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Thread: Neuro-Optometry

  1. #1
    Bad address email on file Darris Chambless's Avatar
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    Neuro-Optometry

    Hello to all,

    I was wondering if anyone is familiar with the designation "Neuro-Optometrist"? I'm not a "babe in the woods" by any means but I have never heard of this before and was wondering if any of the rest of you had. Is it like "Behavioral Optometry"?

    Thanks in advance,

    Darris C.

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    Neuro-Opthalmology

    I have never heard of "Neuro-Optometry" Do know a couple neuro-opthalmologists. I have had their job described as "He is the link beween the opthalmologist and the neurosurgeon." Translation: When the opthalmologist cannot diagnose the problem or cure the problem, he runs a lot of tests and tells the family why the opthalmologist can't fix the problem.

    I suspect "Neuro-Optometrist" is a bid by optometry to get in on this much like everyone once tried to get in on the pie with dyslexia.

    Chip

  3. #3
    Bad address email on file NC-OD's Avatar
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    Thumbs up Neuro-optometrist

    I only know of a handful of neuro-optometrist. Basically, these are usually residency trained OD's who choose to specialize in problems of the visual nervous system. As such, they frequently are also involved in Low vision as well.

    Most OD's (and OMD's) do not want to "use up their time" diagnosing and treating these somewhat difficult patients, such as those with visual field loss from strokes, neuritis, MS, papilledema, Horner's, Migraine etc. So they refer. (Especially those at Wal-Mart......sorry I could not resist).

    The neuro-optometrist or neuro-ophthalmologist generally work by referral-only from other eye docs for cases of unusually optic nerve appearance or unusually signs/symptoms. Of course, after diagnosis of a tumor or aneurysm they are referred to a neuro-surgeon.

    There is a hugh range of OD jobs. All OD's are not equal. Some refract to sell glasses for Wal-Mart and others are Professionals.

    It's a tough job.

  4. #4
    Bad address email on file Darris Chambless's Avatar
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    Hello NC-OD,

    I have to say I like your style :) Sorry it took so long to get back to this thread but I've been a bit busy here lately (which is a good thing)

    I agree with you in that all Optometrists are not equal. I've worked for two of the best in my home town and both had different specialties. However, those specialties were self taught or they were good at certain things because of the way they practiced Optometry. I do however feel that Neuro-Optometry is a self designed title and does carry a very strong medical connotation with it. To me that's going a little too far, but then it does give a head of steam to my O.D.O.O. designation :)

    Also I do have a question for you with regard to Ortho K. Have you seen a big surge in its use by OD's? We have four OD's in town that are really pushing it. They have a variety of names for it none of which are Orthokeratology. Most call them "Sleeper lenses" or "Corrective curve contacts"

    I do have to address your comments on the Wal-Mart doctors. Many would argue that you have the same caliber of OD in those offices as anywhere else and to that I would say that straight out of school they are correct, but after having been in practice for several years the difference in the independent and the chain OD's are night and day. There is a reason though that many either don't think about or refuse to admit and that is the type of practice that you have from one to the other.

    If we use Wal-Mart as an example we can look at the clientele. The majority of patients in a Wal-Mart office are there for convenience. They were already shopping at Wal-Mart anyway so why not stop and get their eyes checked while they're at it. The doc here has a good 60 to 70 percent of his clientele are walk in patients. He does a booming business but he's not going to see those patients with retinal proliferation, or stribismus, ambliopia or any other visual anomoly unless by accident. The private practitioner, on the otherhand will see these patients on a more regular as well as deliberate basis because the patients seek these doctors out for special care.

    As I said it's all in what you see on a daily basis. I have a very good friend of mine that manages a Wal-Mart optical here. I trained him and he worked with me for about a year and a half. He has expressed to me that if it weren't for having been trained by me and working with me in the independent setting he would have never learned much of what he knows. He said that Wal-Mart just simply doesn't offer or do a lot of the things that we did at the OD's office and sometimes he gets discouraged about not being able to use what he knows to get some things done for the patients, but as he said "It's corporate."

