Yes. Probably more a fault of the OD schools than the doc. Too many schools and students and not enough patients for proper training. And it's only going to get worse with 4-5 more schools opening soon.Originally Posted by peregrinerose
I took it upon myself to monitor and shadow speciality OMDs to learn more.
NC-OD,
I think the poster might never tell us why they posted here. I do know that optcomlist and odwire are both great venues. However, in those venues, it is difficult or even unlikely that one can remain anonymous like here. Therefore, anonymity might have been the goal here.
You have to admit, Fezz, that most of the jawing here is about optical stuff and most of the "medical" stuff is only listened to if it is from an ophthalmologist. Therefore, when the optometrist posted originally, I'm going to guess that he/she was inviting a response not from anyone else but another optometrist.
And look how YOU are treating a collegue OD on here... very much less than professionally.
Somehow this makes me think of the first few employers I had who when I pointed out a particular article or tidbit to them they would look and say: "That's strictly optometric." with disdain in thier voice. (Which accounts for some of what NPDR preceives as my attitude concerning OD's.) As I have grown older while I may still have such prejudice, I have learned that some accurate and intelligent things come from the mouths of OD's. I am still tainted enough to chuckle at the things that do not meet this criteria or are what I see and more bottom line than patient oriented.
However it is possible that even us lowly technician types, could say something worthy of note by O.D.'s or O.M.D.'s You many have noted that until recently (for me this means the last couple decades) almost all CL Courses for OMD's and others were by CLSA (almost entirely opticians).
While I am grossly underwhelmed by our "continuing education" I have even learned that presentations by newbies who don't realize thier "great discovery " is older than they are, occasionally remind one of or present a new pearl of knowledge.
Chip
To be fair...
I am familiar with NC-OD from back in the days (8-9 years ago) when I myself was planning on entering OD school. He was very active on student based websites and optometric sites, and has always known he wanted to be more medical based and took the steps to go there. He was always willing to give advice and encourage others to seek out their own way and not be slaves to the chain mentality. While he and I may have sparred over a couple of things, I have always had the upmost respect for him.
I would love to see him post here more, but unfortunately if one looks at his postings, almost every one has been somehow been discounted or triggered flames. It doesn't make this site seem so friendly and open to all when that occurs. Some will persist to post, others will hold back except in times where they feel compelled.
I believe we can all learn from another, be it peer to peer on the same level or each of the 3 O's working together to support one another and to share our insights and knowledge.
Cassandra
"Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland
I agree with your last paragraph completely. I don't think that less than professional behavior is appropriate in any forum, and calling another doc (without knowing anything about them) incompetant based on one question they asked is professional. Your friend may have a kind heart and be a great mentor, but he didn't show that facet on this thread. It's our job as more experienced docs to help foster confidence and good patient care in our younger collegues rather than be so quick to criticize them or tell them they shouldn't be managing certain diseases.
And Chip, it bugs the living daylights out of me when professions don't listen to each other. I have learned a great deal from the opticians on staff in this office. No one profession or specialty has a monopoly on knowledge. We all have something to both offer and learn from the others.
It was just a very silly question to me. Kind of elementary. That's all. I apologize.
And thanks for the kind words Cassandra. I'm not as militant against commercial ODs any more. I've mellowed out. I still think they are lazy *****s but.........it is what it is, right?
It's all good.
Not to wander to far from the original thread, but this IS a site for all eyecare professionals, but more disconcerting to me is your assumption that an optometrist asking questions of opticians is somehow an indication of incompetence on the part of an optometrist. In my 29 year career, I have been asked questions by both optometrists and ophthalmologists regarding refraction, contact lens wear and therapy, low vision, mangement of recurrent erosions, eikonic spectacles and everything in between. I am well known for my willingness to consider patient mangement a multi-disciplinary effort, and find consultation with others to be often very productive. Many opticians are far more knowlegeable than I am in these areas, and you may reconsider your beleif that an optometrist has nothing to learn from an optician.
Ahhhhh.......here we go.
Note nowhere did I say that this optometrist should not ask a question to an optician. Never said it.
The OD did not appear to be asking a question about how to treat a corneal abrasion or how long will it take to heal. He said, and I quote, "
This was the question:
"hi all,
What's the best way to check VA when your patient still has a lot of residual and ointment while txing a corneal abrasion?"
That's about like asking, "what is the best way to play the piano when your fingers are broken"? or "What's the best way to fix a flat tire when it has a leak".
I mean, how many ways are there to check acuity? So the question just had me stumped...or perhaps the way it was asked. Seems almost like a trick question. What IS the best way to check visual acuity when treating a corneal abrasion? Maybe standing on your head.:bbg:
Get back to the OP's question. I personally found the different response's interesting, as stated by peregrinerose. 10 different ways to hopefully accomplish the same thing.
