Optometrists, Ophthalmologists Fight Over Eye Care Rights

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Comments

Eddy

Subject:

As a private practice od I can say that the level of a general eye exam, contacts, low vision etc... Is much more superior from an od vs an md. As far as ocular disease, they are pretty much equal. The main difference is the setting that many ods practice in In commercial settings and set themselves up to refer hard disease cases to mds because of the push to rx glasses. As far as surgery, if ods start to get a mandatory residency training period in surgery, then there is good reason to think they can can do it just as well as an md. But at this time that is not the case. I would like to note that if any md ( non ophthalmologist) wanted to do practice dentistry, eye care or anything else , they are allowed under the md license without being qualified. This is ironic but also hypocritical. I saw an ent once rx himself contact lenses under his non ophthalmology license. So if mds are going to bring down other professions, let them not be above the law and play god. For example I diagnosed a brain tumor through papilladema on a patient that was missed by her pcp which would of died without this urgent diagnoses. So mds, get a grip, you make plenty of mistakes. But if you're an md it get shrugged off and pushed under the rug. So for those touting how mds can do no wrong go and check the lawsuits out there against the so called perfectly trained mds that do no harm. But again, at this time ods should only do surgical procedures if and when residency training is done in a competent way and not just through legislation.

Matthew

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Future Ophthalmologist here. I think expanding the scope of practice would be understandable if optometrists had to undergo some kind of surgery specific residency. You wouldn't go to a dentist for oral surgery. OMF surgeons expand their practice by passing medical boards and completing a surgical residency. You can't make up for experience with legislation, so lobby for optometry surgical residencies instead of lax legislation. You will then have the option of being competent at what you practice rather than relying on weekend courses. I have only done a two week rotation in Ophtho thus far, and I saw a few patients who were blind due to undisguised glaucoma even though they had been seeing optometrists yearly.

Dr onyeagwara olachi(MBBS)

Subject:

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.

Tayo

Subject:

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.

Tayo

Subject:

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..

Darrell

Subject:

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

mike

Subject:

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.

Dr. Bridgette Fuller

Subject:

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.

RileyD

Subject:

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.

Tayo

Subject:

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..

James

Subject:

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.

Ben

Subject:

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.

David

Subject:

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.

Pablo Picasso

Subject:

You don't even have to "spin the wheels" anymore.
i.e. better here, or better here?
Just copy the numbers from the auto-refractor onto a piece of paper,
and let an Optician fill the prescription.
Then call yourself an Optometric "Physician".
What a joke!

Bob P

Subject:

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.

William Jones

Subject:

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.

AJ

Subject:

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.

Babs

Subject:

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.

Dr. SG

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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.

Jitney

Subject:

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.

Jan Parks

Subject:

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!

Patricia Mace

Subject:

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.

Rich

Subject:

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.

Angie's List Staff

Subject:

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.

Dr. N

Subject:

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

Barbara

Subject:

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.

Dominick Maino, OD, MEd

Subject:

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?

Reader

Subject:

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?

Dr. G

Subject:

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.

Dr S

Subject:

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.

Jason Clopton, OD, FCOVD

Subject:

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.

Dr. C

Subject:

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.

Christine

Subject:

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.

Martin

Subject:

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.

Merrilee S. Leatherman

Subject:

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.

martha r

Subject:

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?

John

Subject:

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.

Bob

Subject:

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.

Very disappointed

Subject:

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!

Edde

Subject:

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?

LastoftheZucchiniFlowrs

Subject:

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.

C,McIntire

Subject:

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.

Kathleen McNelis

Subject:

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.

John

Subject:

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.

Mary M, OD MS

Subject:

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.

Joan Yost

Subject:

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.

Lori

Subject:

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

Ms. C.

Subject:

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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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I second the original question (still unanswered). Speaking as someone who logged in today to try to find an attorney, I see this category as one that's exactly what I have my Angie's List membership for:

1. It's important that I find a good one
2. I'm not an expert enough to know myself who is a good one
3. The industry is full of advertisements and misinformation
4. I wish I knew what experiences other people have had


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I don't care about lawns--I planted mine in clover and don't have to mow it. When I do need to mow I use a rotary Fiskars mower, which is great--or a scythe. That's right--a scythe (the European type, which is smaller, and it's very good exercise). Gas-powered mowers, chemical fertilizers and weed killers--all nasty stuff that gets into everyone's air, soil, and water. I'm sure my neighbor doesn't like my wildflowers, semi-wild pockets of fruit bushes, and unmown areas and yes, dandelions (I have 10 acres) but that's too bad. It's better habitat for wildlife, especially the pollinators on which our food supply depends. I think this obsession with the Great American Lawn is a waste of time and resources. Plant some food instead.


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I'm not sure Angie et. al. want you to have a complete answer to this question. By re-subscribing at the Indiana State Fair in 2012, I think I paid $20.00 per year for a multi- year subscription. Maybe even less. At the other extreme--and I hope my memory isn't faulty about this--I think the price, for my area, for ONE year was an outrageous $70.00. And they debited me automatically without warning. I had to opt out of that automatic charge. I like Angie's List, but if some of the companies they monitor behaved the way they do in this respect, they'd be on some sort of Pages of Unhappiness. I'll be interested to see if this comment gets published or censored out of existence.
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That's very difficult to answer without seeing the house. As one poster said, the prep is the most important part. On newer homes that don't have a lot of peeling paint, the prep can be very minimal even as low as a couple or a few hundred dollars for the prep labor.

On a 100 year old home with 12 coats of peeling paint on it, then the prep costs can be very high and can easily exceed 50% of the job's labor cost.

A 2100 sq ft two story home could easily cost $1000 just for the labor to prep for the paint job. That number could climb too. Throw in lots of caullking  or window glazing, and you could be talking a couple or a few hundred dollars more for labor.

Painting that home with one coat of paint and a different color on the trim could run roughly $1000 or more just for labor. Add a second coat  and that could cost close to another $1000 for labor.

For paint, you may need 20 gallons of paint. You can pay from $30-$70 for a gallon of good quality exterior paint. The manufacturer of the paint should be specified in any painting contract. Otherwise, the contractor could bid at a Sherwin-Williams $60 per gallon paint and then paint the house with $35 Valspar and pocket the difference. $25 dollars per gallon times 20 gallons? That's a pretty penny too.

That was the long answer to your question. The short answer is $2000 to $4000 and up, depending upon the amount of prep, the number of coats, the amount of trim, and the paint used.