Optometrists, ophthalmologists fight over eye care rights

"Even though I love my optometrist, I would never, ever let him do surgery," says Denishia Martin Hostetler, an Angie's List member in Bowling Green, Ky., where lawmakers this year gave optometrists the right to perform some surgical procedures and expand scope of practice in other ways. "I would want a full-fledged MD, with lots of experience and credentials."

But Tom Wiesle, a member in Plano, Texas, expresses a less popular opinion in saying he'd feel comfortable going to his optometrist for laser surgery - if only his state allowed it. "I totally trust him," Wiesle says. "He's just so knowledgeable."

From California to Maine and 16 states in between, optometrists have been pushing to broaden services, exacerbating a turf war with ophthalmologists who provide the full spectrum of eye care. By being allowed to do more, optometrists insist they can help patients save money and benefit through improved continuity of care and fewer referrals to ophthalmologists, who are more expensive. "We're not holding ourselves up to be ophthalmologists," says Bill Reynolds, an optometrist in Richmond, Ky., and legislative chair for the Kentucky Optometric Association. But training and expertise have evolved, he argues, and practice needs to catch up.

Ophthalmologists fire back that optometrists - who attend a four-year post-graduate optometry program but lack their eight years of medical school, internship and residency training - are sidestepping critical experience and education. "They want to practice medicine without going to medical school," says Dr. Daniel Briceland, a highly rated ophthalmologist in Sun City, Ariz., and secretary for state affairs with the American Academy of Ophthalmology. "This is how people get hurt."

Intense optometrist lobbying over the last three years has produced mixed results. In eight states, they won approval to prescribe more drugs, administer additional types of injections like local anesthesia and - in the case of Kentucky - perform laser surgery. They failed to prevail in seven others, with lawmakers withdrawing proposals, killing bills on adjournment or stripping scope-of-practice provisions. Texas, South Carolina and Nebraska were still considering legislation at press time.

In West Virginia, the debate grew especially contentious as eye doctors on both sides of the issue testified at the state capitol in Charleston, with ophthalmologists sporting "Surgery by Surgeons" stickers and optometrists wearing "I Support Optometric Physicians" badges. West Virginia legislator Don Perdue thinks optometrists and ophthalmologists are sincerely concerned about what's best for patients, but add that both have professional clout and financial interests at stake as well - "money being of primary interest." Where scope of practice overlap, Perdue contends, they're vying for the same patients.

As chair for the state's House of Delegates Health and Human Resources Committee, Perdue became intimately acquainted with the two groups during a marathon negotiating session last year. "We spent those 16 hours locked in my office literally trying to keep people from clawing each others' eyeballs out," says Perdue, who ultimately voted with the majority to allow optometrists to prescribe more medications and administer some injections after laser surgery was taken off the table.

California legislators also rejected laser surgery but agreed to reduce training requirements for treating glaucoma, saying optometrists graduating after 2008 receive sufficient preparation in school. However, medical groups have sued to prohibit the new regulations from taking effect, saying optometrist education doesn't go far enough. "[The regulations] don't protect patients," says Dr. Craig H. Kliger, an ophthalmologist and executive vice president of the California Academy of Eye Physicians & Surgeons.

Optometrists' move to deliver more of the care traditionally provided by ophthalmologists has helped to blur the line between the two professions. According to a recent online poll of Angie's List members, 93 percent claim to know the difference between optometrists and ophthalmologists, but 25 percent went on to incorrectly describe an optometrist as a medical doctor. "I thought they had to go to medical school," Hostetler says. "But they're referred to as doctors nonetheless. That's kind of a misnomer." Chuckling, she adds: "I have three master's degrees and I don't get to be a 'doctor.'"

Like Hostetler, most poll respondents have reservations about seeing an optometrist for anything but basic eye care. Just 8 percent would turn to one for help with glaucoma - which optometrists are permitted to treat in every state but Massachusetts. When it comes to injections and laser surgery, only 2 and 4 percent, respectively, say they would trust an optometrist.

Oklahoma became the first state to allow optometrists to perform some laser surgeries in 1998. That's also when lawmakers explicitly upheld their right to administer injections, remove eyelid lesions and prescribe an expanded list of medications. "The procedures we're doing are not technically involved," says David Cockrell, an optometrist in Stillwater and spokesman for the American Optometric Association. "We've never had a single case of a patient being harmed reported to the [state optometry] board. That's a pretty startling statistic."

It's also a misleading one, says ophthalmologist Dr. David Parke II, former head of the highly rated Dean McGee Eye Institute, based in Oklahoma City. "We had several patients come in with horrible complications from totally unnecessary surgical procedures," says Parke, now the executive vice president and CEO of the American Academy of Ophthalmology.

Pam Odum of Owasso, Okla., outside Tulsa, says she never would have gone to an optometrist for laser surgery had she known he was not a medical doctor. "I was almost blinded," says Odum, who sued Jan Jay Rigney for negligence and says his incompetence in performing a procedure to correct astigmatism and the homemade eye solution he gave her caused temporary blindness and permanent blind spots. "To this day, I have limited vision," Odum says. Rigney, who settled the case with Odum for an undisclosed sum, declined to comment.

