. If HB 36 is killed in the Health Committee it cannot progress any further. Optometrists are currently using legislation which allows them surgical privileges in states like Oklahoma to support this petition. The only physician member of the North Carolina general assembly stated that the vote was “precariously close”.

We need to generate as many calls/e-mails to the Health Committee as possible this weekend. Please e-mail all of them! I’ve already done so.

The more opposition to the bill they hear, the more likely we are to defeat it.

In addition please enlist as many of your friends and family members as possible. I am attaching a list that has the telephone numbers and e-mails of members of the Health Committee.

Please forward this to as many physicians as possible.

Thanks for any help you can offer.

Thanks for posting this. I just emailed all of the committee members.

 

[dantt]

Very interesting testimony. What do you think about comparisons to ophthalmology practices that employ physician assistants to perform parts of their surgeries?

 

[KHE]

If you didn't know it already, these Optometrists really don't care about doing the hard stuff like PKPs and PVR cases. Their primary goal is being able to do LASIK (i.e. lots of $), being the primary gate-keepers of all eye care (i.e. control), and perhaps even taking the bread and butter of cataract surgery and medical retina (e.g. intravitreal injections). Let's hope some of these posts opens some of the young Ophthalmologists' eyes out there.

I don't think you're really correct on any of that.

First the standard disclosures:

1) I'm an optometrist in Connecticut with 17 years experience
2) Connecticut is a state with a wide scope of practice and I've been prescribing oral medications including narcotics for over 15 years.

Because of that, we don't have scope of practice battles in Connecticut and optometry and ophthalmology are generally able to get along and focus our combined efforts on managed care and regulatory issues which mutually benefit both professions. It's actually quite nice.

I don't want to pretend to speak for doctors in the state of Florida as I've never practiced there but in general, the issue with scope expansions in other states is not about doing procedures, especially things like LASIK and cataracts. As I've said before, there are 45,000 optometrists in the United States and approximately 15,000 ophthalmologists. (IIRC) Let's say 20% of ophthalmologists do LASIK. That's 3000 providers. If we waved a magic wand and granted optometry LASIK rights and only 5% of optometrists decided to pursue that would nearly double the supply of providers overnight while leaving demand EXACTLY the same. With cataract surgery, it would be even worse.

What is that going to do with fees? They will crash through the floor. For LASIK, we would be looking back with fondness at the $299 per eye highway billboards as the "golden age of LASIK." Cataract surgery is already poor and declining what seems like daily. Adding a glut of providers will not help that.

Believe you me, optometrists understand that completely.

The issue isn't about gaining rights to perform specific procedures. It's about deciding who is ultimately going to control the profession of optometry.

 

[LightBox]

I don't think you're really correct on any of that.
The issue isn't about gaining rights to perform specific procedures. It's about deciding who is ultimately going to control the profession of optometry.

If you read the bills in FL, NC, and GA, then I would beg to differ what is the ultimate intention of Optometry. No matter what "truces" are made (e.g. few years ago in FL), the Optometric leadership wants more and more. Most optometrists that I know don't want to do any of these procedures, but for some reason their leaders keep pushing for them. I really do feel there is a higher percentage of ODs that feel like they "deserve" to perform PRK/LASIK because they know something about the eye.

Btw, how often does one really need to prescribe a narcotic? I've been doing lots of eye surgery and managing complex patients for many years, and I have written maybe one script in the past 5 years.

 

[Mad Jack]

Inb4 pharmacists, naturopaths petition to perform ocular surgery.

 

[hello lady!]

I don't think you're really correct on any of that.
I've been prescribing oral medications including narcotics for over 15 years.

Btw, how often does one really need to prescribe a narcotic? I've been doing lots of eye surgery and managing complex patients for many years, and I have written maybe one script in the past 5 years.

That was the first thing that I asked myself too. I don't ever prescribe narcotics and was trained not to in residency. What conditions have you been managing that require narcotics?

