ask me about eyes

[Upstairs]

Interesting thread, a few questions:

What are the drops called that make your pupils dilate, and how do they work?

When testing the pupil's response to light in people who are unconscious or in a coma, what can we learn?

[slim]

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Slim,

What is with the quasi-ad hominem attacks? I have my business website on my profile. This makes me an a-hole and a cocky bastard??

Here's the first thing that popped up on LASIK complications-- these are the ones you claim don't exist:

Endopthalmitis post LASIK



Retinal Detachment Post-LASIK

From the American Academy of Ophthalmology:

Scope of Practice
The Academy, along with many other physician specialty organizations, continues to faces increasing challenges to its scope of practice on both the state and federal levels. To protect patient safety and ensure the highest level of quality eye care, the Academy is engaged in an ongoing battle against non-physicians who do not have the education or training to diagnose eye diseases or perform eye surgery.

As problems emerge in states across the country, the frontline for defending ophthalmology’s scope of practice remains in Oklahoma, where the Academy is on the offensive to reverse a rule recently passed that allows optometrist to perform over 100 surgical procedures with a scalpel.

On the federal level, non-physicians are using various federal agencies in an attempt to expand their scope of practice. Last year, the Academy successfully overcame a threat by optometrists to expand their practice within the Department of Veterans Affairs (VA). Following efforts by the Veterans Eye Treatment Safety Coalition and congressional leaders, the VA rescinded a directive that allowed optometrists to perform laser eye surgery on our nation’s veterans and Surgery by Surgery was reinstated throughout the VA. While this battle was won, the Academy continues to monitor and work with other federal agencies, including the Indian Health Service and the Department of Defense, to ensure the highest level of quality eye care is maintained for every patient.

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Calling yourself the "family doctor" for eyes is misleading. Optometrists are not trained to treat the vast majority of eye diseases. You have been brainwashed by your lobby to think of yourself as "the first line of defense" for eye diseases. Perhaps in the great socialist North it is different, but here, no patient is turned away for lack of a referral. They may at times be triaged to an appropriate specialist, or perhaps even to an optometrist. In the few states where you can perform "minor surgery" you have accomplished this by legislation, not by obtaining further training (i.e. going to medical school) which would qualify you to be a surgeon.

You state that the purpose of this thread would be to answer 2+2ers general ophthalmic questions. Why not handle just the optometric/refractive ones which you seem more than capable to do? The posters with sudden loss of vision, sudden onset of floaters, and decrease vision in the face of diabetes all need examinations by Medical Doctors , which would be someone who did 4 years of medical school, 1 year of internship, 3-4 years of residency, and then maybe 1-2 years of fellowship.

Finally, you SHOUT YOUR IGNORANCE with regard to Avastin as it has now changed the entire landscape for proliferative retinopathies. The vast majority of patients show improvement of their vision which has previously been unknown in age related macular degeneration. Additionally, this stuff makes abnormal vessels in diabetics melt away. The fact is, you don't know about it, its very important, and you should probably be content to spin those dials instead of mismanaging serious eye disease.

I submit that you have violated OOT Policies by being an OP in an "ask me " thread where you really aren't an expert, and by flaming me for no good reason. Perhaps you will catch NT in a good mood.

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Dr Steve,

You are an cocky ahole bc you come on here attacking optometry as a profession and boasting about all your years of schooling. Btw, your 27 years of schooling including "kindergarten" about the funniest thing I've ever heard.And your comment about MD Making a Difference is further proof you are a pompous individual. You probably wear your white coat with your name on it to the poker tables to make sure people know you're a DOCTOR. Now, there's no doubt as a retinal specialist, you know more about the eye and eye diseases and especially the retina than I do or any optometrist does. But why come on here and slander another profession? I clearly stated I was an optometrist and as such I am qualified to answer the vast vast majority of questions that the general public may have. If someone asked me about surgical procedures that I do not know about, I would tell them that it is beyond my scope of practice and advise them to ask an ophthalmologist.On the other, if you were presented with a case which was beyond you, you would proabbaly not be able to admit it and as such, put a patient's sight in jeoprardy.Oh wait....you know everything because you had 27 years of schooling.

In Canada, optometrists are the first line of defense when it comes to the eyes and I am pretty certain that is the case in the US as well. Patients do not come into optometric offices with their eyeballs dangling out of their orbits everyday....they come in with common problems like corneal abrasions, conjunctivitis, blepharitis, cataracts, strabismus, refractive problems, macular degen etc etc. We are here to DIAGNOSE these conditions and treat them if we can so that the ophthalmologists are not inundated with these "trivial" maladies. We refer them for treatment when there are urgent or complex cases that we cannot treat. I can just imagine how happy my local ophthalmologists would be if we sent every pink eye and blepharitis to them.

Basically, you are saying that any medical profession that doesn't have the MD degree is useless and are prone to misdiagnosis. I can tell you many,many cases of misdiagnosis by family doctors when it comes to eyes. An optometrist is university (not kindergarten or daycare) trained for 4 years on the eye. OD's work in many hospitals across the US managing and treating eye disease, they don't just work beside Walmart Optical like you think. I have friends who are family doctors and they tell me that they receive about 2 weeks training on the eye during medical school.

