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Up Front | Oct 2004

ISRS/AAO’s Perspective on the OD/MD Struggle

The organization's chairperson weighs in on efforts by legislative lobbies and recent restrictions on meeting attendance.

The partial ban on optometric attendance at the AAO's annual meeting (followed recently by a similar measure from the ASCRS) is a tender subject for both optometrists and ophthalmologists. Although many of us supported optometrists in their request to prescribe antibiotics, ophthalmologists as a whole are deeply upset by the optometry lobby's aggressive pursuit of surgical privileges. A concern was that optometrists might use course attendance to bolster their legislative efforts for these privileges. The ISRS supports the AAO's and ASCRS' decisions to limit optometric attendance at their meetings. The ultimate effect of these moves cannot now be known, but they will certainly cause some hard feelings. This article summarizes my view of the issues in play and of the action needed for the future.

Worth noting is that a certain level of background training is assumed of AAO course participants. Specifically, individuals are expected to have completed medical school, an internship, 3 years of residency training, and, in some cases, 1 or 2 years of fellowship training. If optometrists wish to be trained to perform surgical procedures, they may attend medical school, and some have done just that. To obtain surgical privileges by legislative edict, in my opinion, is unfair to the public. Ophthalmologists have the necessary training in anatomy and basic science as well as hands-on experience with a high volume of surgical cases. A physician must see a lot of pathology in order to differentiate between an inflammatory reaction in the cornea, such as diffuse lamellar keratitis, and an infectious process.

The AAO, ISRS, and ASCRS have all published guidelines on the ethical comanagement of refractive surgery patients. Many refractive surgeons engage in some level of comanagement. I comanage some patients with optometrists, and I am confident that they will perform accurate refractions as well as preoperative examinations and that they will refer patients back when they are having problems. Most of the optometrists with whom I have talked do not desire to perform surgery, but they do need to understand the basics of the procedures. I have given seminars on wavefront technology to optometrists who work with me or the center where I practice. It is important for them to be up to date on the latest techniques and technology so that they may, for example, differentiate between good and poor candidates for wavefront-guided laser procedures.

Ophthalmologists' active and monetary support of their societies is needed. Members of the ISRS' executive committee have all made significant financial donations in support of the Surgical Scope Fund. AAO and ISRS members are encouraged to make contributions as well through the AAO's Washington, DC, office.

The optometry lobby has always been better organized and more active compared with the ophthalmology lobby. We must act to counter efforts to expand the optometric scope of practice. The situation in Oklahoma was a red flag. Optometrists can become licensed in that state and now perform surgical procedures at VA hospitals under the supervision of an ophthalmologist (the terms of this supervision are unclear). Potentially, optometrists could then argue that, if the surgical care they provide to this country's veterans is adequate, then why may they not operate on the citizens of the remaining

49 states? This argument would be difficult for state legislators to refute, particularly if they do not understand the difference between ophthalmologists, optometrists, and opticians. Ophthalmologists must work to educate legislators and the public on this score.

Unfortunately, the partial bans on optometric attendance at the AAO and ASCRS annual meetings will prevent some optometrists from delivering presentations on optics, refractions, contact lens fittings, and even wavefront studies. It was time, however, for these ophthalmic organizations to take a stand in the current struggle. To paraphrase a comment made by Richard Lindstrom, MD, at the Storm Eye/ASCRS Clinical Update 2004, “It is time to draw a line in the sand.”

James J. Salz, MD, is Clinical Professor, Ophthalmology, University of Southern California, Los Angeles, and is Chairperson of the ISRS/ AAO. Dr. Salz may be reached at (323) 653-3800; jjsalzeye@aol.com.
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