OD ban from AAO meeting viewed as unnecessary, damaging

A controversial decision by the American Academy of Ophthalmology (AAO) to exclude optometrists from the educational portion of its annual meeting has sparked strong reactions from ODs throughout the country.

Recently, these sentiments culminated in a statement by American Optometric Association (AOA) president Victor Connors, OD, expressing a wish that the AAO retract its decision.

“We would say that we hope they would reconsider this decision,” Dr. Connors said in an interview with Primary Care Optometry News. “It is not good for the collegial relationship between optometrists and ophthalmologists, and it’s not good for patients.”

According to an AAO news release, the exclusion of optometrists from the meeting’s educational forums is based on raised “standards for participation” in these programs. “The standards, consistent with the education and training of ophthalmologists (Eye MDs), will preclude participation by optometrists,” the press release stated.

While these raised standards are not explicitly defined, the press release went on to state, “Academy educational programs are developed for ophthalmologists who possess the educational foundation of medical school, internship and residency.”

However, these raised standards do not apply to nurses, technicians and assistants, who can still attend the meeting except for skills transfer courses, which are open only to physicians. Michelle Stephens, AAO media manager, said in an interview.

Basis for the decision

According to Allan D. Jensen, MD, president of the AAO, the decision to ban ODs from AAO courses was made by the AAO board after considering a recommendation from the council representing the AAO’s membership.

The council discussion was prompted in part by the April 28 signing of HB 2321 in Oklahoma, which clarified Optometry’s Practice Act to include the word “surgery.” The bill was introduced in response to an earlier opinion issued by the state attorney general and was intended to re-establish the ability of optometrists to perform basic procedures such as punctal occlusion or epilation of lashes.

For some ophthalmologists, however, such legislation was viewed as an encroachment on the territory of ophthalmologists. “This legislation will basically let optometrists be ophthalmologists without the benefit of medical school,” Dr. Jensen told Primary Care Optometry News.

Ophthalmologists were additionally concerned that allowing optometrists to attend courses at AAO meetings essentially enabled ODs to seek expanded practice scopes.

Dr. Jensen estimated that fewer than 100 of the attendees at AAO courses are registered as optometrists.

“The council was concerned that optometrists were using the fact that they were taking educational courses as a basis for appealing to legislators for expanded scope of practice,” Dr. Jensen said. “The academy decided that while we were pleased to provide education to optometrists, we’d rather not have them use that to claim that they are medically trained.”

Dr. Jensen said the courses had also been open to ODs as a means for improving their optometric practices and to enhance working relationships between optometrists and ophthalmologists. “When we gave this opportunity for education, it was not for them to become ophthalmologists,” he said. “It was for them to better their own practices. We have nurses and technicians who take courses at our meeting, but they don’t then go to the legislature and say they want to do surgery.”

But according to J. James Thimons, OD, a Primary Care Optometry News Editorial Board member based in Fairfield, Conn., optometry to his knowledge has not sought to parlay CE course attendance into surgical privileges.

“I have been involved in the therapeutic legislation of about as many states in this country as anyone. I am well aware of what is being used to create the appropriate information stream for politicians to consider for optometry’s advancement,” he said in an interview. “And in my entire foray into that arena in boards of optometry, I have never once used the education I received at any ophthalmology meeting as a basis for credentialing.”

Politicizing the field of knowledge

The reaction of many optometrists to the AAO’s decision has been a combination of disapproval and confusion.

“About 99% of optometrists don’t even know the reason the AAO is doing this,” said Paul Karpecki, OD, who has lectured at AAO meetings. “Apparently, it has to do with surgery, but I would have to think that the percentage of optometrists wanting to do intraocular procedures is next to none anyway.”

Along with bafflement over the motivation for the decision, optometrists also strongly disagree with the approach the AAO is taking to solve this perceived problem. “I’m just not sure that closing communication and education can benefit the professions or our patients,” said Dr. Karpecki.

“As an academician, I do not condone the restriction of education by any group based upon preconceived notions or other biases,” said Alan G. Kabat, OD, associate professor at Nova Southeastern University College of Optometry. “And certainly, the withholding of knowledge should never be used as a tool for retaliation by one group against another.”

