Attendees discuss VA, low vision, research

Issue: December 2005

ByNancy Hemphill, ELS, FAAO

Dr. Augsburger began the question-and-answer period by asking Drs. Catania and Quinn to comment on Oklahoma ODs being prohibited from using lasers in Department of Veterans Affairs facilities.

“It was a tremendous travesty of justice,” Dr. Quinn said. “Within the VA system, optometry is now the only profession that is regulated outside of the normal credentialing process. These practitioners have provided evidence of training and competency, and yet they’re precluded from offering those services to patients.”

Dr. Catania agreed. “It was a demonstrated model that worked,” he said. “Optometry was doing the job well, but it speaks to what I said earlier. We’ve awoken a sleeping giant, and when one of our strongest arms of this profession, the VA, can’t survive the pressure, that is an indication of what we’re taking on.”

Specialize, inter-refer

Audience member Richard S. Kattouf, OD, DOS, expressed his concern that, despite the specialty areas in optometry, such as low vision, developmental vision, orthoptics and corneal refractive therapy, most optometrists still choose to be generalists. He commented that the financial future of optometry is in performing the medical procedures optometrists do now, but also getting involved in the specialty procedures they are not doing.

Dr. Kattouf added that optometry is not a profession that inter-refers. “We have an awful lot of growing to do before we can go to the next step,” he said.

Stay on the offensive

Another attendee pointed out how optometry “fanned the flame of medicine” when it pursued diagnostics, then therapeutics, then orals and injectables. “And, yes, they seem to be a little more organized, and, unfortunately, we’re not as organized as we need to be,” he said.

Do we sit back and wait, or take the offensive? he asked. “I’m not pumped to do surgery, but we need to keep moving ahead if we want optometry to stay as it is rather than mixed in with three or four other professions,” he said.

Dr. Catania stressed that he is not opposed to pushing the boundaries and moving forward. “But it doesn’t always have to be scope of practice,” he said. “Reimbursement, participation in plans, recognition, those are the battles we should be looking at right now.”

Differing state laws a challenge

An audience member brought up the issue of always having to fight 50 battles because the optometry laws are different in every state.

Dr. Quinn responded, “Uniformity of state practice is a laudable goal. However, the practical reality is that ophthalmology is stronger in some places than in others, and the ability to get the law changed is a function of your political strength.”

“We are where we are because of the ability for us to have gone to the rural states and create models that we then used in other states,” Dr. Catania added. “It’s just a game.”

The next step: SLT?

Another audience member commented on how optometrists sometimes lose patients when glaucoma treatment with therapeutic agents fails and the next step is selective laser trabeculoplasty – and a referral out of the practice. “This is a perfect example of a laser procedure that’s simple and noninvasive,” Dr. Quinn responded. “I don’t understand why we shouldn’t be doing it.”

“It’s a very compelling argument,” Dr. Catania added. “Maybe that’s something we should start looking at, selecting very narrow areas that we recognize could affect us down the road, and start by subtly working on those areas rather than working on surgery in general.”

Research negatively affected

Susan Cotter, OD, of Fullerton, Calif., said, “A good indication that ophthalmology is taking this fight much more seriously than DPAs and TPAs is that they’ve banned us from attending their meetings. She said an international meeting in its online registration form bans optometrists. “I think it has implications for affecting optometric research,” she said.

“For example, at the American Academy of Ophthalmology meeting, they have a forum each year where the best papers published in their journal are presented,” she continued. “Last year, one of the papers was the ‘Vision in Preschoolers’ paper by Paulette Schmidt, OD, who had the National Eye Institute grant for study. Dr. Schmidt was not allowed to present at that meeting. This year, it was the Amblyopia Treatment Study III, for which Mitchell Scheiman, OD, was the lead author. It, too, had to be presented by an ophthalmologist.”