    Don't get me wrong I think these places offer a great place to start for many and you can learn the basics there, but there are many aspects that OD's and Opticians alike will not be exposed to in a corporate settings such as Wal-Mart because of time constraints of availability of equipment to do such jobs. Many would argue with you and or me for saying these things, but I can guarantee that if you ask any that started out in corporate setting and then move to an independent practice they would tell you that they have leanred so much more in the private sector than they ever would have in the corporate opticals and offices.

    Oh well, it's just our opinions ;)

    Take care and it was good hearing from you.

    Darris C.

  5. #5
    Bad address email on file NC-OD's Avatar
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    Ortho-K

    Hello Darris,

    Thanks for the comments,

    I am not a big fan of Ortho-K. There are not many docs in my area doing it. If your going to have an ill-fitted contact lens on all night pressing on your cornea, you might as well have refractive surgery. In either case we just don't know the long term implications on the cornea. It may very well disrupt the endothelium to a critical point over time and cause severe corneal problems.


    That said, I am not for or againts Ortho-K or refractive surgery. I just try to give my patients all the information and let them decide. If they ask me for my honest opinion..........I tell them I wear -4.00 Purevision contact lenses daily wear.:p

    And nerver-ever get Lasik from a spectacle wearing surgeon.:D

    As far as Wal-Mart is concerned..........well I guess thats for another time............:cheers:

  6. #6
    Master OptiBoarder Alan W's Avatar
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    With all due respect.......

    The world is made up of all kinds of people.
    Wal-Mart optometrists are not a genetically different group nor are they an inferior group. Some, as Cole-associated OD's, Sam's associated OD's, etc. came to these "hosts" because they were poor retailers on their own at one time, philosophically against prescribing unessential glasses just to pay the rent. Others came to these "hosts" because they were first timers and then moved out on their own from there. So on and so forth. By and large, from 35 years of experience working with both MD's and OD's I found the ratio of poor practitioners to the general professional population no greater in the "host environment" than anywhere else. However, what I did discover was that a whole lot of them, wanting to practice pure clinical optometry without the pressures of prescribing for glasses in order to make the rent or the car payment, had to take on greater numbers of patients in order to make the necessary or desireable bucks. There are those who have done well as clinicians dispite the volume, and have seen about everything there is to see, clinically speaking, taking good care and referring when needed. Others, not so well. Quite a few left these hosts to work in a slower or more enriched atmosphere, clinically speaking. And, then the "catch 22" syndrome continues. Then there are those who are just plain poor practitioners. And, you'll find them in every professional landscape. Lucky is the experienced optician who partners with the optometrist who wants to practice pure optometry and lots of it, and will let a managing optician worry about the "other" part, the business and marketing side. And, guess what . . . I return to doing just that in mid October. NO MORE CORPORATE OPTICS!

  7. #7
    Bad address email on file NC-OD's Avatar
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    Alan W. is right,

    There are very good OD's and Opticians working at places like WalMart.

    One of my best friends has been practicing at WalMart down the street from my office. (He actually "runs" 3 stores in our city along with 2 other OD's). He has been there 5 years. I met with him for lunch a few weeks ago and I almost didn't recognize him.

    He was a beaten, defeated man. Despite making great money, he was completely burned out. He told me he was tired of working 6 days/ 50-60 hours per week. He is hoping to cut back to 2-3 days per week, giving up whatever money he had to. And is trying to find an OD to take over for him.
    He is ready to quit optometry all together.........

    He made the mistake many new OD's are making. They are attracted by easy money with little risk. Almost always they regret it a few years down the road when they have become dependent on the money and unable to live with less as is necessary when starting their own practice.

    So while neither the OD or Walmart are bad entities here........the combination in not a good mix. He finally realized that has been a TOOL of the corporation....making them money by working like a dog.....money that he could have made for himself.......seeing 3 or 4 patients an hour instead of 6-8. He told me he felt like he was working on a factory line.