Cockrell says if malpractice were a big issue, insurance rates for optometrists would have shot up in Oklahoma. Parke argues the reason they haven't is because optometrists are mostly still prescribing just glasses and contacts, which carry little risk. The potential danger to patients is very real, he adds.

Out of some 25 highly rated Oklahoma optometrists surveyed by Angie's List Magazine, only three say they perform PRK or another type of laser surgery. Although it's been more than a decade since the new law went into effect, most continue to refer patients to ophthalmologists at surgery centers who perform a high volume of procedures, including Lasik, which optometrists aren't permitted to handle.

Tami Ross, a highly rated optometrist in Oklahoma City, says she's certified to perform laser surgery but the investment in equipment isn't practical. "The lasers are pretty expensive," she says, estimating that PRK equipment costs as much as $500,000. "Unless you can pay for them doing [procedures on] a lot of folks, it's not worth having them."

However, Ross adds that many more optometrists in rural areas are performing surgery and she expects to see an increase in cities, too, because laser training's become the norm in optometry schools. "It's part of their curriculum now, so you're going to see more and more of that done than in the past," she says. "The new [optometrists] are taught it from day one."

Optometrists in neighboring Texas are among those seeking approval to perform laser surgery. If successful, optometrist Jeff Thomas says he might expand his services to include corrective surgery for certain cataract patients. The highly rated Dallas area optometrist - and Wiesle's provider - agrees with his peers that broadening care can reduce the need for referrals, save money and better serve patients. "That's the bottom line," he adds.

A household survey conducted by the Agency for Healthcare Research and Quality says patients spend about $50 on an eye exam out of pocket, whether they see an optometrist or ophthalmologist. But the total spent by all parties, including insurance, Medicare or Medicaid, is $132 for ophthalmologists compared to $94 for optometrists, says Jeff Rice, CEO and founder of Healthcare Blue Book, which analyzed more than 15,000 patient records. Similarly, he says, opening a blocked tear duct costs the system $169 for an optometrist versus $232 for an ophthalmologist.

"On average, it looks like ophthalmology gets paid about 40 percent more than optometry for the exact same services," Rice says. "I think it costs more because of the higher level of training and some of the additional overhead of a medical practice." Ophthalmologists also earn more than twice what optometrists make - $305,724 compared to $126,319, according to CareerBuilder.com.

In Texas, Thomas says he was taught how to use lasers and treat glaucoma when he went to the University of Houston College of Optometry in the 1990s, years before the state allowed optometrists to prescribe glaucoma medications. "They definitely train beyond the current scope of practice," he says.

Due to legal restrictions, students at the school gain experience by performing laser surgery on animals, primarily rabbits, says Earl Smith, the school's current dean. "About a quarter of our class rotate through Oklahoma and get experience on humans," Smith says, adding that others only operate on people after they graduate.

All 19 accredited optometry schools nationwide teach courses on lasers, according to Smith, also the president of the Association of Schools and Colleges of Optometry, a nonprofit representing the interests of optometric education. However, Smith didn't have precise details about hands-on training. "Every school strives to make sure their graduates are eligible for licensure in every state," he says, meaning they learn skills to match scope of practice and beyond.

However, Briceland says post-optometry school education can amount to weekend courses at the Holiday Inn to learn surgery. "There's no standard of education," he says. While ophthalmologists may also learn new laser techniques at short seminars, Briceland says ophthalmologists already have a broad base of experience. For example, they perform many different surgeries, from Lasik to cataract surgery, on human patients during medical school, internships, residencies and up to two years of optional fellowship training. "How can you claim four years of post-college education is the same as 8 to 10?" Briceland asks. "You can't."

Educational differences didn't stop Kentucky optometrists, who successfully pushed to become the second state nationwide to allow them to perform some laser surgeries. A strong bipartisan majority passed the bill in February and Gov. Steve Beshear signed it into law the same month. "This new law will mean more Kentuckians can get the eye care they need," Beshear said, pledging that optometrists who expand scope of practice will undergo extensive training. In addition to surgery, the Kentucky law gives optometrists the ability to administer injections like local anesthesia, prescribe more drugs and grants the state optometry board broad authority to further expand scope of practice, save for prohibited procedures like PRK and Lasik.

Critics say nearly $400,000 in campaign contributions was responsible for the legislation's swift approval. "The optometrists had an excellent lobby," says state Rep. Susan Westrom, one of only a few legislators who voted against the law. She contends it was rushed through: "I don't think we can trust the outcome because we didn't have all the information."

Though Westrom goes to an optometrist and considers their role integral to eye care, she sees no reason for the broad expansion of practice. Woodford Van Meter, a highly rated ophthalmologist in Lexington, Ky., and president of the Kentucky Academy of Eye Physicians and Surgeons, agrees with her. "There's never been a consumer group, an advocacy group or a patient group that's said this is a good idea," he says.

But Reynolds believes expanded services are a logical step in the evolution of primary eye care. "I think that if consumer groups were properly educated on it, if they could look at the educational background of optometry [and] at the history of safety of optometrists, they would be in favor of these procedures," he says.


