Golgo13

Some of the posts here are biased and poorly written. It is this unsophisticated approach that derails the true intent of what you are trying to convey. These scare tactics and unresearched opinions are invalid.

After 5 years practicing as an optometrist, I decided to go to medical school and train as an ophthalmologist. I am now a fellowship trained specialist. I am not here to defend ODs or MDs. And I do not live in Louisiana. An OD colleague sent me an article and a link to this forum.


I want everyone to understand that the current curriculum in optometric programs are very intense and specialized in many areas, including theoretical optics, ocular biology, biochemistry, neuroscience, pharmacology and clinical application of examination techniques and principles. These schools are very refined and structured to learn as much as possible of the eyes in 4 years. We had courses in lasers and injections in optometry school and practiced YAG capsulotomies on cow and pig eyes.

The knowledge base that I had after graduating optometry school was amazing compared to the little exposure to the eyes and the visual system in medical school.

Optometry's limitation is the the amount of training post graduation. Even though I had seen nearly 2000 patients before graduating school, I still knew I had more to learn - essentially you are left alone to refine your clinical skills and knowledge after graduation. Furthermore, most students defer the optional one year residency. This should be required. These programs offer additional training in areas of ocular disease, pediatrics, low vision and binocular vision disorders.

Medical school definitely approaches eye care from a more systemic approach - having a more complete understanding of the management and relationships between treating patients for their medical conditions as well as their subsequent ocular manifestations. My internship, residency and fellowship were extremely intense. I had a distinct advantage over my counterparts with my background in eye care and this allowed me to serve as chief resident in the department. My students were impressed with my understanding of the eyes and visual system.

I don't feel that privileges should come with out training. Trust me, my first months in surgery were nerve racking. There is a lot of training and self teaching. I saw many post operative cases that I wish I hadn't. Some were mine - some were from the other residents. Even in practice today, there is a wide range of skill and ability amongst surgeons and doctors and healthcare providers as a whole. There are good, average and poor providers for all professions.

So the real question is. How do you select the best to train in these intense surgical and medical programs?

The ability of optometry to train further is limited by legislation. The bill passed in your state allows them to train to perform some less invasive procedures. These proposed procedures are routinely done in office with the proper instruments and equipment. I could train my certified ophthalmic tech to do these. I would rather see qualified optometrists train in an ophthalmology residency than receive minimal training elsewhere. This will never happen unless the medical community opens it's doors to other healthcare professions. I am glad to see that a lot of progress has been made in the areas of oral surgery and podiatry. (Both non MD based professions)

How ODs will train will be interesting. Who will govern those who qualify? Some of these procedures take time to master. Weekend courses can certainly give you an idea how it's done but more practice and training are needed. Just so you know - MDs also attend short seminars on new techniques and procedures.

I do not believe that going through medical school is the only way to safely train to perform eye surgery. I can say that most of what l learned about surgery/medicine happened after I graduated.

The pre requisite to having surgical privileges lies in the training post graduation not in the program itself. Even without medical school I believe that I still would have been equally as good of a surgeon as I am today.

The reality is that most of the ODs that I know don't have an interest in expanding their scope of practice. It's the smaller minority that are seeking this legislation. I don't foresee the majority of ODs jumping to the opportunity to train or certify to do these procedures.

An area of concern is that ophthalmology residency classes are shrinking and optometry schools are expanding. The era of the mid level practitioner is amongst us. ODs examine at least 70% of those who seek eye care. PAs and NPs are opening their own practices and see patients in urgent care and minute clinics at pharmacies.

Those ODs that are associated with ophthalmology clinics and hospitals may see a benefit from the expanded scope. But in the end it is about patient care, though reimbursement continues to influence how that care is delivered.

I don't think any good healthcare provider would want to attempt surgery without proper training. As we move into a system that holds providers more accountable for their abilities and faults this will truly separate the good from the bad.