  8. #8
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    Insight

    3+ years ago I was challenged to one of the most life changing experiences in my family's life. My daughter sustained a near fatal traumatic brain injury in addition to losing a facial nerve and a severe penetrating injury that missed the carotid artery by less than a 1/4inch. We dealt with a diffuse closed head injury that included a dual front and right side temporal injury. It took a long time to figure out where we were 2 + years of rehab. We encountered speech therapy to help think and meds to assist.(along process) I learned so much about the brain, thinking, cognition, muscles, vision, etc. I also learned so much about post traumatic stress disorder.

    Together with my background and an OD who I consider a very close friend we assisted my daughter in rehab process with the neuro team. TBI recognizes the correlation that neurooptometry can bring to the plate. It is valuable and should not be dismissed. It is a complimentary rehab team member when necessary. I also know that my background helped round out our effort. Check out cnsneuroskills website. Learning skills also used several low vision techniques to bring things into cognition and later longer term memory.

    Today with many prayers she is a college student with short term memory deficits but educated to employ learning strategeys.

    :cheers:

  9. #9
    Master OptiBoarder Alan W's Avatar
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    re: neuroptometry

    Here in Clear Lake Texas there is an optometric practice that has very good reputation. Neoroptometry plays a strong role in the practice related to learning disorders, and they have a subspecialty office dealing in just that. I'm not in a position to evaluate the practice of neoroptometry. But, they seem to enjoy the support of the school district as well as referrals from several other eyecare professionals nearby. I certainly would not rule out these people or that subspecialty going forward.

  10. #10
    Bad address email on file Darris Chambless's Avatar
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    Hello there again,

    Now I have to say that I love Alan like a brother, but why does he get all the credit??? :-) I too said that there were good OD's and Opticians working at these corporate entities just that a lot of what they get to see is very routine and because of constraints put on them by the corp. they didn't get to practice a lot of things that they could if they were independent.

    So with that said I want my pat on the back and a peck on the cheek :)

    Darris C.

  11. #11
    Master OptiBoarder Alan W's Avatar
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    Darris, Oh, Darris, Oh Darris!!!

    Bro
    You deserve the credits . . .
    I want you to have them from the bottom of my heart!
    And, its true . . .you did say some very similar things.
    And, certainly, if I had known when I put NC-OD in my last will and testament, that you would be cut out . . . I would never had done it.
    So, I am revising the ol LW and T to include a clause that says:
    "If Darris Chambliss makes any statements that strike any resemblance to anything I have said, and that what I have said receives any credit that Darris doesn't receive, Darris is entitled to due and fair compensation. To wit: My old Walmart uniform, roll of little red circles that Walmart insist be used to verify progressive seg heights and PD's, and gold stars used to collect points for selling AR to customers who have absolutely no need for it since they are busy working on oil rigs, but it kicks up the profit line and lowers the payroll!"

  12. #12
    Bad address email on file Darris Chambless's Avatar
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    Okay Alan,

    But where's my peck on the cheek? :)

    Darris "Still waiting" C.

  13. #13
    Master OptiBoarder Alan W's Avatar
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    Darris . . . . wait no more!

    My Friend......
    wav. files are NOT valid attachments on the Optiboard.
    So, I'm emailing your peck on the cheek.
    But, as a token of my affection, the gIF file attached is just a starter.
    Alan
    Attached Thumbnails Attached Thumbnails Click image for larger version. 

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  14. #14
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    :D Here is my peck on the cheek Darris! Hope to meet you some day. Oh fearless leader!

  15. #15
    Bad address email on file Darris Chambless's Avatar
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    My dearest Alan,

    Thank you for that wet and titilating peck on the cheek. It was devine. Was it good for you too? :) I'm still all a gush over it. It was dreamy. Words cannot describe it, but poetic and soothing would come close.

    Not wanting to critique or look a gift horse in the mouth but the tongue thing in the ear was a bit much. Could have done without that but hey, I got the bonus plan :)

    Bev, you may pat me on the tushy if you like :)

    I look forward to meeting everyone in person one of these days and am slowly but surely succeeding. Some will be happy to see me while others will turn and walk away, but either way all of my subjects will have met that which is I "The Supreme Leader" :)

    Take care Alan, Bev...Love ya both,

    Darris "The Supreme Leader" C.

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