 

[KHE]

If you read the bills in FL, NC, and GA, then I would beg to differ what is the ultimate intention of Optometry. No matter what "truces" are made (e.g. few years ago in FL), the Optometric leadership wants more and more. Most optometrists that I know don't want to do any of these procedures, but for some reason their leaders keep pushing for them. I really do feel there is a higher percentage of ODs that feel like they "deserve" to perform PRK/LASIK because they know something about the eye.

I guess we will have to agree to disagree on that one.

Btw, how often does one really need to prescribe a narcotic? I've been doing lots of eye surgery and managing complex patients for many years, and I have written maybe one script in the past 5 years.

It's very rare. Perhaps once or twice in a year.

 

[hello lady!]

I guess we will have to agree to disagree on that one.



It's very rare. Perhaps once or twice in a year.

What conditions do you use them for?

 

[KHE]

What conditions do you use them for?

Allergic conjunctivitis.....astigmatism.....sometimes mild NPDR.

You know....the usual stuff......

 

[awftho]

Allergic conjunctivitis.....astigmatism.....sometimes mild NPDR.

You know....the usual stuff......

But seriously, I am curious, what do you use them for?

 

[VA Hopeful Dr]

But seriously, I am curious, what do you use them for?

My best guess would be for corneal abrasions, same reason I (a family doctor) do.

 

[MstaKing10]

I don't think you're really correct on any of that.

First the standard disclosures:

1) I'm an optometrist in Connecticut with 17 years experience
2) Connecticut is a state with a wide scope of practice and I've been prescribing oral medications including narcotics for over 15 years.

Because of that, we don't have scope of practice battles in Connecticut and optometry and ophthalmology are generally able to get along and focus our combined efforts on managed care and regulatory issues which mutually benefit both professions. It's actually quite nice.

I don't want to pretend to speak for doctors in the state of Florida as I've never practiced there but in general, the issue with scope expansions in other states is not about doing procedures, especially things like LASIK and cataracts. As I've said before, there are 45,000 optometrists in the United States and approximately 15,000 ophthalmologists. (IIRC) Let's say 20% of ophthalmologists do LASIK. That's 3000 providers. If we waved a magic wand and granted optometry LASIK rights and only 5% of optometrists decided to pursue that would nearly double the supply of providers overnight while leaving demand EXACTLY the same. With cataract surgery, it would be even worse.

What is that going to do with fees? They will crash through the floor. For LASIK, we would be looking back with fondness at the $299 per eye highway billboards as the "golden age of LASIK." Cataract surgery is already poor and declining what seems like daily. Adding a glut of providers will not help that.

Believe you me, optometrists understand that completely.

The issue isn't about gaining rights to perform specific procedures. It's about deciding who is ultimately going to control the profession of optometry.

Lots of really solid points. The final sentence is really at the crux of the struggle here. Optoms want control of what they can and can't do and ophthalmologist who have had that control for ages want to keep it. The question that we should really be asking is what's best for patients instead of what's best for providers. Do you really believe that what's best for patients is to have optoms with minimal training doing laser procedures? Is power and money (let's be realistic here, both huge motivators in scope expansion) ultimately in the patients best interest?

 

[MullerCell]

I can't understand why an optometrist would ever need to prescribe narcotics. The only time I ever do is a few days worth following a scleral buckle or ruptured globe repair. I don't think they are too interested in these procedures....unpredictable timing, too much skill/work required, and not enough reimbursement.

 

[hello lady!]

My best guess would be for corneal abrasions, same reason I (a family doctor) do.

I don't think that is an appropriate use of narcotics. Even in surgeries where we intentionally scrape off the epithelium we do not use narcotic pain meds post operatively.

If your patient is in that much pain for a corneal abrasion, they should be referred emergently.

 

[ophthope]

Let's hope some of these posts opens some of the young Ophthalmologists' eyes out there.

I finish residency in 4 months. We're all talking about it. We don't need our minds opened.

