Why do optometrists do things an ophthalmologist should do, and viceversa?

Discussion in 'Optometry Archives' started by douglas, May 8, 2008.

  1. douglas

    douglas Guest

    Any thoughts on optometrists treating non-refractive eye problems?

    Could any one compare the refraction abilities of an ophthalmologist
    vs. those of an optometrist, or are they both equal? And why do they
    let optometrists --in the US-- treat things like glaucoma, cataracts,
    convergence disorders, accomadation pathologies, conjunctivitides,
    etc.? Optometrists should refer their patients to
    one who is more qualified to treat them, ie an ophthalmologist. And
    why do ophthalmologists refract patients for lenses, or treat low
    vision? They too should refer their patients to one who is more
    qualified to treat them, ie an optometrist. Both types of eye doctors
    have their place in the healthcare system...but they shouldn't do each
    other's jobs, it's less productive and could lead to misadventures.
     
    douglas, May 8, 2008
    #1
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  2. douglas

    Zetsu Guest

    Good questions, interesting topic.
    I think that ophthalmologists can do all the things an optometrist can
    do, i.e. refract patients, because theoretically they have more
    training than an optometrist plus the additional training needed for
    ophthalmology, therefore they are 'qualified' for anything an
    optometrist is. In real terms, though, I think you are right about
    optometrists being more experienced with refraction and thereby better
    specialized and accomplished refractionists. So if you were to compare
    the overall refractive ability of an ophthalmologist versus an
    optometrist the latter would be higher. Also, I heard that
    optometrists can take additional training mid-way through their career
    to give them some of the qualifications of an ophthalmologist, so they
    have the legal ability to prescribe and medicate patients with
    medicine or eye drops and stuff like that for people with eye
    pathologies like glaucoma and cataracts.
    You may be right about non-specialized people doing the job that in an
    ideal world a specialized person should do, but in the profession I
    think there is often a lack of 'ideal', for example all the
    ophthalmologists might be too busy dealing with other cases so they
    have to let the next best qualified person, i.e. an optometrist, do
    the job they would have otherwise done.
     
    Zetsu, May 8, 2008
    #2
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  3. douglas

    Zetsu Guest

    I meant 'because theoretically they have exactly the same training as
    an optometrist'
     
    Zetsu, May 8, 2008
    #3
  4. douglas

    MS Guest

    Good question.

    I have an eye infection, and went to my optometrist about it, a few days
    ago. Why? I've been to him for contact lenses, and I haven't been to an
    ophthalmologist, don't know any. Also, he's close, and when I called, they
    said I could come in right away, for him to see me.

    Whereas, if I went to my family doctor, he is farther away (very significant
    that day--as my eyes were so bad, I could hardly open them, probably unsafe
    to drive at all, but I had no one to drive me, so at least this drive was
    close), and it probably would have been more difficult to get an
    appointment.

    The optometrist seemed knowledgeable about it, but perhaps an
    ophthalmologist would have been better. I don't know. He put me on
    antibiotic eye drops (zymar), and of course I'm not wearing my contacts now.
    I don't know what an ophthalmologist might have done differently.

    It certainly would have cost me less, to go to my general practitioner, as
    it would have been covered by my medical insurance, with a $10 co-pay.
    Although I have vision insurance, which paid part of the cost for my contact
    lens fitting and lenses, I was told at the optometrist's office that my
    vision insurance doesn't pay at all for an eye infection, and I had to pay
    $65 on the spot, for a few minute office visit.

    Not sure if going to an ophthalmologist would be covered by my medical
    insurance, or if they only take vision insurance as well. Anyone know? In
    any case, as my Blue Cross med insurance is mostly HMO (with some minor PPO
    benefits as well), I would probably need a referral from the GP to go to an
    opthal covered by med insurance. All that takes time. So, for the benefit of
    time (able to go in right away), and nearness to my house (although I'm sure
    there are opthals just as near or nearer), it was convenient to go to the
    optometrist.

    That said, one does wonder if an ophthalmologist would be better-trained in
    dealing with something like an eye infection, than an optometrist, and
    whether it could have been covered by insurance that way.
     
    MS, Jul 12, 2008
    #4
  5. douglas

    MS Guest

    Sorry, Dr. Tyner, but I did not say that one should wait a week, or that
    "optometrists aren't "supposed to" do what they're trained to do".

    I actually didn't say any of the things, that you assume I said. You can
    read what I actually wrote farther down this message.

    I was just wondering about a couple of questions, responding to what Douglas
    had written. I did not make any assumptions. And in fact, as I wrote, I DID
    go to my optometrist, and as I wrote, I think it was the right choice for
    the situation.

