EyeNet Magazine


New Policy for Meeting Attendance

OD Expansion: We Are Also to Blame

Not Your Ordinary Patient

New Policy for Meeting Attendance
I applaud the Academy for finally taking a stand against the intrusion of optometry into ophthalmology. The Academy’s meeting attendance ban was long overdue. More action like this needs to happen. Too many underhanded and covert activities have occurred to blur the lines of distinction.

Maybe a television message is next to educate the public about the differences between ophthalmology and optometry? Let us use this decision as a stepping-stone to accomplish other great efforts to save our profession. I hope ASCRS will follow suit.

Your reward is $500 for the Surgical Scope Fund. More bucks to come with the next victory. I challenge other ophthalmologists to match my contribution.

Christopher J. Gualtieri, MD
San Diego

OD Expansion: We Are Also to Blame
As a practicing ophthalmologist, I see my colleagues to be as much to blame for this scope of practice debacle as the optometrists themselves.

I know many ophthalmologists who comanage cataracts with optometrists for referrals or comanage LASIK patients, and often the patient believes the optometrist is somehow involved in the procedure. Others will “sponsor” optometrists allowing them to treat glaucoma. Comanage is really a euphemism for “pay for a referral” because if a problem were to arise, the optometrist would send the patient back to the surgeon.

If we truly believe optometrists are capable of handling postoperative complications and treating glaucoma, we are basically saying the only reason we go to medical school and through residency training is to perform surgery. Surely this shouldn’t take us seven years. In return for referrals, ophthalmologists are cheapening their extensive training to make a better living than those who won’t comanage.

The Academy has responded to the Oklahoma situation by not allowing optometrists to attend its meetings. Meanwhile, MDs are giving lectures at optometry meetings. We as a profession are to blame for our current situation. We continue to undervalue ourselves and do nothing to educate the public about the difference between ophthalmologists and optometrists. If we allow optometrists and the public to think optometrists are capable of handling all medical eye problems, the next logical step is optometrists will want to do the surgery themselves. I would like our Academy to be more assertive in helping ophthalmologists see that we are largely responsible for the current dilemma.

James E. Hunt, MD
Santa Rosa, Calif.

Not Your Ordinary Patient
Tensions continue in the Middle East and conflict in Iraq remains in the news. But sometimes we need to step back and see a less dark side of things. It has been more than 13 years since the United States first deployed with a robust medical group and state-of-the-art equipment. I was the first Army ophthalmologist deployed in the area on the ground in Saudi Arabia and the first ever to deploy to a combat zone with an operating microscope and associated microsurgical equipment.

During the buildup known as Desert Shield, I received a call reporting bilateral eye trauma during a convoy accident. This would be our first patient! Would our equipment perform in this harsh environment, with only “tentage” protecting it? We learned that our casualty was not from U.S. or coalition forces. For what important person was this equipment, expertise and diplomatic pressure being mobilized?

It was a cat! No ordinary feline, this was the highly regarded pet of a local official. Continued friendly relations hinged upon the completion of this mission. Ophthalmology and veterinary teams were assembled. Ketamine (or was it catamine?) anesthesia was induced. The right eye had a dense anterior segment hemorrhage and an opaque cornea. No treatment was undertaken here. The left eye had an organized anterior chamber clot. A bimanual washout of the chamber was done and the incisions sutured closed. The posterior pole could be visualized with the indirect ophthalmoscope.

How well did the kitty do? He had ambulatory vision; he ran away the next morning. Or, as the case report says, “the patient was lost to follow-up.” But technology had proven itself—even in the Saudi desert.

Brian T. Nolan, MD
Lexington, Ky.

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