But all of the Ophthalmologists training us made a ton of money looting medicare in the late 1980s doing phaco at $3000/pop and let a lot of bad things come down the pipe that we're having to deal with. They gave over control of patient care for referrals and money.

I'm $250,000 in debt from medical school, my starting salary is ~$200,000, and over the next couple of years before I buy into a practice I'll be very seriously considering what the future looks like.

Because quite frankly, my generation inherited this mess and the older generation isn't willing to fight this battle that they caused.


So when an Optometry school calls me up with a lucrative offer asking if I'll teach their top students to operate, I'm going to take the job. I don't "owe" anything to a profession full of people who aren't fighting for the future of the profession or for patient safety. Maybe I can teach these ODs to recognize when their patient is going into volume overload acute-on-chronic CHF on the table during cataract surgery. It's happened to me. If not, the "OD surgeons" will probably end up killing some people, but it will all be "government-approved" and I'll have made my money off of it just like the last generation did. I learned from the best I guess. And I'm only being partially sarcastic with all of this.


SO yeah. Our eyes are open. And we're mad, but not just at the ODs.

...Adding a glut of providers will not help that.

Believe you me, optometrists understand that completely.

The issue isn't about gaining rights to perform specific procedures. It's about deciding who is ultimately going to control the profession of optometry.

I'll believe that when they stop opening more Optometry schools, taking $200,000 from kids with a B-average and spitting them out into a $80,000/yr job in a Walmart if they're lucky and telling them that somehow the baby boomers are going to miraculously provide enough patients for them to be successful in the future.

Your profession is over-saturating the market, plain and simple. And most ODs realize this but you all appear to have no control over it.

It's also hard to believe it's not about ODs wanting procedure $$$, since when they lobbied in Oklahoma that patient's needed "better access to care" the first thing that happened when OD scope expansion passed is a few ODs hired an MD and started a refractive surgery center. You can say what you want, but actions speak louder than words. Haven't seen any ODs taking call in rural ERs and fixing lid lacs. Y'all want to share the open globes and the canalicular lacerations and all the uveitis patients then yeah, lets share everything. But those lobbying for scope expansion really don't want a fair share. They want to be able to do cash-only procedures and refer out any complications or difficult cases.

 

[Slide]

I finish residency in 4 months. We're all talking about it. We don't need our minds opened.

But all of the Ophthalmologists training us made a ton of money looting medicare in the late 1980s doing phaco at $3000/pop and let a lot of bad things come down the pipe that we're having to deal with. They gave over control of patient care for referrals and money.

I'm $250,000 in debt from medical school, my starting salary is ~$200,000, and over the next couple of years before I buy into a practice I'll be very seriously considering what the future looks like.

Because quite frankly, my generation inherited this mess and the older generation isn't willing to fight this battle that they caused.


So when an Optometry school calls me up with a lucrative offer asking if I'll teach their top students to operate, I'm going to take the job. I don't "owe" anything to a profession full of people who aren't fighting for the future of the profession or for patient safety. Maybe I can teach these ODs to recognize when their patient is going into volume overload acute-on-chronic CHF on the table during cataract surgery. It's happened to me. If not, the "OD surgeons" will probably end up killing some people, but it will all be "government-approved" and I'll have made my money off of it just like the last generation did. I learned from the best I guess. And I'm only being partially sarcastic with all of this.


SO yeah. Our eyes are open. And we're mad, but not just at the ODs.




I'll believe that when they stop opening more Optometry schools, taking $200,000 from kids with a B-average and spitting them out into a $80,000/yr job in a Walmart if they're lucky and telling them that somehow the baby boomers are going to miraculously provide enough patients for them to be successful in the future.

Your profession is over-saturating the market, plain and simple. And most ODs realize this but you all appear to have no control over it.