    Also, not to defend Douglas, whom I don't know, but notice that his post was
    not one-sided, as he also speculated that perhaps optometrists were better
    than ophthalmologists in refracting patients, and better in prescribing
    glasses and contact lenses for them. I don't know if either of his
    speculations have any validity--but just pointing out to you, that it was
    not one-sided.

    I am curious, however, about your statement about insurance. Are you saying
    that medical insurance, such as Blue Cross, will normally cover medical care
    provided by optometrists? I'll look into that in my medical plan. If that is
    the case, however, wouldn't it have made sense for the ODs office staff to
    ask what medical insurance I had, or at least to suggest that it might be
    covered by my medical insurance, rather than just saying "not covered by
    insurance" (meaning the vision insurance)? (They had never asked for info
    about my medical insurance.)
     
    MS, Jul 13, 2008
    #5
  6. douglas

    MS Guest

    Just to carry on this discussion a little farther, I have another question.
    (And it is purely a question, out of curiosity, I am not making any
    assumptions.) (I am not arguing at all here, just asking.)

    I doubt you would say that the training, and areas of practice specialty, of
    an optometrist and an ophthalmologist, are exactly the same. (If they were,
    there would be no need for two different types of eye doctors.

    It is clear to me, that your opinion is that in the case of an eye
    infection, as I have, that an optometrist is just as well-trained in
    treating it, as an ophthalmologist is. You may well be right about that, and
    in fact, that is exactly what I did.

    However, is there any eye condition that, if it occurred to you personally,
    might cause you to see an ophthalmologist for a consultation, rather than an
    optometrist?

    So again, not making any kind of argument, but just asking---what do you
    consider to be the differences between the two types of eye doctors, and for
    what kind of condition would you choose one rather than the other?
     
    MS, Jul 13, 2008
    #6
  7. douglas

    Mark A Guest

    And why do ophthalmologists refract patients for lenses, or treat low
    Because it is profitable, especially if they can get the patient to buy the
    glasses or contacts from them.
     
    Mark A, Jul 13, 2008
    #7
  8. douglas

    Mark A Guest

    For any serious eye disease or injury, you are probably better off with an
    ophthalmologist, who has an MD degree. For something simple like a simple
    infection (if that is the correct diagnosis) an experienced OD is usually
    OK.

    In most states a physician's assistant (nurse) can prescribe antibiotics for
    most infections (sinus, ear, skin, etc) and the patient may never see the
    doctor. Same principle applies to an OD treating eye infections (it is not
    rocket science). Of course, if the diagnosis is wrong and there is a more
    serious problem, then you might have a more problems with an OD, just like
    you might have problems with a nurse trying to treat a serious medical
    issue.

    A Ophthalmologist does not spend very much time in school learning about eye
    care, since their medical school education is much more general (basically
    the same training as all other MD's). An OD knows from day 1 when they enter
    a School of Optometry that they will be focusing (no pun intended) on eye
    care (and the curriculum reflects that), whereas an MD may not get much eye
    care training until their residency. So experience (on-the-job training) is
    often more important that education in dealing with these matters.
     
    Mark A, Jul 13, 2008
    #8
  9. douglas

    Dr. Leukoma Guest

    I just want to emphasize that part of the problem of optometric
    service inclusion has been the lack of a national standard of
    licensure for optometrists. What optomerists can treat and the drugs
    they can use (formulary) varies by state. Curriculums and training
    continually evolve with the times, but laws are slow to change.

    Most physicians would love to opt out of the plans. In my area,
    finding a dermatologist on our health plan is almost impossible as
    most of them are busy doing cosmetic treatments not covered by
    insurance. Cosmetic dentistry is another area.
     
    Dr. Leukoma, Jul 13, 2008
    #9
  10. douglas

    MS Guest

    Getting OT here, but it would certainly be unfortunate if most physicians
    opted out of insurance plans. Medical care is way too expensive for most
    people to afford it, without insurance. If most physicians opted out of
    insurance, medical care would only be for the wealthy, and many people would
    not get necessary health care, as some do not now (who do not have
    insurance). With less people getting health care, there would be a rise in
    epidemics, etc.

    I'm curious--which do physicians find more difficult to deal with--medicare,
    or private insurers? (I know this is the wrong forum to be discussing this,
    as most ODs tend to deal more with the vision plans, which isn't really what
    I'm discussing here. But since we started to discuss the difficulties
    physicians have with insurance, I'll carry it a little farther.)

    I think most people, including doctors, would agree, that the current US
    health insurance system is pretty messed up, and needs some serious reform.
    So the question is--what type of reform?

    I wonder what people would think of the following? What if, instead of the
    plethora of different insurance plans that doctors have to deal with now,
    there was (as everywhere else in the developed world), a national insurance
    plan, i.e. single-payer? Let's say that that one plan was not anything like
    an HMO, but more like a PPO. Or, perhaps, like Medicare, just expanded to
    cover all ages?

