Story by Walt Williams
CHARLESTON -- Eye-care specialists are at odds over a proposed law that would give the state’s optometrists more authority to prescribe medications and perhaps perform some minor surgeries.
The proposal has pitted the West Virginia’s optometrists against nearly the rest of the state’s medical community, which has lined up in opposition to the legislation. However, optometrists said they are seeking what already is available to their counterparts in a majority of states. The legislation’s opponents are mischaracterizing the bill by claiming it would give them the authority to perform eye surgery.
“This bill is not about optometrists doing surgery,” Bill Radcliff, a Huntington optometrist, said. “It’s about changing an antiquated (law) that tries to specifically outline what medication may be provided not only now but in the future.”
The proposed law is contained in two identical bills before both the state House of Delegate and Senate. Both would give optometrists more authority to prescribe medications, order clinical tests and perform other procedures to treat eye conditions provided that the state Board of Optometry drafts rules spelling out what they can and cannot do.
Optometrists are the specialists many patients see when they need to get new glasses or contact lenses. They already have the ability to prescribe some medications and provide relatively minor invasive procedures. The field differs from ophthalmology, whose practitioners are physicians who treat eye diseases and are trained to perform eye surgery.
Optometrists can get their doctors’ degrees after four years of optometry school. Ophthalmologists, on the other hand, are physicians who need eight to 10 years of schooling and training before they can enter the field on their own.
It is the state’s ophthalmologists who are the loudest critics of the bill, saying it would put patients’ health at risk by allowing some optometrists to perform medical procedures they might not be properly trained to do.
“At times we see patients where we have one shot – one shot to make a difference in a patient’s eyesight potentially for their health, for their lives and well-being,” Dr. Edgar Gamponia, an ophthalmologist in Morgantown, said. “With training we hope we can do what’s best for the patient.”
Twelve state medical groups have joined the ophthalmologists in their opposition, including the West Virginia Hospital Association, West Virginia Board of Medicine and West Virginia Academy of Family Physicians.
But the legislation has gained support from many state lawmakers, who see it as a means of reducing health care costs.
Several lawmakers have signed up as cosponsors on both the House and Senate versions of the bill, and a House Health and Human Resources subcommittee held a hearing on the House version March 16.
Opponents mainly pointed to the extensive training ophthalmologists receive as a reason why the bill should be rejected.
However, they also noted a 2005 national survey that found that 95 percent of respondents said they preferred ophthalmologists to perform eye surgery — including laser surgery.
In addition, opponents said the bill would remove legislative oversight and transfer decision-making power to a board whose members are mainly optometrists.
Supporters of the bill – including a representative from the pharmaceutical company Johnson & Johnson — argued that current state law simply isn’t keeping up with advances in medicine. For example, Johnson & Johnson is now developing contact lenses that will dispense eye medication. Optometrists could not prescribe the lenses under current state law, with patients instead needing to seek out an ophthalmologist, whose services are more expensive.
Optometrist BJ Nibert of Oak Hill said his counterparts in surrounding states could perform procedures he is not allowed to do under state law, such as inject medicine around the eyes. He said he didn’t see the need for patients to be referred to other specialists for ailments that he and his counterparts could treat themselves, saying such referrals drive up costs.
“What is the logic to restrict a doctorate-level program from providing the level of care they are qualified to deliver?” he said.
The bills are House Bill 2978 and Senate Bill 570.
