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Thread: Glaucoma specialist slams BC Health Minister

  1. #1
    Excalibur
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    Glaucoma specialist slams BC Health Minister


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    bilateral peripheral scotoma LandLord's Avatar
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    I don't understand why Coastal Contacts can't just require a prescription like everyone else
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    Tic Toc.

    May 1st is coming up really soon...

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    Quote Originally Posted by Excalibur View Post
    Interesting article; particularly when the same Minister increased the scope of practice of optometrists to include the diagnosis and treatment of glaucoma. Further, according to the BC government web site a more recent change includes the use of emergency glaucoma treatment and the application of diagnostic ultrasound. If I remember correctly organized ophthalmology also objected and continue to object to optometrists treating glaucoma in BC, Ontario and just about any other national or international jurisdiction. Is it possible the headline of the story can also be used to describe ophthalmology's objections to the deserved increases in optometrists scopes. So come on Excalibur - you are having a great time with firing up your electorate, but this type of BS doesn't do justice to any sensible discussion.
    Last edited by Flybynight; 05-01-2010 at 09:56 PM.

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    Quote Originally Posted by AnotherOD View Post
    Tic Toc.

    May 1st is coming up really soon...
    May 1st has come and gone Caesar. I am checking news articles to see if the country west of the Rockies fell into the Pacific. In the meantime I came across this document that I found to be just as stupid as the rest of the debate. https://www.cpsbc.ca/files/u6/MoHS_O...ts_090112_.pdf

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    Quote Originally Posted by Flybynight View Post
    Interesting article; particularly when the same Minister increased the scope of practice of optometrists to include the diagnosis and treatment of glaucoma. Further, according to the BC government web site a more recent change includes the use of emergency glaucoma treatment and the application of diagnostic ultrasound. If I remember correctly organized ophthalmology also objected and continue to object to optometrists treating glaucoma in BC, Ontario and just about any other national or international jurisdiction. Is it possible the headline of the story can also be used to describe ophthalmology's objections to the deserved increases in optometrists scopes. So come on Excalibur - you are having a great time with firing up your electorate, but this type of BS doesn't do justice to any sensible discussion.
    If you read the glaucoma specialists blog, you will notice that he himself is in support of optometrists treating glaucoma.

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    Quote Originally Posted by Oedema View Post
    If you read the glaucoma specialists blog, you will notice that he himself is in support of optometrists treating glaucoma.
    Your just couldn't resist could you?

    Mr. Daryl Beckett Director, Legislation & Professional Regulation Ministry of Health 5‐2, 1515 Blanshard St. Victoria, BC V8W 3C8
    Dear Mr. Beckett:
    RE: PROPOSED OPTOMETRISTS REGULATION
    The College of Physicians & Surgeons of BC (the “College”) writes in follow‐up to the proposed optometrists regulation recently posted by the Ministry of Health Services. The Executive Committee of the College had an opportunity to review the proposed regulation, and directed that further information and advice be obtained from the BC Society of Eye Physicians and Surgeons prior to the College finalizing its position on this important regulatory matter.