Endophtalmitis is not a considered a LASIK complication. Lasik is not intraocular surgery. Endophthalmitis can occur even through dental surgery or other procedures where the organism can enter through the blood stream.

I suppose dentists are not real doctors either because they are not MD's and since Max-Facial surgeons who are MD's can do the same thing, they must be incompetent.

Avastin and the like are all overated. You make a living off these drugs and as such you promote them. Look at PDT and how it was hyped as a cure for wet amd......please give me a break.

Lowly optometrist,

Slim

[slim]

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Cliff notes: ODs have less training than MDs. Not all are truly capable of being a "primary eye doctor" although some definitely are. Personally, I would go to an MD with any eye problem more significant than refractive/glasses/contact lens issues. MDs have better general medical training as well.

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While I agree with most everything you said in your post ,including optometrists should not be performing surgery, I completely disagree with the quote above. Optometrists are more than capable of being primary care eye doctors, as much as Family Doctors are capable of being overall primary health care providers. Yes there are plenty of incompetent OD's but there are just as many incompetent MD's. It is not a result of lack of training, it is a result of individual ineptness and stupidity.

You have no idea how many patients come in to see me for a red eye that doesn't go away weeks after seeing their GP who gave them Garasone drops. Whenever an GP sees red eye, it's Garasone. I've had cases of angle recesssion, HSV keratitis and angle closure etc where the GP prescibed Garasone because the eye is red. I'm not saying GP's are not well trained, they have broad knowledge about everything but poor knowledge on specific organs and tissues. They are good primary care providers.....just as OD's are but that's why there is tertiary care.

[7ontheline]

Slim,

Well, I prefer civil arguments, so we can agree to disagree. If I wasn't being clear, I meant that I would recommend that people with eye problems see an ophthalmologist, as opposed to an optometrist. I would trust almost any optometrist for an eye problem over an general family practice MD any day of the week. My problem is that in my experience I have seen too many problems handled incorrectly by optometrists. Most of the time this is not the case, but IMO why take that chance? I definitely feel that there is a place for both ODs and MDs within the realm of eye care, and that a minority within each group causes a lot of problems for the majority.

[The Yugoslavian]

Slim,

Awesome advice! I went to see my eye guy (optometrist not ophthalmologist) and he quickly identified what I have as some sort of conjunctivitis (forget the word he used) and gave me lubricant drops and ointment stuff for my eyes. I just figured since my eyes weren't red, I didn't have anything but then they started swelling up (almost like black eyes).

Oh, he said that not wearing contacts was uber-important. And I would have ended up wearing them all day yesterday if you hadn't told me to take them off! wooo!

THANKS SLIM! 9/10, would recommend advice from again, [img]/images/graemlins/wink.gif[/img].

Yugoslav
PS I asked him if I should see an ophthalmologist for something like this and he said no, not since optometrists can prescribe drugs and good ones are going to be able to correctly diagnose just about all problems.

[slim]

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Slim,

Well, I prefer civil arguments, so we can agree to disagree. If I wasn't being clear, I meant that I would recommend that people with eye problems see an ophthalmologist, as opposed to an optometrist. I would trust almost any optometrist for an eye problem over an general family practice MD any day of the week. My problem is that in my experience I have seen too many problems handled incorrectly by optometrists. Most of the time this is not the case, but IMO why take that chance? I definitely feel that there is a place for both ODs and MDs within the realm of eye care, and that a minority within each group causes a lot of problems for the majority.

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7ontheline,

Here in Canada, Toronto specifically, ophthalmologists do not see patients without referals. There is no way they can. They are already so busy as is, there is no way they can accept patients just walking into their offices with any sort of ailments. Like our hospital emergency waiting rooms, which are filled with patients with colds and flus, MD offices would be filled with people with pink eye and styes and subconj hemes. This is where OD's come in.....we are here to rule treat minor problems and direct patients who need tertiary care appropriately. I think the problem is that MD's feel threatened by OD's increasing scope of practice.Maybe they should be, I don't know....we don't really have that problem in Canada. MD's can't seem to shake that image of optometrists from 60 years ago as a guy who only does refractions and knew nothing about pathology. Fast forward to 2006......many optometry schools have MD's on staff teaching OD's. DO you really think they teach us anything different than they teach med students? Do you really think that 4 years studying one organ is not enough to make OD's competent front line eye docs? Yes you see some cases from OD's that may be misdiagnosed, but there are way more that are correctly diagnosed. Perhaps we should ask OOT to tell stories about visits to their GP for non-ophthalmic health issues that are misdiagnosed and see if it's MD's are really that perfect. When an OD or chiropractor or other health care misdiagnose or mistreat, it's bc we're not MD's.....but when an MD misdiagnoses, there is backing from fellow MD's and coverups.

[slim]

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Slim,

Awesome advice! I went to see my eye guy (optometrist not ophthalmologist) and he quickly identified what I have as some sort of conjunctivitis (forget the word he used) and gave me lubricant drops and ointment stuff for my eyes. I just figured since my eyes weren't red, I didn't have anything but then they started swelling up (almost like black eyes).

