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Focus on new technology, not surgery

Issue: December 2005

ByNancy Hemphill, ELS, FAAO

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CLEVELAND – Louis J. Catania, OD, FAAO, a Primary Care Optometry News Editorial Board member and practitioner at Nicolitz Eye Consultants in Jacksonville, Fla., took what he called the “practical view” in the scope of practice debate. “We should not be pursuing expansions into invasive surgery,” he said.

Surgery requires unique training and unique philosophy, he said. “It’s a unique educational process that we do not have in our profession,” he said. “We came into optometry understanding that it’s a nonsurgical profession, and it was our choice to be nonsurgical in our care. It takes a lot of experience to be a good surgeon, and optometry will never achieve that. There is no way any optometry school in this country can ever provide enough surgical material for optometry students to become surgeons.”

He also pointed out the oversupply of surgeons. “They can’t find enough surgery to do themselves,” Dr. Catania said. “They’re creating what they call ‘medical ophthalmology’ residency programs now, because they know that there are too many surgeons.”

Optometry should improve its current educational programs, Dr. Catania said. “We don’t have enough time in the 4 years to give students the education they already need,” he said. “And if we don’t retain our vision care status in health care, we’re dead in the water.”

An increased use of technology is where the profession should be looking, he said. “Corneal refractive surgery is rapidly starting to wane because the results are just not very good, based on what we’re learning about things like higher-order aberrations,” he said.

Dr. Catania is seeing a movement back to nonsurgical alternatives such as contact lenses that correct higher-order aberrations, better spectacle correction and corneal onlays. “Technology is far more important than surgery at this point,” he said.

He also stressed an increased need for using ancillary personnel to gather the data captured with new technology. On the same note, optometry must continue to control opticianry. “They’re a political force already,” he said. “They’re taking over Canadian provinces in refracting, and it’s just a matter of time until they come south and take over the states as well.

“We always love to denigrate dispensing, but why are ophthalmologists starting to dispense?” Dr. Catania asked. Because they are realizing they can make more off their dispensary than doing surgery, he said. Ophthalmology and opticianry are looking to fill the void optometry is creating in vision care.

“Our political strength is just not what it used to be,” he said. “I think some of you old-timers would agree that corporate practices depleted our ranks of politically oriented, aggressive and interested young worker bees. We gave every young optometrist a very good profession. Maybe we made them too soft by doing that.”

Growth in health care means technology, Dr. Catania said. The public needs better technology to make health care and eye care more efficient. Optometry should commit to new technologies to control its future, he said.

Surgery is not worth the risks, the surgery time and cost, malpractice insurance, equipment nor instrumentation, he said.

In his rebuttal to Dr. Quinn’s subsequent presentation, Dr. Catania stated that he would never say there will not be a time for optometry to pursue surgery, but given the current conditions and circumstances, this is not the time. “If the leaders in this profession who are moving optometry in the direction of surgery succeed, it will all be a matter of timing,” he said.

He also commented on the blurring of the line between ophthalmology and optometry and its confusion among third-party payers. “And if we blend into one profession, I’m worried that it won’t be optometry,” he said. “We’re going to be absorbed if we let that happen.”

Dr. Catania said he agreed with Dr. Quinn on the issue that optometry should have legislation to allow ODs to use their own professional judgment, but he fears that such a bill will never pass.

He asked the audience if they would refer one of their loved ones to a surgeon who has had incomplete training vs. someone they know as a great surgeon. “I refer to surgeons who hate optometry, but I refer to them simply because I know they’re the best at what they do,” he said. “I will do the right thing for my patients and go against the grain. We don’t want to see mediocre surgeons out there. And we certainly don’t want to be one.”

For Your Information:

• Louis J. Catania, OD, FAAO, can be reached at Nicolitz Eye Consultants, 1235 San Marco Blvd., Ste. 301, Jacksonville, FL 32207; (904) 398-2720 ; fax: (904) 398-6408; e-mail: lcatania@bellsouth.net.