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Thread: The end of "refracting-MD's?"

  1. #51
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    Scandiamed=Dr. Franklin


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    Franklin was doing Schiotz tonometry, which is antiquated and invalid. Do you really think these guys work inside an optical store, disregard their medical training, and then use the cutting edge in technology?

  3. #53
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    Physcian Shortage?

    There is a family physcian shortage, yet refracting MD's take the time to do sight testing in optical stores rather than work as a family doctor. Must be a good reason. ($?)

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    From CPSO, Dr. Franklin's eye exam

    Dr. Franklin testified that he used an autolensometer to assess the patient’s current
    prescription for eyeglasses. He used an autorefractor followed by trial lenses. He
    testified that he did an external eye exam followed by a retinal exam using an
    ophthalmoscope with a slit lamp aperture. He performed scleral tonometry in cases
    where he felt it was indicated. His practice was to chart only significant positive findings.

    note: "ophthalmoscope with a slit lamp aperture" is not equivalent to actually using a slit lamp

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    I've said before that MD's in Ontario are allowed to do any contorlled act, except scaling teeth, but including dispensing glasses. They need no further training beyond their MD. We have all seen the poor work these guys do. After the controversy of cosmetic surgery, the CPSO made up new guidelines, but still did not restrict any MD, no matter their training, to perform cosmetic surgery. The CPSO is sure not going to restrict refracting.

  6. #56
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    The CPSO doesn't hold them up to the same eye exam standards as eye doctors. Unfortunately, the public does not know the difference, and, unless they have experienced a full eye exam, often they believe a sight test is a full eye exam. As well, refracting MD's are often confused as optometrists.
    But with the shortage of family doctors, what is the motivation for refracting MD's to work for optical stores instead of working as family physicians (what they are trained for)?

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    Quote Originally Posted by NorthStar View Post
    The CPSO doesn't hold them up to the same eye exam standards as eye doctors. Unfortunately, the public does not know the difference, and, unless they have experienced a full eye exam, often they believe a sight test is a full eye exam. As well, refracting MD's are often confused as optometrists.
    But with the shortage of family doctors, what is the motivation for refracting MD's to work for optical stores instead of working as family physicians (what they are trained for)?
    Makes me wonder whether or not these refracting MD's have either residency/internship under their belts?

  8. #58
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    Most are GP's and have no more training than that. I even knew of one fellow who was an anesthetist.

  9. #59
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    Do you mean this one?:
    http://www.cpso.on.ca/Doctor_Search/...09&iCPSO=56787

    What is disturbing is that with all the complaints early in his career as a resident in anesthesia the CPSO determined Dr. Im was too unprofessional to practice medicine and stripped his licence of all medical priveleges except for "refractive optometry" in an optical store - if there is such a specialty.
    So the CPSO deemed him not professional enough to be a medical doctor, but OK as a refracting MD.
    Then in 2004 he was arrested.

  10. #60
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    Appeal Denied, but...

    From CPSO: http://www.cpso.on.ca/docsearch/deta...=4&id=%2023701
    Appeal denied, but the suspension seems to have been eliminated leaving only a 1wk preceptorship and a couple of inspections.
    This case sets a precedent that refracting MD's are not subject to the same standards as eye doctors, only to the standards of a "general practioner limited to eye exams" - whatever that means. Specifically, in the decision it was decided that a dilated fundus exam is not a standard of care required by a GP. Essentially this sets up a lower standard of eye care permitted for refracting MD's.
    So if they miss an undiagnosed or symptomless retinal tear or disease - no liability. How does this help protect the public? Unfortunately, the John Q. often assumes the refracting MD is a optometrist.

  11. #61
    bilateral peripheral scotoma LandLord's Avatar
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    North Star, I know exactly how you feel.

    There are receptionists, or "certified" optometry assistants who measure, fit, dispense, fill Rx's and counsel patients every day. They provide a different level of care than opticians, and John Q often assumes the assistant is an optician.
    Sent from my BlackBerry® wireless device

  12. #62
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    Nobody goes blind from a seg. ht. that is 1-2mm too high, but that is for another thread.

  13. #63
    Master OptiBoarder Shwing's Avatar
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    back to the original discussion (sorta), here in Alberta, the government is considering de-insuring eye exams completely.

    They de-insured (this means: paid/ not for by the government) eye exams for those between the ages of 19 and 64 back in '94. .

    Anyway, the Ophthalmologists have been asking for de-insurance of eye exams for everyone all along- Why? because none of them are General Ophthalmologists- all 100 +/- in the province are sub-specialists, and so none are refracting, so why waste tax-payer $$ paying for eye exams no-one is doing?