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Comments

Wow I had no idea this was even going on!

please and please,if you want to be an optometrist,you know where you should go and if you want to be an ophthalmologist you also know where to go.optometrists should stop the inferiority complex because they are important too.l started out initially in a school of optometry oblivious of the fact that they don't do surgeries but when l knew this fact in my 2nd year,l ran out and entered med school and l:m hoping to be an ophthalmologist.lets stop the anarchy please.

All schools of optometry should be converted to ophthalmology residency and all students should take all required exams to be ophthalmologists and OPTOMETRY as a sole practice abolished if it's scope as become too narrow for people practising it.

I think this non-issue has been made into an issue where there are no blurred lines? One is called "optometry" and one is called "ophthalmology" and they mean different things. If you knew that why put in for one if you wanted all what the other had to offer? Why do these distinctions exist? For division of labour and creation of jobs for a wide variety of people each with its job description.. The truth of the matter is that a construction worker can learn to do surgery without going to medical school if shown what to do and he is put through it consistently enough.The difference is appropriate certification not the knowledge only... Why should an ophthalmologist EXIST? There must be someone who is vast in all areas that concern the eye and the human body and vice cersa and is certified for it. Why should other specialties exist? Because the ophthalmologists can't do it ALL. Is there anybody born that was named OPHTHALMOLOGIST at birth ? NO..Therefore he who wants to be an ophthalmologist and not an optometrist shall do what is required to be an ophthalmologist and be certified. Can a nurse be an ophthalmologist?Yes can a physiotherapist become an orthopaedic surgeon YES..There must be decorum not because optometrists are not intelligent enough but because they are OPTOMETRISTS and ophthalmologists are OPHTHALMOLOGISTS and the LAW and state should require the PERSON with the HIGHEST CERTIFICATION on the EYE to perform surgeries on the EYE not just because he has the knowledge but because the state recognises his knowledge and training through his certificate..

Apparently, the author's only research was to get Ophthalmology's public relations "spin". This, of course, can be summarized as "thou shalt have no independent health care profession that do not give themselves unto the authority of the AMA". Doctors of Optometry are an Independent profession, so obviously they are not medical doctors (in servitude to the AMA). Optometry has evolved in its techniques, education and service to its patients. So has Ophthalmology. There are good and bad practitioners in both fields. Optometrists get more training on vision disorders and more hours of pharmaceutical classes, Ophthalmology get more hours of training on the rest of the body, but little to NO training in contact lenses. A second year student can proficiently perform the laser procedures under debate. Choose your eye-doc based on his reputation among the patients in your community who've seen him for years, not on some political "spin" from the AMA. Honor and integrity will drive the professionals in both fields to refer the problems they are not equipped to handle to those who are. "Blessed are the eyes that see what you see!" Jesus the Christ. Luke 10:23

Just ask any ophthalmologist how many optometry misdiagnoses they saw during residency training. Also, optometrists do four years of school of which two are clinical. An ophthalmologist does three years of clinical work and then 2 more during fellowship. Finally, the clinical experience during ophthalmology residency is with much more sicker complex patients. Doing a ton of routine eye checks is not the same as seeing patients with eye disease. Optometrists comparing themselves to ophthalmologists is a joke. As an optometrist if they would have their mother see an OD if they had a real disease in their eye. You are kidding yourself.

Ignorance is bliss I guess! Optometrists go to 4 years of optometry school if they are going to only prescribe glasses and contact lenses. However, as a BOARD CERTIFIED DIPLOMATE of the American Board of Optometry, I would like to educate people that beyond optometry school there are: 3 National Board Exams to pass, a 1 year Residency, a Fellowship in whatever specialty we choose, then up to 50 hours of continuing education classes per year to keep your license up to date (more or less in certain states). Then, in Texas where I live, I trained to acquire my Optometric Glaucoma Specialist License in 2009 and in 2012 I passed a Board Certification Test to be one of the top 5% in my profession to be able to medically diagnose and treat most eye conditions. No, I do not do surgery but you can bet if I did, I would have the top training and be confident in my skills just like an ophthalmologist and the optometrists that do the procedure in Oklahoma. What you don't realize is that a LASIK surgeon doesn't go through 8 yrs of training for LASIK....they take laser courses that last between 3-6 mos, which is exactly what the optometrists do when they perform the corneal surgery. I would not agree with optometrists performing cataract or retinal surgery or corneal transplants. Yet, LASIK is a whole lot different. If you don't know the technique or anything about the eye, I can see how you would think its only for the M.D. to do but you are WRONG IN ASSUMING THAT.