NC-OD, If I misunderstood your post, my apologies. It still appears to indicate a strong bias against opticians, but if not, my mistake. I have taken the liberty of buying you a scratch and win ticket in hopes of making amends, and since you are so far away, I scratched it for you. I am sorry to report you didn't win anything, but better luck next time.;)
It is an interesting question....I can only think of PAM test or a laser interferometer to get an idea of the potential VA.... I think that is whats being asked here. Another way is to guess at the VA based on the clarity of the media that the doc can observed the fundus thru an ophthalmoscope. The clearer the view of fundus the better acuity.
Dannyboy:idea:
[quote=npdr;226921]NC-OD,
I think the poster might never tell us why they posted here. I do know that optcomlist and odwire are both great venues. However, in those venues, it is difficult or even unlikely that one can remain anonymous like here. Therefore, anonymity might have been the goal here.
I posted here because it seems like 99% of the responses on odwire are laced with criticism. I hate the disgusting attitude of many of the "professionals" on odwire, and so I don't go there anymore.
The reason I asked the question was because this is the largest corneal abrasion that I have seen or managed. Guess I got too much retina on my externs, not enough corneal abrasions. And on externs you always had someone else to ask....there was always a staff doctor. Now, sometimes in practice I have questions, so I went to a place that contains good eyecare related material with professionals in all aspects of eyecare (okay, I don't think I've ever seen any OMDs, but enough of you work very closely with ones that I trust most of your information), to ask said questions.
We all know there's a thousand different ways to treat stuff and we each have our own ways. I followed Wills Eye, used an ointment to give better relief (ever tried Vigamox on a wide open cornea- it burns!!!), and just wanted to make sure that I was on the right track. My patient is healing nicely.
I have learned lots of new techniques and tricks to try during eye exams to achieve the quickest, most accurate results by following this board. My initial question was posed to see if anyone else had anything they like to do to check VA through ointment. (like irragate or something like that).
So if asking questions and wanting to learn new stuff makes me an incompetent doctor, I'd rather be that than than a hard-*** who thinks they are right and refuses to learn and grow!
Sograd: Sorry we were so critical but the point is only how well, Or how poorly, does he see after healing counts.
scograd,
Understandable. Unlike posterior segment pathology where most pathology is rated by central acuity and most pathology is rather deliberate, anterior segment traumatic events are more governed by the active pathology. Only when the active pathologic process has subsided can a reasonable visual asessment be made.
Thank you again for your post.
ODs posting on Optiboard:
1) I love this site. I come here to learn about the optician field, and I learn a ton.
2) I would NEVER post, in an open forum, medical questions. NC-OD is dead on.
3) NPDR's advice should be heeded. Take it to ODWire, and leave it off here.
4) If you can't figure out why I'm saying this, you are daft.
5) Certainly hang around here and learn opticianry and ask their experts, and contribute your expertise if/when they need an ODs opinion.
6) This is truly an optician's site, despite the ecumenism of the title, so respect it as such and preserve it.
I respectfully disagree. We as opticians can also learn from the OD posts here, whether or not we actually do perform that function in our everyday position. Some of the best cl fitters I saw were opticians, in licensed states where it was within their right. In this case, most would defer. More than likely to the OD's, like yourself, or an OMD.
You don't want things in a public forum? Join up, and post in the PROFESSIONALS ONLY forum. OD"S welcome always, and problem solved.
That's reasonable OBX.
What the OP needs to know is that this is a PUBLIC forum! Get a grip.
I took the pleasure of compiling the responses to the OP's question. Please review and relate which are relevant to the OP question. You might see a pattern. As you can see the majority involved personal attacks rather than constructive posting. If there is to be an inter professional dialog, then the discussion should be strictly related to the facts of the case and why one method should be better than another.
First back to OP. The OP was dealing with a llarge corneal abrasion and the OP wanted to know how to best take VA through oph ung.
1. PAM might work, but it is really a retinal evaluation for the cataract surgery and is in fact not much in use at this time.
2. The keratometer is great for measuring the irregularity of the middle 3-4mm but not if the abrasion wasn't in the middle. A topograph? But it cannot detect epithelial brakes?
In summary, to respond adequately to OP is to under the underlying question and its premise. If one is presume some degree of comfort in answering this question it is to see the premise involved that VA may be useful for legal reasons (and that might be the actual fear here) but isn't necessarily helpful or even useful for the actual progress of an epithelial break.
Pony up you guys. We ALL have a lot to share.:)
As I had thought and was intimated by other optometric posters, that although there is much to learn from many, I do feel that the OP's intent was unclear in the message.
Testing acuities through a corneal abrasion and through ointment is done all of the time by optometry and ophthalmology practices as a "vital sign". I doubt that optical-only environments do so but I am willing to be corrected here.
Vital sign of what? Degree of healing? Make sure the structure behind the cornea hasn't started to die?
Chip,
Testing VAs in follow-up for virtually any condition is standard of care. It can be a very good indicator of resolution or worsening of a condition. The ONLY time I do not test VAs before performing any other testing is with acute chemical injury to the eye....in that case I irrigate first, test VAs second.
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