    Except my guy, but he's old as PMMA...
    :-}
    Shwing

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    Dr. Franklin to be reprimanded

    Slap on the wrist
    http://www.cpso.on.ca/whatsnew/commi...t.aspx?id=1448

    Another refracting MD who received his MD license in 1960 and in 2003 self-imposed a "[restriction on his practice to perform] eye refractions only."
    http://www.cpso.on.ca/docsearch/deta...=5&id=%2017542

    Again refracting MD's seem to be held to a lower standard of eye care by being permitted to perform refraction without obligation to perform ocular health assessment.

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    Quote Originally Posted by NorthStar View Post
    Slap on the wrist
    http://www.cpso.on.ca/whatsnew/commi...t.aspx?id=1448

    Another refracting MD who received his MD license in 1960 and in 2003 self-imposed a "[restriction on his practice to perform] eye refractions only."
    http://www.cpso.on.ca/docsearch/deta...=5&id=%2017542

    Again refracting MD's seem to be held to a lower standard of eye care by being permitted to perform refraction without obligation to perform ocular health assessment.
    It's nice to see that all of the O's have their fair share of problems, oversights and exceptions to the rules...

    1. The refracting MD's think they are Ophthalmologists and make their own sets of rules.

    2. The Optometrists (most, not all) think that their assistants do not require training, certification or post education. Straight from Harvey's grill to reception to pre-exam performing field testing, operating auto refractors and contact lens training/dispensing.

    3. The Opticians...well, we are unfortunately fortunate enough to have Mr. Bergez.

    ;)

  16. #66
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    You mean optical stores don't hire "burger-flippers" to work the dispensary or just shift a salesperson over from the shoe department? A relative of mine worked their way through college dispensing eyewear at a prominent optical store in T.O., alone 75% of the time with only on-the-job training, to do everything from frame selection to grinding and pick ups. It wasn't until years later when I informed them that that was illegal and they realized they could have gotten in trouble.
    Anyway this is for another thread.
    Eye exams that don't provide standard of care ocular health testing has the potential for harm; dispensing eyewear with uncertified personel has the potential for eyestrain. IMO it is essential that dispensing be done by trained certified personel; if you have incompetent staff the real harm will be to your reputation and eventually your bottom line regardless if you are an optician or optometrist. Patients may be inconvenienced and frustrated, but unlike undetected, undiagnosed eye disease, there is no permanent damage to vision.

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    Quote Originally Posted by NorthStar View Post

    1. IMO it is essential that dispensing be done by trained certified personel; if you have incompetent staff the real harm will be to your reputation and eventually your bottom line regardless if you are an optician or optometrist.

    2. Patients may be inconvenienced and frustrated, but unlike undetected, undiagnosed eye disease, there is no permanent damage to vision.
    I agree with number #1.

    I beg to differ with number #2.

    In most cases, #1 goes undetected. However, suppose that patient from #1 falls down their stairs or crashes their car with their new bifocal lenses???

    Now you have a bigger, expensive problem and one that requires a lawyer. It is also one that is fully visible to the industry, your peers and the general public. That's alot to gamble on for saving a few bucks an hour.

    Meanwhile, Betsy is gone back to flippin burgers.

  18. #68
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    #2 same thing could happen to a perfectly fitted first time bifocal wearer.
    And improper fitting or bifocal height does not cause eye damage. And according to the Ontario Opticians college website there have been a number of opticals dispensing without licensed opticians over the last number of years - if there was truly damage being done there would have been a public outcry in the media. And in the U.S., a much more litigious country than Canada, aren't there some states in which opticians are unregulated, allowing anyone to dispense? (ed: in 28 states there is opticians are unregulated - anybody can call themselves an optician and open an optical store.)
    Anyway this issue probably has been extensively discussed on other threads. This thread is about the CPSO allowing a lower level of eye care to exist, similar to the scenario of plastic surgeons vs. less qualified cosmetic surgeons.
    Last edited by NorthStar; 10-30-2009 at 08:10 AM. Reason: addition

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    There will always be good, bad and characters in all professions regardless of regulation.

    :cheers:

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    Check out this example of one "refracting MD's" exam findings. I'm sure you'll agree that it's extraordinarily thorough!:drop:
    http://forums.studentdoctor.net/show...=1#post8812741
    Attached Thumbnails Attached Thumbnails picture1copyb.jpg  
    Last edited by Oedema; 10-30-2009 at 12:07 AM.

  21. #71
    bilateral peripheral scotoma LandLord's Avatar
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    Question for the ODs who have worked at least 10 years. It feels like the issue of blindness being caused by non-OD refraction has been over-proselytized.