    In providing these comments on the proposed regulations, the College has considered carefully the need to ensure patient safety while recognizing the desire of government to increase public access to health care providers. The College acknowledges that as health care evolves, scope of practice activities of one health profession may overlap with another. Our comments regarding limits on the proposed expanded scope of practice of optometrists are based on the College’s position that broadening the scope of practice and responsibility for optometrists in some circumstances poses a risk to patient safety.
    The following points set out the College’s comments and concerns regarding the proposed regulation for optometrists.
    Restricted activities
    (1) (b) Removing a superficial foreign body:
    It is the position of the College that “removing superficial foreign bodies” should be revised to limit procedures to the epithelial layer of the cornea and to not transgress below the Bowmen’s membrane. Any procedure which invades below the surface of the cornea is, by definition, intra‐ocular and is inappropriate for optometrists.
    (1) (c) Tear duct irrigation:
    It is the position of the College that probing and irrigation of the tear duct is an invasive procedure which should be restricted to those with medical training. As the lacrimal drainage system is far more complex than it appears, there is a possibility for misdiagnosis and mistreatment. Probing should only be done by
    Excellence in medical practice
    College of Physicians and Surgeons of British Columbia
    RE: PROPOSED OPTOMETRIST REGULATION
    January 12, 2009
    those practitioners who have the skill and knowledge to surgically and medically manage the lacrimal system.
    (1) (d), (e), & (f) All references to diagnostic drug or therapeutic pharmaceutical agents should be prefaced by the word “topical”. It is the position of the College that optometrists do not have the skill and knowledge to prescribe oral or intravenous pharmaceutical agents for diagnostic or treatment purposes. The training required to appropriately prescribe systemic agents is quite different from that required to appropriately manage topical routes of administration of therapeutic or diagnostic agents intended for optometry use.
    Limits or Conditions on services and restricted activities
    (2) Re: notification of a patient’s treating physician.
    It is the position of the College that an optometrist must identify the patient’s treating physician and communicate accordingly. The cornerstone of collaborative practice involves communication. It is unacceptable to simply leave this regulation as “if known” as the obligation is upon the optometrist to make an effort to identify the physician(s) involved in the patient’s care.
    The schedule of Diagnostic Drugs and Therapeutic Pharmaceutical Agents as listed is generally supported by the College with the exception of corticosteroids and anti‐viral medications. It is the position of the College that the use of topical corticosteroid agents may place patients at risk if they are not appropriately diagnosed. Likewise, it is the position of the College that the diagnosis of a herpetic eye infection is a serious disorder, one that is usually managed by a consultant ophthalmologist. Herpetic eye infections are considered ocular emergencies and are generally managed by referral from the general practitioner to the ophthalmologist.
    Thank you for the opportunity to comment on the proposed regulations. If further discussion or clarification is required you are welcome to contact the undersigned.
    Yours truly,
    H.M. Oetter, MD Registrar
    College of Physicians and Surgeons BC

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    So some MD from the college of physicians that probably doesn't know jack about the eye or eye care writes a letter in opposition to optometric use of drugs - do you really think that is credible? Newsflash, we've been using drugs everyday day here in BC for a year now, what's your point? I'm sure the physician I prescribed drugs for today didn't care, if she did she could have have done so herself.

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    The point of my posts is not to flame other professions or to play games with quotes. All comers can play that game, there are a great number of authorities that can be referenced to support one position or another. However the informed opinion of the the College of Physicians and Surgeons of BC or the British Columbia Society of eye Physicians and Surgeons or any other players should not cloud the real discussion. That facts are these - less than 45% of Canadians receive any comprehensive eyecare. Most seniors eye care is from a pair of ready made readers from Costco, a Drug Store or any amount of non registered suppliers. All of which is the norm for many people. So how are the ECP's going to reach the 55% of people who cannot or do not come through our offices. The leading cause of blindness is uncorrected refractive error. The most cost effective form of visual screening is a simple Snellen chart. These are not my figures but those of independent organizations such as the World Health Organization.

    Congratulations on achieving the diagnosis and treatment of glaucoma - it is well deserved. However I would pause more than twice to dismiss any organization - especially the various CPS as "doesn't know jack"

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    "The leading cause of blindness is uncorrected refractive error . The most cost effective form of visual screening is a simple Snellen chart. These are not my figures but those of independent organizations such as the World Health Organization."

    This is not the case in North America; this pertains to 3rd world countries.
    In N.A. the leading causes of blindness are ARMD and diabetic retinopathy.
    Last edited by NorthStar; 05-03-2010 at 11:08 AM.

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    Quote Originally Posted by NorthStar View Post
    "The leading cause of blindness is uncorrected refractive error . The most cost effective form of visual screening is a simple Snellen chart. These are not my figures but those of independent organizations such as the World Health Organization."

    This is not the case in North America; this pertains to 3rd world countries.
    In N.A. the leading causes of blindness are ARMD and diabetic retinopathy.
    Not according to "The National Coalition for Vision Health" I found this quote on their on line information

    "Treatment options: Most causes of visual impairment and blindness can be prevented, by interventions or through healthier lifestyles. The greatest cause of vision loss is refractive error, which occurs when a person does not use or update corrective lenses. Refractive error is, thus, the most easily correctible source of vision loss."