I'm both an OD and MD. After graduating optometry school, I practiced full scope medical eye care for 3 years. However, I felt that the limits of full surgical eye care limited my capacity to treat my patients and expand my practice. I elected to enroll back into medical school and hired an OD to cover my practice with myself only seeing patients only on Satudays and days off from medical school. This is what I can share. After 4 years of optometry school, optometrists are way ahead in the knowledge of eye care than after 4 years of medical school. Although an optometric curriculum is dynamic, it is also very specific. In addition to all of the core medical sciences, courses in advanced medical/ophthalmic optics/ ocular biology/ neuroscience and neuro - anatomy gave me a clear cut understanding of the ocular system and disease processes. Topped with courses in ocular disease, glaucoma, pharmacology, binocular vision and retina, countless hours in clinic and externship. I had seen nearly 2600 patients before I graduated OD school! I only ever looked into a handful of eyes during medical school - mostly as a part of my training as an OD. I had amassed a much greater knowledge base in eyes in the first 4 yrs of OD school than the whole 4 years of MD school. That is simply the nature. OD school is very specific/ MD school very broad. Now, this is where the key difference lies, after OD school, there is an optional one year residency that most ODs defer. This can be in areas of primary eye care, ocular disease, pediatrics etc. After medical school we complete additional required residency, one year in general and 3-4 years in ophthalmology. It wasn't until my residency that I began to "focus" on eyes and diseases. I saw that a lot of what my fellow residents were doing were self learning and hands on training in eye care. They were often impressed at my knowledge base in eyes/ refraction and technical skill. When one of my colleagues found out that I was an OD first, he commented, "Wow, they really teach you a lot about the eyes in there dont they?'. I replied, "Yes, they do. " Being on both sides of eye care has given me a perspective that has helped me grow tremendously. Unless they've done it, neither profession knows exactly what one another has gone through to earn the responsibilty to care for the health and vision of another person's eyes. I can say that ODs are trained very well in primary eye care and therapeutics, however their lack of surgical training limits the scope of their practice. Only MDs who have done post graduate residency and training in ocular surgery can perform these procedures safely. With that said, I've had discussions with fellow ODs and MDs alike who ask... "What if ODs came out of school and enrolled into an ophthalmology residency?" What result would you have? I would like to think that we would have an amazing eye care professional who has an ultimate understanding of ocular health/disease and vision. All of the health professions have good and bad practitioners. That's just how it is. Not every player in the NFL is a superstar, some are certainly better than other. Don't judge the ECP that you're seeing based on title alone (OD vs MD), but rather on your experience and the level of trust you have in him or her. I've seen patients that had previously seen an OD or another MD and the story is always the same when you hear about why they left. If they don't trust you and you don't educate them on their eye health, they'll go find someone who will. A good doctor will always put your concerns before his, whether he is an OD or an MD.

thank you for a fair explication !

You are perfectly right .Having being on BOTH sides you know what obtains. But people forget the reason why distinctions are made between specialties . Many more OPTOMETRISTS are better at OPTOMETRY than opthalmologists who try to practise Optometry.It is clear that you know why ophthalmology is a higher level of training compared to optometry. No disregard to optometry which is a true specialty on its own and you are the best qualified because you are both.Therefore let anyone who wants to practise eye care at the highest level go to both schools or be an ophthalmologist or an optometrist..No blurred lines..

The people in the post are merely arguing for higher prices and less access for other patients so they can feel good about "higher standards." They wish to deny access for the poor, putting more pressure on the meager services provided by the state. They want to deny competition and they wonder why the healthcare system is broken.

Don't ignore the fact that Ophthalmologists spend the first 3 years of Medical School learning about the rest of the body, and in essence, cram their ocular training into only 1-1.5 years before they are thrust into rotations. Meanwhile, Optometrists begin ocular training from day one of Optometry school and can therefore conclude they receive essentially 2-2.5 times the duration of training before they are sent out on rotations where they train for a year and a half, and then many attend residencies for a year after graduation as well. While MD's are "real doctors," they tend to rely on surgery and the big money makers, OD's seem to care more about their individual patients and have the ability, possibly due to cost, to see patients on a more regular basis; in doing so, they are able to identify changes and potential medical conditions better. In no way is an OD a replacement for an MD, but having the ability to take care of patients in house, for routine care, instead of referring out and possibly losing information that is not sent back to your practice is a huge issue in practice today.

Wow. I am offended personally and professionally. This is the worst piece of "reporting" I have EVER seen. CLEARLY biased and paid for by politically motivated AMA Ophthalmology PAC. This "author" uses selectively biased interviews, loaded jargon and clearly does not understand, nor did any research pertaining to, what optometry is capable of as a profession. Disappointed does not even come close to my feelings toward Angie's List. Personally, my wife and I were subscribers to Angie's List. Not only is our membership going to be cancelled, but I will make it a point to negatively influence your business as much as possible, as you have chosen to do with ours.

I just joined Angie's this year. I will not be renewing. Unbelievably biased and poorly presented. How could I ever trust your site again? I will tell everyone I know.

I am in favor of leaving things as they are and keeping the traditional responsibilities unchanged. I believe surgery should be left to the medical doctors. In my experience with optometrists I've gotten the used car salesman vibe in some offices, where they're trying to rush you through, sell whatever gives them the highest margin and get you out the door. There isn't as much talk about what's best for the patient. Instead it's just stop using your current contact lenses and cleaning solution and start using what I'm selling. It's better. I've been to some who were totally professional, but I think overall as a profession, optometrists can be a little like chiropractors where it's more about making money and repeat business than about health.