    Do you know what percent of your patients have gone blind?

    In what percent have you detected asymptomatic sight-threatening disease? (Not including cataracts)

    Have you missed any?

    What percent would have actually gone blind if the patient had waited until symptoms arose?

    What percent of the population is blind in countries where no eyecare exists?

    Yes, I know there are some evil, greedy refracting MDs, OD's and RO's.

    But honestly, is non-OD refraction a REAL problem or is it just a turf war$?
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    Quote Originally Posted by LandLord View Post
    Question for the ODs who have worked at least 10 years. It feels like the issue of blindness being caused by non-OD refraction has been over-proselytized.
    Only in practice on my own less than a year:

    Quote Originally Posted by LandLord View Post
    Do you know what percent of your patients have gone blind?
    Zero, none. Detected plenty with existing/recent blindness, all but one only monocular so far. The one bilateral blindness can partially be blamed on a GP failing to refer and gettting the diagnosis WAY wrong.

    Quote Originally Posted by LandLord View Post
    In what percent have you detected asymptomatic sight-threatening disease? (Not including cataracts)
    about 15% of my patients present with some form of potentialy blinding condition (this is excluding cataracts btw... my opinion of cataracts is that they are stictly part of the refractive continuum, hearing every patients tell me they have a family history of cataracts drives me nuts).

    More importantly though are the patients I've detected systemic disease in: several diabetics, hypercholestrolemia in a 22 yo, one brain tumor, carotid artery stenosis, vitamin B1/B12 deficiency,

    Quote Originally Posted by LandLord View Post
    Have you missed any?
    None so far:cheers:
    c

    BTW, why would you guys even want to do refraction? There's plenty of expertise needed in ophthalmic dispensing, we need more lens experts, not more refractionists anyways. Which brings me to this point, if you're not prepared to handle eye health then refraction is just going to be a major PITA as you're going to waste your time going through the motions with people that just don't have the potential to see very well/or as well as they'd like. Being able to look at the eye and find the cause saves me alot of time with the phoropter!

    And for those of your who are thinking I'm practicing is some place with a special population full of eye disease ridden old foggies.... Wrong, I'm in the fittest city in canada, with some of the longest life expectancy, and still blows my mind how many weird things I see in a day, especially in relatively young patients.

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    Quote Originally Posted by Oedema View Post
    And for those of your who are thinking I'm practicing is some place with a special population full of eye disease ridden old foggies.... Wrong, I'm in the fittest city in canada, with some of the longest life expectancy, and still blows my mind how many weird things I see in a day, especially in relatively young patients.
    I'm thinking it, especially since your anecdotes don't come near statistical data from the National Eye Institute at the National Institutes of Health.
    http://www.nei.nih.gov/eyedata/pbd_tables.asp

    I have found more often than not numbers unless actually looked at seem to have a way of messing with us, I have worked with a doctor who would worry about a specific case for days upon end and not even realize that the patient they are worried about was 2-3 days ago and many exams ago. Unless you actually have numbers showing 15% I would find that hard to believe, hey if you do you should do a research on why your neck of the woods has more disease then the rest.

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    add up the prevalence of AMD and diabetic retinopathy and you get close to 15% without any additional conditions.

    But I'm wouldn't put much confidence in that data as it seems to indicate that the prevalence of either myopia and hyperopia among seniors is only 35%?? Yes maybe only 35% of stubborn seniors wear their glasses but they ALL have it.

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    Quote Originally Posted by Oedema View Post
    add up the prevalence of AMD and diabetic retinopathy and you get close to 15% without any additional conditions.

    But I'm wouldn't put much confidence in that data as it seems to indicate that the prevalence of either myopia and hyperopia among seniors is only 35%?? Yes maybe only 35% of stubborn seniors wear their glasses but they ALL have it.
    The percentages in this case don't add up like you suggested, the percentage are of selected groups by their ages so if you add them all up the percentages are going to average out amoung each disease group, then their is no way of showing which patients have concurrent conditions of AMD and Diabetic Retinopathy and how they would be counted in this study.

    Another note is that those under the age of 40 were not included because of insignificant data, this group is larger than the data set and would no doubt lower the percentages.

    Unless your seeing nothing but 40yo+ patients 100% of the time 15% would not hold up, again if you have more recent data I am always willing and ready to read up some more on the topic since it is fascinateing.

    I find that the part I admire about optometry is the amount of care that goes into the patients in a practice by those exceptional few, it is more likely that the lower percentage takes up 15+% of your empathy for the patients situation. That's something that I truly admire.

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