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User Comments [ post comment ]
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Yes, eye training in medical school is minimal, but those 4 years set the strongest possible foundation to understand human physiology and systemic disease, so that when the more difficult years of residency training come along one can best appreciate the role of the visual system within the context of the body as a whole. And in those subsequent years of training, a resident sees literally hundreds of patients with all aspects of a given disease under the guidance of multiple ophthalmic subspecialists. This includes not only the surgical aspects of ocular disease, but also the medical ones. And the setting is primarily the hospital, not the classroom. In this process, ophthalmologists learn best when a condition is simple or complex, what medical treatments are best, and when surgery may needed. Optometry school simply does not offer these types of training opportunities. Yes, I am impressed with the amount of work you do to learn your profession. Yes, you are very good at refractions and binocular vision. Yes, you are important in the role of screening for eye disease. Thank you! Yours is an honorable profession. Yet, you and dishonor the foundations of optometry when you overstate your abilities and seek to broaden your scope of practice through legislation. If I chose to broaden my scope of medical practice, I would go back to school to earn further certification by the pertinent national organization governing that area of medicine. I would not go to a state legislative body that has no expertise in my particular field. By the way, surgeon is not spelled surgeion. | ||
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Awesome. just awesome............Really i am impreesd from ths post......the person who creat this is a great human.......thanx for shared this with us. Vanraj | ||
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WHATEVER!!!!!!! You are drinking crazy cool aid.....One of my friends in who did both programs said that there are things that optometrists learn that ophthalmologists don't and vice versa. We get far more training in Binocular vision, visual science, and anything refractive---for god sakes I am really good at retinoscopy and I will be very clinically sound with medical eye care. My friend went back to do invasive ophthalmic surgery and complex medical eye treatment...In the primary eye care realm he said the difference is minimal.....The fact is I will have the legal right to do most of what a medical ophthalmologist does and I WILL! Optometry School is just as difficult as medical school and anybody who thinks otherwise is naive.....I have 11 courses 25+ semester hours and I sleep 4 hours a nite...So you are WRONG... Medical school "eye training" is minimal (my best friend is in medical school---I study with him) and I saw the "eye system module"------a joke in every way.....Both tracts are different because one is training you to be a primary eye care physician--an optometrist while the other is training you to be an eye surgeion----ophthalmologist. | ||
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Unfortunately Mr 2nd yr, until you have been through medical school and an ophthalmology residency it is you who shall remain naive. Just ask any of your optometric colleagues who went back to school for another 8 years to become ophthalmologists! | ||
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Eyemds, Andrew, Adam, ......you guys just DONT get it.....I am in optometry school and I just finished a year of general pharmacology training and will undergo 2 more years of eye disease and ocular pharmacology training...We well qualified to prescribe medications and treat eye diseases as evidenced by the fact that in 46 States we can prescribe oral medications, topical ocular medications, and narcotics. Optometrists already provide these services 1) Comprehensive Eye Health Exams 2) Minor in office surgical procedures (punctal occlusion, foreign body removal. corneal scraping, anterior stromal micropuncture, etc..) 3) Prescribing of glasses and contacts to correct refractive disorders. 4) PRESCRIBE MEDICATIONS (ORAL AND TOPICAL) TO TREAT PRIMARY EYE DISEASES such as: ---Glaucoma Diseases ---Dry Eye Diseases ---Eye Allergies ---Eye Infections (bacterial, viral, and fungal) ---Eye inflammation and Pain (they prescribe NSAIDS and narcotics such as Vicodin or Tylenol w/ codeine) ---Hypotrichosis (now Latisse (Bimatiprost Ophthalmic Solution--to lengthen eye lashes) 5) Refer to other practitioners PRN for further treatment of things beyond optometric scope 6) Co-management of Eye surgery. 7) Are fully liable (from a legal point of view) in the medical decisions they make. The fact is my dental counterparts who I take classes with have similar didactic training to me but go on to do injections, prescribe schedule II narcotics, and perform dental surgery (the Degree is Doctor of Dental Surgery!) with only a 4 yr doctoral degree like ours and NO residency.....The difference is they established their market share in that profession over 150 yrs ago and have no counterpart or analagous profession in medicine to compete with them. Optometry DOES----it is called ophthalmology. Those of you that don't recognize this are clueless and naive. Optometrists, Dentists, and Podiatrists are all Physicians as well. Under Medicare, Medicaid, U.S. Social Security, Optometrists (O.D.)'s , Dentists (DDS's) and Podiatrists (DPM's) are all classified as PHYSICIANS! Physicians: 1) have clinical doctorate degrees---called Dr 2) Diagnose and treat disease 3) are IDLP's (Independent Doctorate Level Prescribers) of medications 4) Can run a practice on their own 5) Have complete autonomy (unlike PA's and nurse practitioners who have physician supervision) 6) are 100% legally liable for their decisions WOW -----I just described what optometrists, dentists, podiatrists, and medical doctors all do........... my future shingle: "Dr. So and So O.D. Optometric Physician Specializing in the Treatment of Eye Diseases and Disorders." and yes this is LEGAL in the state I will be practicing in....... So wake up everybody it is 2009 and Optometric Medicine has come of age. | ||
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Dave, Maybe you're not sued as much as ophthalmologists because your profession always sits on the patient too long and then turfs to us to let us clean up the mess and we're the one that has to tell them they're blind. To prevent being sued for slander, we don't point fingers at ayone. You also don't fall under the same guidelines that we do since you charge most of your patients out of pocket and don't bill Medicare/Medicaid. If we had our receptionists perform OCTs and HVFs we'd be in jail. | ||