There are both good and bad doctors found in all specialties and all disciplines. However,I believe that if you have an eye condition that may result in loss of vision you will want to see the best qualified doctor you can, even if this means that you have to drive to another city or pay a bit more. I believe that an ophthalmologist is truly the more qualified and capable person to best handle medical and surgical problems. When I need my glasses or contacts updated, my optometrist is fine. I know something about the training of both types of doctors, and believe that if I were to require a procedure like an injection or laser, I would definitely prefer the higher trained ophthalmologists. Thank you for this article.

Thank you for giving us both sides of the stroy. I have gone to both and I am still looking for a good one in either field.

If you only read this one passage, you will get the gist of this article. "I thought they had to go to medical school," Hostetler says. "But they're referred to as doctors nonetheless. That's kind of a misnomer." Chuckling, she adds: "I have three master's degrees and I don't get to be a 'doctor.'" Shame on you Angie.

I go to a ophthalmologists an lots of money I see the Dr. for 22 secs. He has no time for questions etc. But when I see the Optometrist I get questions answered, fears calmed and even get my prescription glasses filled at a much lower price. Sadly I think I am paying ophthalmologists office for status not for eye care.

Some of the commenters say who they are; others are silent. I work with a ministry to medical students & am familiar with their training, at least from talking to the students as they progress. The ophthalmology students study general medicine, drug interactions, biochemestry, etc for the first 2 years. The 2nd two years they follow doctors of different specialties around the hospital, sometimes making coffee runs, sometimes being more involved in patient care (depending on the med school & specific specialty). Sometime during that 3rd year, they decide what to specialize in. Fourth year--more of the same, with slightly more responsibility. Then comes Residency. Still different rotations, some in the hospital, some in surgery, some in other specialties. Increasing hands-on during that 4-year training. Optometrists spend the first year doing some of the same training, then focus more extensively on eyes for the next 3 years. I hear this discussion from both sides. Seems to me that it would be very helpful in rural, underserved areas, to have the option available of having optometrists perform surgeries. The students I talk to are like the med students; some like the surgery idea, others prefer clinical work. It doesn't sound like ALL of the optometrists are jumping in to try to do surgeries even where it's legal. And it seems that their abilities would be vastly enhanced by being able to "work on" people (under supervision, of course) legally. Don't have a dog in this fight. Just throwing in my two bits!

I have had a disease that could have left me blind, Fuchs Corneal Dystrophy. I was seen by two Opthamologists who weren't sure what was wrong with my eyes. The second Opthamologist referred me to The Eye Institute at the Froedtert Hospital in Milwaukee, WI. There after running tests they determined that all my eye sight difficulties were "in my head". I went back to the second opthamologist and she said she just knew that this wasn't "all in my head." After repeating some tests, she sent me to an Opthamologist who was a Corneal Specialist. He examined me and told me that I had Fuchs. It is a hereditary disease. I searched from 1995 until 1999 for someone who knew why my eyesight was going so fast. Dr DeCarlo did my first corneal transplant in 1999. It was a complete transplant and it took a long time to heal. Now there is a new method of doing transplants and it takes just a fraction of the time to heal. I have also worked with people who had severe and chronic mental illness and most of them are poor. If some procedures could be done by Optometrists, this would mean the difference between thier getting the treatment they need or not, I would say that I would rather they got the treatment they need up to a point. Obviously, in my case even four Opthamologists couldn't figure out what was wrong with my eyesight. Still I persisted because I knew there was something wrong. I would bet that if an Optometrist had seen me, she/he would have refered e to the Eye Institute. You can see where that got me. All necessary eye surgeries are covered by Medicare and there is no reason people should have to go without what they need. However, if they fall on the broad line between having good health insurance and no or little health insurance that is always going to be where the difficulty lies. Just one more thing. My mother, in all likelyhood, had Fuchs Corneal Dystrophy. Unfortunatly she had it when they didn't know what it was. They did cataract surgery on her and she never saw well again and in fact was legally blind within just a few years. Consequently, I would not lay all my cards on any one table. If you can get by with an Optometrist by all means do. If you get refered and you don't get the help you need, keep searching. Eyesight is a very valuable and highly underated commodity. I am thankful that after many eye problems, today I can see clearly out of one eye and I can still see periferally out of the other. I can drive, read, garden, paint and do sculpture because I persisted.

I've been to several optometrists and switched to opthamologists in because of continuing vision difficulties. More education + residency = more knowledge and experience. Not a difficult concept.

The story focuses specifically on optometrists’ efforts to expand scope of practice — to include, for example, laser surgery. Admittedly, it’s a divisive issue, and we took great pains to get feedback from all sides. This a complex issue, and many nuances that go into reporting don’t wind up in the final story. Please know we take your concerns very seriously, and we take pains to make sure all sides get a hearing.

I am disgusted by such ignorant reporting. You have lost me as a customer.

Here in Indiana, I received services at two centers once it was determined I had glaucoma and cataracts. In both places, optometrists monitored my eyes and examined them every 6 months, or more often, as they got worse. I saw an ophthalmologist when it came time for surgery. I trust my optometrists, but would not want to have somebody do surgery who wasn't board certified and who didn't do a lot of lens replacements. After surgery, the optometrist again monitored my eye pressure and healing of the glaucoma surgery. I had pigment dispersion glaucoma (the color on my lenses came off and floated around in my eyes and could block the ducts), so I had no glaucoma after the lenses were replaced. I am still being monitored. I still had to see another optometrist to get prescriptions for glasses. The typical way to be referred to one of the centers is for your optometrist or ophthalmologist to make the initial referral.

