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ODs must maintain professional judgment

Issue: December 2005

ByNancy Hemphill, ELS, FAAO

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CLEVELAND – Christopher J. Quinn, OD, FAAO, a Primary Care Optometry News Editorial Board member and president of Omni Eye Services in Iselin, N.J., took the “progressive” position in the scope of practice debate.

“For years, ophthalmology has tried to define our profession,” he began. “Somehow, ophthalmology was able to force us to define subclasses of drugs, and we’ve had to fight these battles over and over again. Diagnostic drugs … therapeutic drugs … no other profession classifies drugs into both diagnostic and then therapeutic, much less further subclassifications such as steroids, glaucoma, controlled dangerous substances, oral medications, injectable medications.

“And then we have surgery, simply another form of therapy,” he continued. “And ophthalmology is trying to further subdivide surgery into laser treatments or ‘surgery with a scalpel.’

“The heart and soul of this debate is that you should have the right to use your professional judgment to provide care for your patients as you see fit in the best interest of your patients,” Dr. Quinn said.

“I love the dentistry model,” he continued. “If you have a severe toothache, where do you go? You go to your dentist, the general dentist, the primary care provider dentist.

“Your dentist may decide you need a root canal,” he said. “He or she may perform that procedure. Or he or she may decide that you need to see an endodontist or a periodontist, but the fact is that dentist is making a professional judgment about his or her ability to provide the care that the patient needs.”

According to Dr. Quinn, the American Medical Association defines surgery as anything that changes tissue, alters it mechanically, chemically or with ionizing radiation. “If we accept the definition of surgery as being anything that alters human tissue, barbers perform surgery, and it includes body piercing, tattoos,” he said. “By the way, there is one state in the union where tattooing is outlawed: Oklahoma.

“Manicures or anything that’s cutting tissue has the potential for complications,” he continued. “Tanning is using ionizing radiation to alter tissue.”

“Surgical” procedures in eye care can range from orthokeratology to strabismus surgery. “Surgery encompasses a very broad range of procedures, so all surgery can’t be lumped together,” he said.

“One of the best reasons laser has been incorporated into medical practice today is because it is less invasive,” Dr. Quinn said. “It’s a simple procedure. Most ophthalmologists in practice today never had any clinical training using lasers.”

He recounted an experience he had interning at an ophthalmology practice. When the ophthalmologist was delivered an argon laser, “he pulled out the manual and a week later performed his first peripheral iridotomy,” Dr. Quinn said. “Laser procedures are not complicated, and they don’t require ‘years of training’ to master.”

Dentists, podiatrists and chiropractors use lasers, he said, and they did not have to fight to get that right. Nonprofessionals are permitted to perform laser procedures for hair removal and aesthetics, he added. And some certified professionals perform laser surgery “under the supervision of a physician.”

Dr. Quinn agreed with Dr. Catania that the roots of optometry are analysis and correction of refractive error. “Yet we’ve now lost the edge in treating refractive error to ophthalmologists, who are able to apply the latest technology,” he said. “We gave up what is our traditional root and let ophthalmology basically take over.”

The question is not whether optometry should be performing surgery, but rather whether there should be limits on the type of surgical procedures optometrists can perform, Dr. Quinn said. “And I believe that the limit to practice for optometry should reflect the training and experience of each individual and the best professional judgment of the optometrist to act in the best interest of his or her patients.”

In his rebuttal, Dr. Quinn stated that he did not disagree with Dr. Catania on many issues, but that his own arguments are for where the profession should be. “I don’t believe that in my lifetime I’ll be doing surgery,” he said, “but I think that the profession needs to have the debate now and needs to consider its options to continue to grow.”

Dr. Quinn believes an oversupply of neither optometrists nor ophthalmologists exists. “If you look at the public health care need and all the unmet care in our field today, we have a shortage of eye care providers,” he said. “So perhaps some of our energy should be spent on seeing that the public health care need is addressed, and maybe that has something to do with access.”

For Your Information:

• Christopher J. Quinn, OD, FAAO, can be reached at Omni Eye Services, 485 Route 1, Ste. A, Iselin, NJ 08830-3009; (732) 750-0400; fax: (732) 750-1507; e-mail: cqod@comcast.net.