I just got the following letter from the American Academy of Ophthalmology which I thought I'd share:

New Mexico Optometrists Introduce Sweeping Surgery Bill

Patient safety has been put in serous jeopardy with last week’s introduction of a bill that would add surgery to the optometric practice act in New Mexico. This bill extends far beyond the dangerous expansion bill that the Surgical Scope Fund helped defeat in 2005.

This new legislation (S.B.367) exposes all of our patients to serious risk by:

allowing optometrists to perform invasive procedures such as removal of conjunctival and lid lesions, including tumors!
authorizing the N.M. Optometry Board to certify optometric use of SLTs, ALTs, YAG capsulotomies, YAG PIs and ARGON PIs!
permitting optometrists to administer a host of pharmaceuticals, including intravenous drugs (FA), local anesthetics and oral steroids!
We are working closely with the New Mexico Academy of Ophthalmology to aggressively defend M.D./D.O.-only eye surgery.

I should explain a few things. First, some definitions.

An Ophthalmologist is a surgeon with a MD or DO (Medical Doctor or Doctor or Osteopathic Medicine) This is someone who has been through medical school, and has done at least one year of actual training in general medicine as an intern, and then followed with a 3 year residency in ophthalmology, doing nothing but seeing, treating, and surgically operating on patients.

An Optometrist is an OD (Doctor of Optometry). This is someone who has been through Optometry school This is a 3-4 year school, after which the person goes into practice. There is no training in terms of surgery, or in hospitals. There is some training with outpatients.

An Optician is a person who makes glasses

An Ocularist is a person that makes glass eyes.

Note that Ophthalmologists and Optometrists are both called "Doctor". But in fact only the MD/DOs are medical doctors who have experience with surgery. The ODs don't.

I hear you thinking, "Linnea, I really, really don't care. Could you tell a story about poop or blindness or something?"

Well, actually, I can. But I wanted to point out this story. Every few years, the optometrists try to get rights to prescribe medicine and do procedures, for two reasons. First, because it is more convenient. Second, because they can charge a lot of money for the procedures. The problem is this: When an optometrist does a procedure, and screws it up, they send that patient to an ophthalmologist (the surgeon). And let's face it, if you don't have to be the one to deal with your own screw-ups, how careful are you going to be?

To be fair, there are a lot of places in the country that don't have a lot of ophthalmologists, and the optometrists fill in the gaps with general eye care (glaucoma and cataract checks, etc.) If they see anything abnormal they refer it to an ophthalmologist. That's the way it is supposed to work.

The optometrists always complain that the ophthalmologists won't let them do lasers etc because we want to hog all the patients and money. My experience has been that there are plenty of patients to go around. Just try and get a New Patient appointment with an eye surgeon. I dare you. Everyone is booked. But if my diabetic mother needed eye surgery of any kind, I think I'd send her to someone who actually trained to learn how to do it, and knew about diabetes and all of the diabetic eye issues related to the surgery.

So here's a story. I once had a macular degeneration patient that came in with blurriness in one eye, and a handful of films from Fluoroscein ANGiograms (FANGs) that he'd had done over the preceding several months. He had seen an optometrist that through some loophole was doing the test (it involves injecting a dye into a vein, which is a no-no for optometrists) and who'd been following this lesion in the back of the patient's eye. So, just to make this clear, the optometrist was doing a procedure he shouldn't do, watching an abnormality he couldn't recognize, and interpreting a test that he wasn't trained to interpret.

When I looked at the old films my heart just sank. Several months prior, spelled out on the films, the patient had something called a Choroidal Neovascular Membrane (let's call it a goomba) in the back of his eye, and over the months the goomba had grown over his center of vision. If the optometrist had just referred the guy to me months ago when he saw the goomba in the regular exam, instead of doing the FANG which meant nothing to him, I could have lasered said goomba with a 50/50 chance of stopping it and saving the guy's vision. Now it was hopeless (this was in the days before some of the newer treatments for macular degeneration.) Let's just say I was pissed off. A lot.

Oh, and I won't mention 2 years ago when I went to Lenscrafters to get some new glasses and they ran a laughable number of crock tests on me, AND dilated my eyes, and then the optometrist only looked at the right side of both of my retinas. I guess she figured the left sides were probably okay. Okay, I mentioned it. Whoops. smiley4.gif

Listen, there are a lot of really, really good optometrists out there. But even they don't have the training or background to be doing surgery. Or prescribing an unlimited variety of drugs. Not without a complete re-vamping of the way they are trained. I've taught senior students at an Optometric College. Those kids don't have the amount of supervised hands-on training to really know what they are looking at. They do know what is "normal". Anything else: send to an ophthalmologist. That's the rule. Hey, if optometrists want to do a medical internship and take the medical boards and do a surgical residency, then hey, go for it. Otherwise, no lasers or scalpels.


Vocabulary List in comments... smiley8.gif