I previously made comments here (which never showed up) and sent an email concerning my response to this biased article. I have heard nothing from you so far. Will I (and all those noted above) receive an explanation for this poorly written and obviously biased article?

Having worked with both professions for 20 years, I have to say that this article is very biased toward ophthalmologists. Its selective use of “facts” and quotes appears to be an attempt to steer patients away from one profession and into the arms of the other. How much did the ophthalmologists pay to run this advertisement? It’s one thing to note that ophthalmologists and optometrists have had their legislative struggles, but quite another for a supposedly unbiased information broker like Angie’s List to promote one profession over another as it did in this case. This calls into question the reliability of information provided by Angie’s List on other businesses and professions. Is information being provided by Angie’s List because it will help consumers or is it really there because Angie got paid to place it there?

After reading this article, I have no desire to join or promote my business with you. If you are going to smear a profession, why would I support yours. You have lost me as a customer and supporter.

After reading this, I'm not sure I can believe the "reviews you can trust" logo. No ethical doctor, OD or MD, would do a procedure they weren't trained and certified to do properly. As far as lobbying, MDs have a lot more money to get votes than ODs ever will. Maybe the legislators saw the value to patient care when they passed the law.

Thank you for this HACK piece on Optometry. How much were you paid by Ophthalmology? Poor, poor reporting. Your facts are wrong and biased. You obviously have a partner or payer Ophthalmologist from Kentucky. Is this all that Ophthalmology in Kentucky can come up with? If you can't fight the facts, produce a smear piece. I expected more.

I'm surprised Angie's list allowed such a biased article. Obviously the author has an agenda. Lowers my view of the credibility of this site.

This story highlights difficulties people have had with optometrists, but none with ophthalmologists. Quotes from laypeople and doctors are all biased toward optometråists pretending to be medical doctors. Please consider the possibility that not all optometrists are trying to do surgery to earn imaginary points as "real doctors." Optometrists are trained in many aspects of vision care, including refractive, contact lens, low vision, and advanced ocular disease management. There are many types of doctors -- dentists, optometrists, PhDs -- and these require extensive training even if these are not medical doctor positions. Angie's list, as an optometrist, I am taken aback by your choice in reporting optometry vs ophthalmology. There are good ways for both practices to co-exist, and reporting on the conflict alone gives your consumers a very incomplete perspective.

THIS IS AN EXTREMELY BIASED ARTICLE AGAINST OPTOMETRY. OPTOMETRISTS LEARN ABOUT EYES FOR FOUR YEARS WHILE MEDICAL STUDENTS GET ABOUT A WEEK OR TWO ABOUT EYES IN THEIR FOUR YEARS THERE. ALSO DOCTORS OF OPTOMETRY aka OPTOMETRIC PHYSICIANS LEARN THE PHYSICS OF LIGHT FOR 2 YEARS AND HOW IT ENTERS THE EYE AND HOW DISEASES/ABNORMALITIES MAY EFFECT YOUR VISION GREATLY. YOUR FACTS ARE WRONG AND UNFOUNDED. ANGIE'S LIST THIS IS A POOR EXCUSE FOR AN ARTICLE I'M SORRY.

I have been a medical editor and writer for many years so have looked at pros and cons of various MD vs non-MD practices over the years. I think an additional factor should be considered when looking at whether or not one prefers an ophthalmologist to do your eye exam; that is, a medical doctor also is trained to look into your eyes for other medical diseases such as leukemias. The eyes ARE the windows to our bodies and I definitely concur that an MD should be the professional dealing with those diagnostic issues.

The headline of this article is ridiculous and sadly misleading. The rights in question seem to be those of the optometrists, people who are basically trained to test eyesight in order to provide glasses, not to cut into eyes or recognize serious pathology. They may very well do a better job of testing for prescriptions than ophthalmologists, but that's about it. Anyone who allows a glasses-provider to perform medical procedures is extremely foolish. Although you have some guy writing multiple comments here expressing outrage over the article, I am more put out over the fact that this article presents no facts or figures on outcomes, only anecdotal evidence. To the argument that money is saved by allowing lesser trained professionals to work on people and therefore it is good for poor people, really? Who is in favor of a 2-tier medical system, with lousy services for the poor?

I'm a non-physician health care provider, so I can sympathize with the OD's. The bigger picture here is that the medical field has had a strangle-hold on the provision of health care services for decades in this country. The late Nobel prize-winning economist Milton Friedman once referred to the American Medical Association as "perhaps the strongest trade union in the United States". So, I'm skeptical when I hear some state legislator, like the one in this article, make the statement that the OD's had a stronger lobby. And the MD's- with all their money, clout and long history of political lobbying didn't? According to public records, Susan Westrom, the state rep in KY,between 2004 and 2010 received $3500 from the optometrists' professional association and from 2006-2010 she received $1500 from the ophthalmologists. Pretty much a wash. What's harder to determine, and what physicians are better at, is making individual contributions. It would've been instructive to know what individuals were funding Ms. Westrom's re-election campaign. What we do know, is that over the last decade or so, the ophthalmologist PAC has given nearly a million dollars more ($8.5M) to political campaigns than optometrists ($7.6M), so I'm not ready give the OD's the prize for lobbying power and prowess just yet. Trust me, they're up against a huge, well-organized and highly-practiced lobbying machine. MDs need to learn how to compete in the free market. I don't feel sorry for them one bit.