It's also hard to believe it's not about ODs wanting procedure $$$, since when they lobbied in Oklahoma that patient's needed "better access to care" the first thing that happened when OD scope expansion passed is a few ODs hired an MD and started a refractive surgery center. You can say what you want, but actions speak louder than words. Haven't seen any ODs taking call in rural ERs and fixing lid lacs. Y'all want to share the open globes and the canalicular lacerations and all the uveitis patients then yeah, lets share everything. But those lobbying for scope expansion really don't want a fair share. They want to be able to do cash-only procedures and refer out any complications or difficult cases.

You're so absolutely right. We're paying for the sins of our fathers...I only hope our generation has the insight to not eat our own like we have.

 

[ophthapp1]

I finish residency in 4 months. We're all talking about it. We don't need our minds opened.

But all of the Ophthalmologists training us made a ton of money looting medicare in the late 1980s doing phaco at $3000/pop and let a lot of bad things come down the pipe that we're having to deal with. They gave over control of patient care for referrals and money.

I'm $250,000 in debt from medical school, my starting salary is ~$200,000, and over the next couple of years before I buy into a practice I'll be very seriously considering what the future looks like.

Because quite frankly, my generation inherited this mess and the older generation isn't willing to fight this battle that they caused.


So when an Optometry school calls me up with a lucrative offer asking if I'll teach their top students to operate, I'm going to take the job. I don't "owe" anything to a profession full of people who aren't fighting for the future of the profession or for patient safety. Maybe I can teach these ODs to recognize when their patient is going into volume overload acute-on-chronic CHF on the table during cataract surgery. It's happened to me. If not, the "OD surgeons" will probably end up killing some people, but it will all be "government-approved" and I'll have made my money off of it just like the last generation did. I learned from the best I guess. And I'm only being partially sarcastic with all of this.


SO yeah. Our eyes are open. And we're mad, but not just at the ODs.




I'll believe that when they stop opening more Optometry schools, taking $200,000 from kids with a B-average and spitting them out into a $80,000/yr job in a Walmart if they're lucky and telling them that somehow the baby boomers are going to miraculously provide enough patients for them to be successful in the future.

Your profession is over-saturating the market, plain and simple. And most ODs realize this but you all appear to have no control over it.

It's also hard to believe it's not about ODs wanting procedure $$$, since when they lobbied in Oklahoma that patient's needed "better access to care" the first thing that happened when OD scope expansion passed is a few ODs hired an MD and started a refractive surgery center. You can say what you want, but actions speak louder than words. Haven't seen any ODs taking call in rural ERs and fixing lid lacs. Y'all want to share the open globes and the canalicular lacerations and all the uveitis patients then yeah, lets share everything. But those lobbying for scope expansion really don't want a fair share. They want to be able to do cash-only procedures and refer out any complications or difficult cases.

preach.

Sent from my SM-G930V using Tapatalk

 

[VA Hopeful Dr]

I don't think that is an appropriate use of narcotics. Even in surgeries where we intentionally scrape off the epithelium we do not use narcotic pain meds post operatively.

If your patient is in that much pain for a corneal abrasion, they should be referred emergently.

Yes because no corneal abrasion ever hurts no matter how minor, and giving somebody 5 Norcos going to cause massive problems. Come on let's be reasonable here.

 

[KHE]

It's also hard to believe it's not about ODs wanting procedure $$$, since when they lobbied in Oklahoma that patient's needed "better access to care" the first thing that happened when OD scope expansion passed is a few ODs hired an MD and started a refractive surgery center. You can say what you want, but actions speak louder than words. Haven't seen any ODs taking call in rural ERs and fixing lid lacs. Y'all want to share the open globes and the canalicular lacerations and all the uveitis patients then yeah, lets share everything. But those lobbying for scope expansion really don't want a fair share. They want to be able to do cash-only procedures and refer out any complications or difficult cases.

As an ophthalmology resident, I understand completely why you feel the way you do and why you perceive this issue the way you do. If I were in your shoes, I would likely feel the same way.

But as I said before, ultimately it isn't about LASIK or SLT or intravitreal injections.