    I'm sure docs would have problems with such a plan as well, as bureaucracies
    of all types tend to be--well, bureaucratic! However, wouldn't it be simpler
    to deal with only one insurer and plan, that covers everyone, rather than
    with the plethora of different insurers, plans, and forms one has to deal
    with today? And wouldn't it be nice if there were no more HMOs??

    Of course there would still be a role for private health insurers under such
    a system, who I'm sure would offer supplemental coverage, as they do with
    Medicare, to offer a higher level of coverage above that offered by the
    national plan. So, there would still be some dealing with private insurers
    as well. But in general, I would think that the paperwork would be simpler
    for doctors with a single-payer plan, than the current system, with all its
    different kinds of plans, HMOs, etc.

    As said, just about all (or I think all) of the rest of the developed world
    does have such a system, including Europe, Japan, etc. And one sees that,
    once a nation has adopted such a system--no matter what problems they might
    have in such a system (of course, nothing created by human beings is
    perfect, and especially anything administered by bureaucracy!), and what
    reforms are proposed to their system, no country has ever (under
    administrations of different political parties) gone back, from a national
    single-payer system, to the type we have here in the US. No country has
    every abandoned that type of system. Of course problems arise in the system,
    they try to improve it, but would never consider in general abandoning the
    concept of national health insurance. Even when a conservative party is in
    power, no politician would dare propose scrapping a national system, to
    replace it with something like ours. So in general, people must like having
    such national health systems, even if there are some problems that they wish
    to correct, reform, and improve.

    Well, I wrote too much, and as I said, it's off-topic for this thread, and
    even for the NG. (I guess once I get started on a topic, it's hard to stop!)
    Curious to hear other's opinions on this.
     
    MS, Jul 13, 2008
    #10
  11. douglas

    MS Guest

    I'll just add one more point that comes to mind, regarding my recent post
    about what people would think of a single-payer health plan, something that
    might actually affect optometrists.

    How many of you provide health insurance benefits to your office staff? If
    you do, I'm sure you are aware of the skyrocketing cost of health insurance
    premiums, increasingly difficult for employers to afford, and especially for
    small business, like your offices!

    Wouldn't it be nice if the government did the insuring (as with medicare),
    and employers were not expected to provide such benefits any more, taking it
    off your backs?

    In fact, that would be good for American business in general. One reason
    that U.S. companies are finding it harder to compete with foreign companies,
    is the immense amount that U.S. companies have to pay in health insurance
    premiums. For instance, the U.S. auto industry--the fact that they have to
    pay so much of their income in health insurance premiums, makes it hard to
    compete with European and Japanese companies, who don't have to pay a cent
    in health insurance premiums--since that is handled by the government, not
    by employers.

    I'm not saying there wouldn't be costs involved in a national health care
    plan. There is no such thing as a free lunch. Of course, taxes would have to
    be higher (as they are in those other countries), to pay for the plan.
    However, I think the cost involved in the increased taxes, would be much
    lower than what is now being paid in private health insurance premiums, cost
    of emergency room care for the uninsured, etc. In general, I think the
    overall financial cost to society, would be much less than with the present
    system, and it would be a great relief for employers, not to have to deal
    with providing health insurance for their employees any more. (As well, of
    course as the humanitarian boon that everyone would be covered--employed or
    not.)
     
    MS, Jul 13, 2008
    #11
  12. douglas

    MS Guest

    Something I forgot to mention, in what I wrote below about the cost of
    medical insurance for your office staff.

    Since you (O.D.s) are generally self-employed, therefore having no employer
    to insure you, I would guess that you are paying extremely high medical
    insurance premiums (individual premiums being much more expensive than the
    per person cost of group premiums), to insure yourselves and your family
    medically. (Not to mention if you or a family member have a "pre-existing
    condition"--in which case your premium would skyrocket many times higher!)

    How much are you paying monthly overall in medical insurance premiums--for
    yourselves, your families, and your employees?

    As I wrote, no such thing as a free lunch. If there were a national plan,
    and you had no health insurance premiums to pay, you would probably be
    paying more in taxes. However--I doubt that the increase in taxes, would add
    up to nearly as much, as the amount you are paying now in health insurance
    premiums!
     
    MS, Jul 13, 2008
    #12
  13. douglas

    infinitecore Guest

    Opthalmology residency is highly competitive. It requires full 4 yrs
    of medical school and an acceptance to an opthalmology residency,
    which is an extra several years. Many US med grads do not get accepted
    to a single one of these programs.

    Optometry training is relatively easy to get admissions to ( < 3.0 gpa
    in undergrad ), and is not comprehensive as medical school and
    opthalmology residency.

    I do not work in visual sciences and can't comment first-hand but this
    is something to think about.