Dr. Thimons said he doesn’t believe anything positive can be accomplished by the strategic withholding of education. “It’s just an issue of the choice to politicize the field of knowledge, as opposed to maintaining the traditional grounds of political engagement that they have in the past,” he said. “This doesn’t elevate them in any way, and I don’t think it’s helpful to anybody.”

Dr. Jensen does not feel that banning optometrists from the AAO educational courses is likely to obstruct optometry’s ability to learn of new and important ophthalmic developments. “They have their own courses, and they have their own organization, the American Optometric Association,” he said. “I’ve never gone to their meetings. I am sure they have wonderful educational opportunities at the AOA meeting.”

Dr. Thimons agreed that the AAO meetings are certainly not the only venue in which optometrists may gain further education.

“There are many places where programs of that caliber can be accessed, and there are numerous optometry programs that have excellent presentations by optometry, ophthalmology and other physicians, so it’s not that there’s a lack of opportunity,” he said. “It’s just a disappointment that they have elected to make knowledge a point of political interest, as opposed to contesting our differences and similarities on the more typical playing fields that we’ve used in the past.”

Impact on OD meetings

Despite the contention created by the AAO’s decision, optometrists do not anticipate difficulties in securing MD speakers for future optometric meetings.

“I don’t think that will be a problem at all,” said Kirk Smick, OD, who is involved in planning several optometric meetings, including the AOA Congress, Vision Expo East and West and previously SECO. “I just got back from the American Society of Cataract and Refractive Surgery meeting, and many ophthalmologists who are friends of mine came up to me and apologized for what is going on and said that they would be more than happy to continue to lecture at optometric meetings.”

Dr. Smick emphasized that optometrists have no intention of excluding ophthalmologists from any of their meetings, “for the simple reason that any time any society tries to curb the flow of knowledge and information, it is almost self-destructive,” he said.

Dr. Smick added that he does anticipate one change in future optometric meetings as a result of the AAO’s decision – the content of the CE courses may need to be modified. “Our optometric meetings might have to start including more of the subjects that we historically got at that meeting, such as updates on new techniques in cataract surgery, IOL changes and refractive surgery improvements,” he said.

Dr. Smick expressed his respect for the AAO meeting and his disapproval of the decision to ban ODs from it. “It is a very good meeting. I have attended it every year for the past 15 years,” he said. “I am sorry to hear that they’ve decided to do this.”

Line in the sand

From the perspective of the AAO, the measure was necessary to prevent optometrists from overstepping their boundaries, Dr. Jensen said.

“This is a message to optometrists. We love to deal with them, and we value their work,” he said. “But we don’t think it’s right for them to push to do surgery. We are saying, ‘This is the line in the sand. We don’t think you’re trained to do surgery. If you want to do surgery, go to medical school.’”

Dr. Jensen said while he believes the average optometrist does not want to do surgery, he maintains that a few aggressive ODs do have this goal.

“We think most optometrists are probably happy doing ocular evaluation, contact lenses, glasses, routine vision care, low vision rehab and so forth,” he said. “But we think there are a small number of optometrists, some of whom are in leadership positions, who want this for prestige. And they don’t make it a secret: they want parity with ophthalmologists, and they are pursuing the legislation to do that without going to medical school or taking a residency.”

According to Dr. Connors, however, the way in which the matter was handled was inappropriate and unhelpful. “If they wanted to enter into a dialogue on this issue, our phone lines are open,” he said. “We would gladly entertain that. But they initiated this action. It seems the political battle is escalating, and it’s not going in a good direction.”

For Your Information:

• Victor Connors, OD, can be reached at the AOA, at (314) 991-4100; fax: (314) 991-4101. The AAO can be reached at (415) 561-8500; www.eyenet.org.
• Allan D. Jensen, MD, can be reached at (415) 447-0213; fax: (410) 235-1267.
• J. James Thimons, OD, can be reached at (203) 366-8000; fax: (203) 334-2401; jim.thimons@tlcvision.com.
• Paul Karpecki, OD, can be reached at (816) 746-9800; pkarpecki@kc.rr.com.
• Alan G. Kabat, OD, can be reached at Nova Southeastern University College of Optometry, (954) 262-1470; fax: (954) 262-1818; kabat@nova.edu.
• Kirk Smick, OD, can be reached at (770) 968-8888; fax: (770) 960-2465.