It is about who will ultimately control the profession of optometry.

Hypothetically, let's say an eye drop comes out that reduces presbyopia. Will optometry be expected to grovel before the medical board for "permission" to use that drop because it doesn't appear on some "formulary" that was developed in 1994?

We read all the time about contact lenses being developed to monitor blood glucose levels or monitor IOPs. Will optometrists be allowed to fit those contact lenses or is the plan for that type of technology to be solely the domain of ophthalmology?

That's the type of thing that is really what this is all about.

 

[hello lady!]

Yes because no corneal abrasion ever hurts no matter how minor, and giving somebody 5 Norcos going to cause massive problems. Come on let's be reasonable here.

You can also give narcotics for a stubbed toe (they hurt like a bitch too, you know!).

My patients (and the ones of all my colleagues) do just fine without narcotics for a corneal abrasion. Your patients would be too.

 

[VA Hopeful Dr]

You can also give narcotics for a stubbed toe (they hurt like a bitch too, you know!).

My patients (and the ones of all my colleagues) do just fine without narcotics for a corneal abrasion. Your patients would be too.

Probably true, but my fear is that they wake up at 2am hurting with little recourse.

Plus, it's the eye which makes people much more nervous than say an ankle sprain or your aforementioned stubbed toe.

Beyond that, seriously it's literally a handful of Norco.

Interestingly, the ophthalmologist I teched for for 3 years to get into med school would give 3-4 Vicodin (which still existed back then) to his corneal abrasion patients.

 

[MullerCell]

If pain from an abrasion is bad enough to make you think the patient needs a narcotic, a bandage contact lens works a whole lot better than any pain medication. Just refer them to an optometrist or ophthalmologist.

 

[VA Hopeful Dr]

If pain from an abrasion is bad enough to make you think the patient needs a narcotic, a bandage contact lens works a whole lot better than any pain medication. Just refer them to an optometrist or ophthalmologist.

Sure thing. You take referrals at 2pm on Saturday? Or Friday at 5pm?

Don't get me wrong, I'd love to have 99% of my eye patients be not my problem. Trouble is a) patients hate being referred out for stuff, especially my majority uninsured ones b) getting same-day or after-hours appointments is almost impossible. And truthfully, the former is a bigger problem than the latter as there are a few local ODs and MDs that I have good relationships with.

 

[doctortom]

Update: North Carolina ophthalmologists have been doing a fantastic job of voicing concerns of NC voters/patients. See link below:

Poll: N.C. Voters Strongly Oppose HB 36

 

[OD/ MD student]

Thank

Dear Colleagues,

The House Health Committee in North Carolina will be voting on the bill HB36 this Wednesday, 8th March. I have attached a copy of the bill to this post. The bill would allow optometrists to do surgeries (including intravitreal injections) with few exceptions. The bill is purposely vague in what procedures would be allowed if the bill passes. If HB 36 is killed in the Health Committee it cannot progress any further. Optometrists are currently using legislation which allows them surgical privileges in states like Oklahoma to support this petition. The only physician member of the North Carolina general assembly stated that the vote was “precariously close”.

We need to generate as many calls/e-mails to the Health Committee as possible this weekend. Please e-mail all of them! I’ve already done so.

The more opposition to the bill they hear, the more likely we are to defeat it.

In addition please enlist as many of your friends and family members as possible. I am attaching a list that has the telephone numbers and e-mails of members of the Health Committee.

Please forward this to as many physicians as possible.

Thanks for any help you can offer.

You. Ill make sure those representatives are contacted to explain the high safety profile involved with these procedures by optometrists.

 

[ophthope]

Sure thing. You take referrals at 2pm on Saturday? Or Friday at 5pm?

Don't get me wrong, I'd love to have 99% of my eye patients be not my problem. Trouble is a) patients hate being referred out for stuff, especially my majority uninsured ones b) getting same-day or after-hours appointments is almost impossible. And truthfully, the former is a bigger problem than the latter as there are a few local ODs and MDs that I have good relationships with.