    The full discussion appears at the following URL http://www.visionhealth.ca/news/NCVH...9F,%202009.pdf

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    When a lot of provinces stopped paying for routine eye exams, mostly for the 18 to 65 year olds, a phenomena I call exam avoidance increased. A lot of these people are not seeing well, and do not seek attention because of the cost. We used to have these same people chuckle about their older thrifty relatives who kept the same pair of glasses for 5 years.
    Some pairs I have seen in use are about 7 years old....and only built to last(quality-wise) for 2 years!

    I would tend to agree with Flybynight.

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    bilateral peripheral scotoma LandLord's Avatar
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    FlyByNight, Are you for real? If someone's glasses are a few years old, it doesn't make them blind! I haven't cut the grass in a week but it doesn't make me homeless!!

    I might argue that CERTAIN opticians refracting under CERTAIN conditions can be beneficial, but a government unilateral decision to support a company without the proper medical research such as what happened in BC is just wrong.
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    OK Ok - I mistakenly substituted "blind" for "vision loss" which is the phrase used by the referenced article. My Bad :( ..... I notice that all articles now talk about "vision loss" instead of "blind" . I guess it is a better description. I promise to be up on my PC speech next time. I guess I must have got caught up in the hysteria of "third world" eyecare. The National Coalition for Vision Health (whoever they are) also talk about vision loss in AMD and the other causes.

    Quote (Page 19 for the lazy)
    Treatment options: Most causes of visual impairment and blindness can be prevented, by interventions or through healthier lifestyles. The greatest cause of vision loss is refractive error, which occurs when a person does not use or update corrective lenses. Refractive error is, thus, the most easily correctible source of vision loss.

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    Quote Originally Posted by LandLord View Post
    FlyByNight, Are you for real? If someone's glasses are a few years old, it doesn't make them blind! I haven't cut the grass in a week but it doesn't make me homeless!!

    I might argue that CERTAIN opticians refracting under CERTAIN conditions can be beneficial, but a government unilateral decision to support a company without the proper medical research such as what happened in BC is just wrong.
    You haven't cut your grass in a week!!!!!! LAWN ABUSER!!!...........I'm still snowmobiling on mine!!!!! Ha Ha Ha Ha Ha

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    registeredoptician Refractingoptician.com's Avatar
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    Why require a prescription if you are offered a deal which does not require one? Why burden your business down with paperwork anad regulation if you do not have to?

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    Master OptiBoarder cleyes's Avatar
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    Angry Vision loss vs poor vision

    Vision loss is vision gone! Not wearing corrective lenses for a refractive error does not cause loss of vision, just temporary blur correctable by wearing the correct eyeglasses. Loss of vision is LOST vision, which does not return which is caused by all those progressive conditions, which will be now undiagnosed by vision assessment .
    I have been refracting for many yrs , I KNOW that does not an eye exam make, I cannot imagine doing this on my own without MD or OD completing the exam. Just this week, my MD boss diagnosed glaucoma on an asymptomatic 30 yr old. Tension was 35 OU. In BC her fate would have been sealed, she had come in for new gls Rx, perfectly healthy, no complaints, no field loss yet.
    I have had the idea that the ophthalmic community should drown your government ministers with case histories of every asymptomatic patient with sight threatening conditions ,which left untreated would result in real vision LOSS. Drown them in the paper of the known cases, let them imagine the unknown. Guarantee it would be quite the eye opener! Make sure the media are notified.]

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    Master OptiBoarder cleyes's Avatar
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    Redhot Jumper Asymptomatic retinal detachment

    Healthy 40 yr old male came for exam after wearing same pair of Toric Oasys continually for 4 mos! High myope, no glasses for 20 yrs, on his last pair of cls, just needed new cl rx. Refracted to acuity of 20/20 OU. No problems with the corneas [thank god of sil/hy]. New patient, so mandatory dilatation by my MD boss. Lo & behold.....inferior macular sparing retinal detachment...Sent to retina specialist for surgery TODAY.
    Now, I love refracting, but I know too much, I have seen too much to want to do it on my own, without an MD/OD on the premises to complete the exam. "Vision assessment" or whatever you call it is SCHLOCK, the average person has no idea what an eye exam is, how necessary it is. How many people buy otc readers and assume "I see well, therefore I am well", many of them are quite intelligent in other ways. NY opticians are also pushing for "vision assessments"....

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