Pathetically biased article. Ophthalmologists have been claiming that optometrists would harm the public for any expansion of scope of practice across the country for 35 years. Not one prediction by the opthalmologists has come true. Optometrists have provided excellent care and have not abused any expansion in scope of practice and there is no evidence over 35 years to the contrary. It is pretty hard to be 100% wrong every time, year in and year out, but that is exactly the case with ophthalmology. It is isn't about patient care with them. It is about money and control. Before you write such biased articles, do your research. You will find out ophthalmology blows a lot of smoke but there is no fire.

This is a very biased story and us full of political agendas. I would like to know how much education about eyes a "medical doctor" gets in medical school or during their internship? So after those 5 years of training how much does the doctor know about eyes....there answer is very little. That is what they learn during their 3 years of residency. So when you have an "MD" due your surgery hopefully he/she has learned something about eyes before you are their first patient to have cataract surgery or LASIK. Optometrists are NOT trying to perform those type of procedures. Optometrist do go through 4 years of post graduate optometric education (eye based education) and many go on to complete a residency (which was also NOT mentioned in this "informative" article. Since the real debate comes down to $$$ and politics between optometrists & ophthalmologists - there us always going to be some sort of battle between some but in reality they all just need to work together for better patient care. However, sadly it is like Washington it is always a battle of agenda and optometry & ophthalmology is acting to much like republicans and democrats. Shame on the professions!

I have a question, also. First, I agree that I would never let an Optometrist perform surgery. However, I want to take that one step further. My wife and I had eye exams last year and paid over $500 for two pair glasses. Recently she went to another Opt. because the one we had make three mistakes on my lenses. Thus we decided to go to a new Opt. We found out tht the Opt., not knowing we were going to a different Opt. We found out that they doctored up the bill and made us pay more out of our own pocket for the glasses. My wife was charged for two eye exams the same day and didn't have but one. That;s fraud. Now the insurance won't give us glasses until we prove that she didn't have the exams. The business, in Fairhaven, refuses to give us a photo copy of an itemized list of what was performed on our last visit. I've been trying for two months and the last time I went in (Tuesday 9/13/11) she called the police and tried to have me arrested. What can I do to get my records?

This is SO reminiscent of the early battles between Nurse Practitioners and physicians/physician assistants. Their mantra used to be: 'see the bill: kill the bill" when it came to giving NPs additional practice authority. Today, there is NOT MUCH NPs/PAs are prevented from doing, but again the issue is REIMBURSEMENT. I would caution the Optometric group NOT to sign off on anything which requires "supervision" but yes to 'collaboration' or 'co-managment. These two disciplines are integrally bound together. Turf wars between them are NOT REALLY about pt. safety, lets face it. It's all about who gets the ever diminishing piece of the health care cash pie. The old days are OVER. It's now a matter of 'collaborate or die'! The so called 'golden era' of medicine is in the museum of memory (some of us old timers do recall all the glory), but this is a new day and time for change. Science and medicine demands it, our patients demand it and when safety is an issue - we must deal with it as sane members of a professional community and NOT as a herd of bloodthirsty conquerors. Patients today quickly know the difference between our 'wanting to protect THEM from unsafe providers' and 'wanting to keep the bounty for ourselves and no one else.' Mine is an unpopular position, I realize, but I've learned from colleagues in general medicine who have added midlevels to their practices and VASTLY improved their bottom lines given the productivity. Perhaps practices who merge will be on the forefront of ocular health as well? One thing is certain, we will get the outcome we deserve.

I have had Lasik surgery and cateract removal performed by an Opthalmologist at Bascom Palmer. They also give the most extensive exams I have ever had by an Optometrist. They each have specific purposes. Procedures covered by insurance. I have never had an optometrist thaat wanted to perform surgery.

As a registered nurse who has had the pleasure to work with both providers described, I have serious concerns about the one-sided nature of this article in that it purportedly evaluates and recommends care given by one competent, qualified, safe, and professional eye care provider over another. Where is the hard evidence that an ophthalmologist is the superior eye care provider compared to the optometrist? Have you considered any outcome-based evidence studies, research, peer refereed journals in your article or did you reach your conclusions from a few, random opinions? Both providers deliver safe, quality care and a valuable service within the scope of their prospective practices. Let's let them fight their own turf battles and why don't you concentrate on reporting what your members think of individuals within each provider group? Stick to what you know.

The decision as to what kind of health care provider should be totally up to the individusl, and not the government with its protectionist laws. If you want to use an optometrist, fine. If you want to use an opthalmologist, fine. The decision should be yours alone.