I think volume- wise, short term narcotics for eye problems are probably low on the totem pole for narcotic abuse compared to say low back pain but there was that one study recently that showed addiction rates were significant even with short courses, which concerns me as I have never though a short course of Norco would pose any significant risk of harm.

But just so we can have some useful clinical discussion in one of these threads - I've also just never found that treating abrasions with narcotics really helps. Opioids just don't seem to do much for that type of pain. Best thing I've found is just to goop the eye up frequently with ointment to cover the epithelium. I don't even use BCLs all that often for abrasions, just frequent ointment and patients do fine. Post-PRK we use BCLs but that is with the knowledge that everything is completely sterile when that BCL is inserted. I'm sure in many cases it's safe to place a BCL as well, but I honestly think ointment & scheduled NSAIDS seem to help them more with pain than Hydrocodone.

Anyone else care to comment on how they manage pain from abrasions? PCPs included - we don't often see the way you guys manage them since you're capable of treating them without our help often.

 

[DrZeke]

If the patient is reliable and it's a big abrasion I use a BCL.

If it's a smaller abrasion or someone who I worry won't come back I lube up the eye aggressively with antibiotic ointment. I don't use narcotics. I do tell the patient they should just lay down and take it easy for the next 24 hours and that sometimes activity they do - reading and watching tv - may irritate them even more. Also recommend Motrin/Tylenol. If they already take sleep meds at home I tell them to take it.

I aggressively lubricate and patch small children for 24 hours to keep them from rubbing. Also have parents give them Tylenol/Motrin for any discomfort. Generally they do well.




Sent from my iPhone using SDN mobile

 

[VA Hopeful Dr]

I think volume- wise, short term narcotics for eye problems are probably low on the totem pole for narcotic abuse compared to say low back pain but there was that one study recently that showed addiction rates were significant even with short courses, which concerns me as I have never though a short course of Norco would pose any significant risk of harm.

But just so we can have some useful clinical discussion in one of these threads - I've also just never found that treating abrasions with narcotics really helps. Opioids just don't seem to do much for that type of pain. Best thing I've found is just to goop the eye up frequently with ointment to cover the epithelium. I don't even use BCLs all that often for abrasions, just frequent ointment and patients do fine. Post-PRK we use BCLs but that is with the knowledge that everything is completely sterile when that BCL is inserted. I'm sure in many cases it's safe to place a BCL as well, but I honestly think ointment & scheduled NSAIDS seem to help them more with pain than Hydrocodone.

Anyone else care to comment on how they manage pain from abrasions? PCPs included - we don't often see the way you guys manage them since you're capable of treating them without our help often.

Interestingly my own experiences with various post-op type pain has been the same - NSAIDs do seem to help more than narcotics most of the time. That being said, part of this is driven by patient satisfaction issues unfortunately.

For what its worth, I generally prescribe like 5 pills at most - the idea being if they need them more than about 18 hours post-abrasion then they definitely do need to see someone with a slit lamp. Also always do antibiotic ointment as well.

The data about short courses causing addiction issues is usually talking about a 5-7 day course which amounts to about 30 pills.

 

[VA Hopeful Dr]

If the patient is reliable and it's a big abrasion I use a BCL.

If it's a smaller abrasion or someone who I worry won't come back I lube up the eye aggressively with antibiotic ointment. I don't use narcotics. I do tell the patient they should just lay down and take it easy for the next 24 hours and that sometimes activity they do - reading and watching tv - may irritate them even more. Also recommend Motrin/Tylenol. If they already take sleep meds at home I tell them to take it.

I aggressively lubricate and patch small children for 24 hours to keep them from rubbing. Also have parents give them Tylenol/Motrin for any discomfort. Generally they do well.




Sent from my iPhone using SDN mobile

Motrin works wonders on small kids, I mean just surprisingly well for any type of pain.