    The fillings analogy is not a good example. Both general dentists and
    oral surgeons undergo the exact same 4 yrs in dental school, where
    fillings tend to be the bread/butter in the restorative curriculum.
     
    infinitecore, Jul 13, 2008
    #13
  14. douglas

    p.clarkii Guest

    I can speak to your statement since I have been to both medical and
    optometry schools. My comments relate to the US health care system,
    and there are significant differences in the training and scope of
    practice of optometrists around the world.

    Optometry school is indeed much more competitive to get into than you
    think. The average GPA of the entering class in the school I attended
    is ~3.4. The same university's medical school statistics are
    similar. The prerequisites for admission to both schools is virtually
    identical.

    The optometry school curriculum is very similar to medical school
    courses during the first two years-- basic science courses in human
    anatomy, physiology, biochemistry, pharmacology, etc. The depth,
    however, is not as great in some cases as it is in med school. But
    optometry students spend considerable time also studying basic optics
    and physiological optics to a level that ophthalmology programs or
    medical schools simply do not even attempt to match.

    IMHO, graduating from a US optometry school gives a person much
    greater understanding of the eye than a general ophthalmologist has.
    After all, in optometry school 4 years is spent concentrating on a
    single organ system. The eye. How much does a med school graduate
    really know about the eye-- the answer is, very little. A three year
    residency in ophthalmology essentially provides a hands-on
    apprenticeship in seeing how surgeons and subspecialists treat certain
    ophthalmic conditions but does little to tie it all together, or to
    provide for the lack of concentrated study in ocular anatomy and
    physiology that is not provided in medical school. I believe that
    optometrists get better training in understanding general eye
    conditions in otherwise healthy patients who need little more than
    eyeglasses or contact lens correction, or treatment of routine medical
    problems like infections or abrasions. Such patients constitute the
    vast majority of people seeking primary eye care. In short, see
    Optometrist for primary health care, go to ophthalmologists for
    surgical needs or when referred for complex conditions. Optometrists
    can recognize pathologies and refer off to subspecialists as well as
    any general ophthalmologist. Personally I think general
    ophthalmologists are of negligible value in the US health care
    system.

    Not to mention that the demographics illustrate that there are
    insufficient numbers of Ophthalmologists to meet the primary eye care
    to the US population.

    I think your understanding of this topic is rudimentary and simplistic.
     
    p.clarkii, Jul 14, 2008
    #14
  15. douglas

    Dr. Leukoma Guest

    Anybody who really cares can look up the class profiles of any of the
    optometry schools and see that your statements are total nonsense.
     
    Dr. Leukoma, Jul 14, 2008
    #15
  16. douglas

    albi Guest

    Hello all:

    very interesting topic.

    we do not have practicing optometrists (own praxis) here in Germany
    (not allowed), they work in opticians shops, or hospitals, or
    ophthalmology private praxis.

    I did not have the time to read every comment thoroughly, but I think
    I did not read the following argument, which in my opinion is VERY
    important:

    Optometrists do not have a general medical education with more than
    good lay insight into all other medical subspecialities.
    Ophthalmologists have. Bot only education, but individual working
    experience.

    Finishing medical school / optometric school: of course (!!)
    optomentrists are far more experienced in all parts of ophthalmology.

    But the final medical student choosing ophthalmology runs through
    another 5+++ years of highly specialized training. 5 yrs is the
    minimum in Germany, and then you are a General Ophthalmologist, NOT a
    corneal, retinal, paediatric, whatever..... specialist, this requires
    further training. AND you have the background of a full medical
    course, including working (!!) as junior house officer in all the main
    and big fields: internal medicine, surgery, paeds, etc.

    I agree however that the General Ophthalmologist is probably in spite
    of the 5 years less trained in refraction, and low vision device
    fitting.

    Concerning the eye infection:

    1. did the optometrist do a slit lamp examination? Contact lens
    wearing problems, corneal ulceration?
    2. did he do microbiology (cave: keratoconjunctivitis epidemica is
    highly transmissable, and would have meant a sick leave to protect
    others!
    3. did he do an antibiogramm to check whether these drops are
    effective?
    4. did he inquire about any other of your health issues?
    immunologically relevant diseases?
    I donĀ“t quite believe that..... really?

    I work in the field of paediatric and neuro-ophthalmology plus low
    vision. I do need my general medical knowledge and practical
    experience *every day* (including the low vision part! one does have
    to know about the general medical, surgical and neurological diseases
    affecting the elderly to fit low vision devices correctly!), and I
    have studied paediatrics, medicine of the aged patient and much
    genetics on my way as well.

    You never know what you do not know if you do not know.......

    greetings,
    Barbara

    (Consultant of Paed., Neuroophth, Low Vis., university-based)
     
    albi, Jul 15, 2008
    #16
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