Your article was unbelievable. I am an optometrist, and admit my bias as one; Michael Schroder should have also admitted his bias at the beginning of his article. He starts the article saying 16 states are pushing to expand their scope of practice for ODs, but this has been the case for a long time, in the 1970s only a handful of states allowed optometrists to dilate patients, would patients be better served if their retinas could only be fully examined by MDs? Only the "pushing" of optometrists then allowed for the high level of eyecare more people experience now. In the same paragraph he states that Ophthalmologists provide the "full spectrum" of eye care and I have never heard of an Ophthalmologist offering Low Vision or Vision Therapy services. I think that lumping all laser procedures together for the entirity of the article is misleading and that people think that Lasik is the only laser eye surgery and therefore only elective eye surgeries are what has been expanded to, when there are 2 common laser surgeries for post cataract complications and glaucoma management that have very rare complications and large benefit to the patient. Your online poll results were interesting as well, because I am not sure we are "misidentified" when described as "medical doctors." Many states refer to optometrists as "optometric physicians" and we are health care providers who diagnose and treat diseases and who are trained in anatomy and physiology. I think that the author has picked an especially inflammatory commentator against Optometrists and he gave Denishia full reign. Perhaps she is woefully uninformed in many areas of life, but she is allowed to parade it as valid ammunition against an entire profession. Dentists are also referred to as "doctors" and perform surgery and injections, does she also know that they did not attend medical school? That they also "only" spent 4 years in dental school after completing an undergraduate degree? We are all trained for our professions, her master's degrees trained her for whatever she is doing, and my degrees have trained me to care for eyes in a way that far exceeds just glasses prescriptions. The debate about if ODs have done harm in OK with laser permission could have easily been settled by calling the OK State Board of Optometry and asking for claims, but without that research the charges Dr Parke lodges are unsubstantiated. Pam Odum obviously had a bad outcome, but it seems unbalanced to assume that no MDs have been sued and lost the case, in or out of court, because of laser surgery. Dr Briceland is quoted that "there's no standard of education" which is completely untrue, the Council on Optometric Practitioner Education and the States' Boards of Optometry sets the standard for continuing education classes, that all license optometrists are required to complete to renew their licenses (every one or two years). Obviously, you can't control for things said in the comments left after the article. I have tried to just address the items I feel are misleading. I think that this article does a disservice to patients, we are not used car salesmen; we are eye care practitioners, we are doctors, and we are capable of doing a lot of good.

The "surgery" that most people are arguing about is the very lucrative laser surgery. What most people don't realize is that the proceedure is performed by a very expensive computer, not a person. The doctor programs the computer with the necessary ocular dimensions and sometimes monitors the surgery as it progresses. The critical issue is how well calibrated the machine is, and that is done by a specialized electrician, not the doctor. And, unfortunately, the commenter Jan Parks is correct: medical students have very little training that is specific to their area of "specialty" unless they undergo a specialized residency. They are not required to do that, however. The comment about nurse anesthetists is also misinformed. In order to become a nurse anesthetist, the RN must complete a bachelor's program, a master's program and then a one-year specialization. Four years of medical school is no longer the only standard of quality in medical training or care.

I work with Ophthalmologists and Optometrists and I would never let an Optometrist do any type of laser or surgery on me.

There may be a few things that optometrists could add. Think of this: I'm a Cardio-Pulmonary Specialist. I can intubate, put ina chest tube, put in an arterial line, put a patient on a ventilater. So should I do thoracic surgery? HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Interesting article and important topic... as an ophthalmologist I understand the situation well. You have an important fact wrong, however. Ophthalmologist and optometrists are reimbursed the same amount for the same exams or procedures by Medicare, Medicaid, and the vast majority of third party insurance carriers. They are not paid less based on their years and tens of thousands of less hours of supervised training, such as the case of other paraprofessionals.

No one has a "right" to provide eye care. Individuals are given a license or permission to provide eye care. Your use of "right" is a misuse of the word. Many people misuse the word - internet access is now called a "right" by some as is wearing clothing such as T shirts in school. These so called "rights" do not exist. You belittle the true meaning of the word "right" with your trivial use of it.

I had a "genius" optomitrist who claimed my eye problems were not the highly contagious pinkeye and that he prescribed eye ointment that did not include preservatives to which I am allergic. He also told me I was OK to go to work since I didn't have the highly contagious pinkeye. I kept going back as my eye problem kept getting worse. He gave me many ointments he SWORE did not contain preservatives. Ultimately, I ended up in the emergency room on the weekend, a place I avoid. The OPTHAMOLOGIST who saw me said I did indeed have pinkeye which I had been sharing with my co-workers for 2 weeks. AND she took a look at my bag of "non-allergenic" eye ointments and told me that they ALL contained preservatives. Had I kept on using them, I would have caused permanent injury to my eyes. I have had so MANY similar experiences, that I TRY to go directly to an opthamologist due to ongoing problems with dry eyes, etc. . My cousin almost lost an eye due to an optometrist doing laser surgery on her eye. She got an infection that took FOREVER to clear up. I don't even like going to an optometrist just for my annual eye check any more. Unless and until Optometrists actually get the same intense in depth medical training that the opthamologists get initially. Only then would I consider allowing them to expand their practices. I NEED both of my eyes to be FULLY functional at ALL times!

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