Letters

Readers Voice Their Opinions

Replies to the truce

Editor's note: Many readers responded to the letter by Ophthalmology Management Chief Medical Editor Dr. Larry Patterson, (“An Open Letter to Optometry: Let's Call A Truce,” Optometric Management, May 2011), which called for an end to the expansion of optometry's scope of practice into surgical procedures. Below is a sampling of the reader replies.

✉ I agree with Dr. Patterson's argument. Don't re-invent the wheel, no matter what ruse you promote to make it sound legitimate. O.D.s do not need to do surgery. Go to med school if you want to do that. It has been available to you for years the tried-and-true way.

This attempt at trying to do surgery could eventually undo everything we [optometrists] have strived for in the last 10 years and in some cases, the states are still attempting to get there—we don't all have therapeutic [privileges] yet.

Gordon Thomas, O.D.
Palm Harbor, Fla.

✉ Having been intimately involved in numerous battles for expansion of optometric scope-of-practice legislation, I was truly amazed that Dr. Patterson thinks he can stop optometry's mission to expand scope-of-practice legislation to fully reflect our training and expertise.

My response is simple: Optometrists are doctoral-level health professionals, and we owe our patients the very highest level of care we can provide to them.

Ophthalmology has no right to attempt to corral us into practicing beneath the full scope of our education and skills. For optometry to agree to such arbitrary limits would be a dereliction of our duty to our patients.

Robert C. Bauman, O.D.
Stowe, Vt.

✉ Dr. Patterson makes a very valid point, and I have to agree with him.

I considered medicine as a career. I decided against it because I didn't want the pressure. I didn't want to have patients possibly die or be disabled because I couldn't do enough to save them. I didn't want the huge insurance costs and the inevitable lawsuits that come with the degree.

I am happy with optometry as it stands now. I have no desire to perform invasive procedures. I think we are in a good place and agree to the truce proposed by Dr. Patterson.

Joe Lasusky, O.D.
Concord, Calif.

✉ What Dr. Patterson fails to mention is the recent explosion of optometric services available at many ophthalmology practices, including [glasses] dispensing, contact lens services and routine eye exams. Employed optometrists usually provide this patient care. Dr. Patterson is no exception, as in his own words, he's “got very smart and well-trained optometrists.”

As long as Dr. Patterson and others in ophthalmology refuse to fully accept optometry as an independent provider of quality eye care, this battle will continue.

For the record, I like ophthalmology. At our group optometric practice, we've “got (a) very smart and well-trained” ophthalmologist providing surgical eye care. As Dr. Patterson says, “What's good for the goose…”

Roy B. Cohen, O.D.
New York, N.Y.

✉ I couldn't believe my eyes when I saw Dr. West referring, many times, to our “customers” (OM May 2011). It was surprising to see the mercantile emphasis.

Interestingly, Dr. Patterson's comments on the next page made more sense. I'm terribly unhappy about the turn of the emphasis of our profession in concentrating on pathology and forgetting about visual needs.

As a patient (I'm retired from a practice in New York City), my last visual exam was a travesty. I got the feeling that the O.D. forgot that we are binocular creatures. There was absolutely no attempt to check if I had two eyes that worked together. However, I shall go along in my retirement bliss remembering my patients.

Mel Schrier, O.D., F.A.A.O.
Rancho Palos Verdes, Calif.

✉ Unfortunately, and with all due respect, I am convinced that few M.D.s appreciate the value of the O.D. education (Dr. Patterson likened teaching an O.D. to do YAGs to teaching a technician to do YAGs).

O.D.s have a doctorate-level education, just as M.D.s do. Please go to a modern optometry school, and be blown away by the education that O.D.s now receive. You could challenge a graduating O.D. to take ophthalmology boards, and you would find that she would have as good of a handle on the knowledge that the residency-trained M.D. has.

Frankly, O.D.s don't understand why you don't find it dishonorable that your leadership has gone so far as to block O.D.s from attending ophthalmic continuing education events.

You are correct. I don't want to spend huge amounts of my political capital to obtain surgical privileges that I have no desire to have. However, I would spend huge amounts of my political capital to defend a principle that I strongly believe in.

“Lets call a truce.” I agree. You can start by opening back up ophthalmic continuing education to all eye doctors.

Robert Sorensen, O.D.
Hayden, Idaho

✉ I am pleased to see Dr. Patterson has great respect for his optometry employees. But let's get the facts straight:

Optometric scope “encroaches” into your surgical world in less than 5% of the states. In many, if not most of the others, optometric scope has patient care-limiting restrictions based on the myth that one has to attend medical school to care for the medical eyecare needs of a patient.

In Texas, I cannot prescribe oral antibiotics longer than 10 days. I cannot treat a glaucoma patient without having my treatment plan blessed by an ophthalmologist, which means they take over care of the patient. I cannot prescribe oral anti-viral agents. A tattoo artist has more surgical freedom than I do.

I have served as chairman of our legal and legislative committee for many years. I have been in the trenches in these battles that you say we won. We haven't won in almost 15 years, and that was a minor win. The latest “compromise” offered by the Texas Ophthalmological Association attempts to strip all my independence and place my license and scope determination under the obviously “unbiased” watch of the Texas Medical Association. Somehow, I cannot see victory in any of this.

Quit while I'm ahead? Texas optometry scope is so far behind the needs of our patients, that will not be happening. You may not be my enemy, but you would be the exception, not the rule.

Joe W. DeLoach, O.D., F.A.A.O.
Dallas, Texas

✉ There is no truce in your words, only an indirect warning that the A.M.A. will continue the fight, a fight it has battled with multiple professions since its creation. I am saddened you cannot be proud of my profession and how far we've come with our training, rather than the apparent disappointment you show.

The greatest American who ever lived (Abraham Lincoln), with his 18 months of formal education, once said, “ … that we may fall in the struggle ought not to deter us from the support of a cause we believe to be just; it shall not deter me.” But why would we listen to him—he practiced law without going to law school …

Cindy J. Stewart, O.D.
Atlanta, Ga.

✉ Dr. Patterson has it all wrong. The question he should have asked is: Do optometrists do a worse job than M.D.s in areas where their licenses overlap? If the answer is yes, he has a point. If “no,” his point smacks of an old fashioned turf battle.

Ralf W. Lorenz, O.D.
Millbrae, Calif.

A final note: During an AOA annual meeting press conference, President-Elect Dori Carlson said, “kudos” to Kentucky for the scope-of-practice legislation. When asked whether other states had scope-of-practice expansion plans, she said she could not comment, other than to say there have been “rumblings in other states.” OM