Street Smarts
Two Professions at Odds: My Two Cents
Before you take sides in the battle for eyecare supremacy, listen to an O.D. in the trenches.
BY DAN BECK, O.D., Leland, N.C.

When I was still in optometry school, I began to form opinions on the love/hate relationship between them (ophthalmologists) and us. Professors, upper classmen and nearly every article in the optometric journals seemed to view ophthalmologists as egotistical, condescending control freaks. It seemed their organizations existed soley to keep optometry from expanding. None of them could be trusted, and referrals were simply a necessary evil.

The year after I graduated, my referrals were as much about showing the local eye surgeon I could diagnose disease as well as he could as they were about the patients' welfare. The only advantages he had over me -- so I believed -- were a few sharp instruments and different letters after his name. Fast forward.

THEM VS. US

Over the past 10 years, I've witnessed several litigation wars put forth by a vast array of ophthalmic personalities on both sides. Here's a quick and dirty summary of the past decade's legal, eyecare arguments.

According to them:

1. Only medical doctors should write prescriptions. (Never mind that dentists, podiatrists and other non-M.D.s write prescriptions).

2. Laser usage is surgery, and optometrists are not surgeons.

3. Performing injections is surgery and optometrists are not surgeons.

4. Placing punctal plugs is surgery and, well, you get the idea.

According to us:

1. O.D.s receive extensive pharmacological education and should be able to write prescriptions.

2. Lasers are light; light is optics. O.D.s can use all optical means to treat patients, so why not lasers?

3. Injections are not surgery. Nurses, physicians assistants and dentists all inject medication.

4. Placing punctal plugs is not surgery because no tissue is cut or permanently altered.

CORE ISSUE

We can take sides and debate these topics indefinitely, but it all boils down to one thing: Making a living. In a perfect world, O.D.s would perform all the primary care, fit all the contact lenses and eyeglasses and gladly refer all the secondary and tertiary care to ophthalmologists. In turn, the eye surgeons would do what they were trained to do: Cut, suture and refer back.

Why doesn't this ophthalmic utopia exist today? My opinion? There aren't enough surgical procedures to go around. Many ophthalmologists are forced into primary care and dispensing contact lenses and eyeglasses simply because they aren't getting into the operating rooms as often as they'd like. Show me a busy refractive surgeon and I'll show you a doctor who could care less if local O.D.s are injecting medications and inserting punctal plugs.

YOUR ROLE

You already may have opinions about the two eyecare armies and how you'll fit into the continuing struggles. Without going into specifics, let me add my two cents: In more than 10 years of practice, I've learned that a steady flow of referrals is the best way to keep your local ophthalmologists happy and too busy to worry about anti-optometry litigation.