Oh, he said that not wearing contacts was uber-important. And I would have ended up wearing them all day yesterday if you hadn't told me to take them off! wooo!

THANKS SLIM! 9/10, would recommend advice from again, [img]/images/graemlins/wink.gif[/img].

Yugoslav
PS I asked him if I should see an ophthalmologist for something like this and he said no, not since optometrists can prescribe drugs and good ones are going to be able to correctly diagnose just about all problems.

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Did you tell him you got advice from some guy on an internet poker forum? [img]/images/graemlins/smile.gif[/img]

[poincaraux]

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slim,

any thoughts on ortho k?

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Yes.....horrible. You will very likely become progressively farsighted.

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can you tell me more about this? my wife is slightly nearsighted (she wears glasses at dusk and in the evening when she's driving, but otherwise, no problems) and is seriously considering ortho k.

thanks,

-poin

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OOPS....I'm really sorry....I made a mistake. I thought you were talking about RK which is completely a different procedure.

Ortho -Keratology is quite safe although there are reported cases of Acanthomeoba which is a serious eye infecting that can lead to corneal transplant. Even though it is safe, I don't practice it because it makes no sense to me why anyone would benefit from it. Your wife only wears glasses at dusk for driving, so why would she go through the hassle, discomfort and expense of wearing hard contact lenses at night to sleep just so she doesnt have to wear glasses to drive at dusk? The cost of the procedure and contacts usually is close to the cost of having lasik. But in your wife's case, I would probably not even recommend lasik bc her vision seems quite good. It's all risk vs reward. I was blind as a bat so my reward was high and my risk was low when I had lasik. Your wife on the other hand would be low reward low risk....not worth it in my opinion for both lasik and ortho K.

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slim-

here's a little more of the story: her prescription isn't very strong, but her eyes are getting worse. she sees ortho k as a way to keep her eyes from getting worse. she doesn't wear her glasses very often because she feels like her eyes get worse when she wears them. she thinks that, with the glasses, her eyes don't have to work as hard, and so get weaker. so, we were thinking that ortho k would be a way to stabilize her prescription, or maybe even make it better, with very little risk. it would have the added benefit that she'd be able to see pretty well even when she didn't have her glasses with her.

sound like a reasonable idea?

[Jim14Qc]

Hi slim, I had very bad sight from about 5 y/o untill around 15 (during which time my view gradually got better). At 15 I was 20/20 and no longer needed glasses.

My ophtamologist says this is because I went through an operation when I was 11 months old (my eyes crossed... I don't knwo what the word is in english) and they had to cut an optic nerve or something similar.

How come my sight got better and better untill the point where I didn't need glasses anymore? How come I didn't have glasses from 1 year old untill 5? Also, is this common or rare?

Thanks!

[slim]

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slim,

any thoughts on ortho k?

[/ QUOTE ]

Yes.....horrible. You will very likely become progressively farsighted.

[/ QUOTE ]
can you tell me more about this? my wife is slightly nearsighted (she wears glasses at dusk and in the evening when she's driving, but otherwise, no problems) and is seriously considering ortho k.

thanks,

-poin

[/ QUOTE ]

OOPS....I'm really sorry....I made a mistake. I thought you were talking about RK which is completely a different procedure.

Ortho -Keratology is quite safe although there are reported cases of Acanthomeoba which is a serious eye infecting that can lead to corneal transplant. Even though it is safe, I don't practice it because it makes no sense to me why anyone would benefit from it. Your wife only wears glasses at dusk for driving, so why would she go through the hassle, discomfort and expense of wearing hard contact lenses at night to sleep just so she doesnt have to wear glasses to drive at dusk? The cost of the procedure and contacts usually is close to the cost of having lasik. But in your wife's case, I would probably not even recommend lasik bc her vision seems quite good. It's all risk vs reward. I was blind as a bat so my reward was high and my risk was low when I had lasik. Your wife on the other hand would be low reward low risk....not worth it in my opinion for both lasik and ortho K.

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slim-

here's a little more of the story: her prescription isn't very strong, but her eyes are getting worse. she sees ortho k as a way to keep her eyes from getting worse. she doesn't wear her glasses very often because she feels like her eyes get worse when she wears them. she thinks that, with the glasses, her eyes don't have to work as hard, and so get weaker. so, we were thinking that ortho k would be a way to stabilize her prescription, or maybe even make it better, with very little risk. it would have the added benefit that she'd be able to see pretty well even when she didn't have her glasses with her.

sound like a reasonable idea?

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Well, I'm certainly not going to disuade you/her from using ortho-k bc it is safe, but it still doesn't make sense to me why you would choose that over conventional contact lenses. Ortho K works by molding the cornea to a flatter shape(I assume your wife is near sighted) but once the lens is removed after overnite wear, the cornea will slowly go back to it's original shape and her vision will blur again. It does not prevent her prescription from getting worse. Given that it costs a few thousand dollars and many visits to the optometrist and the fact that she has to sleep with the lenses, I personally would not use or recommend it but as long as it's safe, if you guys want to try it, go ahead.