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Removing legislative oversight of any professional board sounds pretty dangerous. Especially if it allows a group to do things that are potentially harmful to the public. The Optometrist's lack of training in aspects of surgery and prescribing medication is scary. I say that our government needs to make sure that there is protection for the safety of it's citizens. Now, it seems to me that optometrists don't have malpractice issues only because they don"t take care of the more complex eye problems. Of the people I know in my community, the ones with the worse eye problems wind up going to an ophthalmologist because their eye problems require more complex care. I know that optometrist provide a good level of care, but it seems to me like their the ones trying to cut in on something that requires a higher level of training. Yes there are good optometrists and bad optometrists, good ophthalmologists and bad ophthalmologists. But one thing is definite -- An Ophthalmologist has much more training, and deals with more difficult eye problems. | ||
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After a dentist graduates, they can go to surgical training for 4 more years to become a oral surgeon. Why are there no battles between them? Optometry and Denistry have almost identical scholastic/clinic training, and you don't hear the oral surgeons complaining about dentists or vise versa. They work together in a field of mutual respect and referral. If optometry could oversee their own board, we may find the professions learn to respect each others place in the eye care field. No matter what scare tactics you hear, optometry wants no part of major eye surgery. | ||
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Gus, the cleaning-up goes both ways. I have seen plenty of patients misdiagnosed and mismanaged by Ophthalmologists ( carotid-cavernous fistula treated with Maxitrol, undiagnosed glaucoma, undiagnosed retinal tears, undiagnosed orbital cellulitis, poorly managed orbital cellulitis, bilateral pressure patching of a patient with bilateral anterior uveitis-I guess it was for photophobia, etc...) This does not include the clean-up needed for the poor surgical outcomes I have seen with RK and LASIK-people pay (paid) a great deal of money to have their eyes bothched; what happened to the oath. So Gus, we both can go back and forth with examples of individuals that received sub-optimal care from both Optometrists and Ophthalmologists, the problem is you cannot produce any literature that supports the notion patient fare better under the care of an Ophthalmologist. Again, if Optometrist provided such poor care as you have stated, then explain the very low rate of lawsuits filed against Optometrist and explain why our malpractice insurance premiums are low. | ||
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OK, so the comment was made that WV's current law is antiquated...... Just how many states that have such scope of practice bills before them have acturally passed one like the one we are discussing ? Is WV really different from other states in how it places limits on optometric scope of practice? Why are so few (if any) organizations or public interest groups supporting such optometric proposals? Where are the studies that show the American public is in need of this change in how eye care is delivered? | ||
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I wish each and every politician could sit in my exam room and hear the stories of how optometrists did test x and test y and still couldn't figure out what was wrong with the patient sitting in my chair. The patient may have received some steroid drops, had visual fields or OCTs every 3 days for 2 weeks then finally got dilated and -gasp- there's an RD, or AMD, or papilledema.... or after treating the corneal abrasion for a week an IOP is checked and "Wow, now they're in angle closure glaucoma!" You guys think we're stopping this to make more money? If we wanted more money, we'd let the bill slide through and we'd have plenty of money after cleaning up all your messes. | ||
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Here are the misrepresentations: "Specialists cost more" -reimbursement is the same for any given ALLOWED procedure for both Optoms and EyeMDs. Therefore, cost of health care will NOT go down. If history is correct, the cost will go up. "Most other states allow optoms to do what they seek in this bill" - this national initiative by optometry to gain surgical priviledges has been almost uniformly struck down in all states where it has been attempted except for OK. In CA, a similar bill was attempted just last year, and the resulting code adopted JUST LAST YEAR is far more restrictive than the "antiquated" existing code in WV. FL, CA, and Washington DC ALL struck down similar initiatives just last year. "We are trained to do this"- The ACGME sets national standards for amount of training required of ALL medical disicplines in order to be certifiied. There are requirements for watching, assisting, and being primary surgeon, as well as call and trauma care. Current Optometry schools have essentially ZERO capabilities to provide this. In WV, a weekend course - A WEEKEND COURSE - was sited as surgical training. (Not sure if it was a Holiday Inn Express) The bill is dangerous and WV citizens will be harmed if it passes. Would you want the airplane mechanic or the airplane pilot flying you ? | ||
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As an Optometrist that has trained in a hospital next to the Ophthalmology residents, who has practiced with a large Ophthalmolgy group and who has interacted with MDs for over 16 years, I can assure you that MDs are not infallible. There is no evidence that patients fare better under the care of an Ophthalmologist as opposed to an Optometrist. Also, take a look at malpractice rates and premiums for Optometrist- they are quite low. The Optometric curriculum is comprised of numerous courses that are found in medical school. A typical Optometric student will spend thousands of clinic hours in the examination, diagnosis and treatment of thousands of patients prior to receiving the degree. As far as "real doctor"; there are a number of courses of study in which a doctorate is awarded- MDs do not have a monopoly on this. This is a turf battle in which Ophthalmology is protecting their bottom line. If Ophthalmologists really care for patients as much as they say, then they would never have butchered so many people with RK. | ||
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There is no comparison between the training to become an optometrist and an ophthalmologist. The four years of medical school, 1 year of internship, and 3 years of residency, and Board Certification is THE STANDARD for quality and safety for all the citizens of this country. Why do we want to dilute this. The years of residency are required to master the techniques, handle the complications, learn the side effects, and take care of real patients with real problems. MD Ophthalmologists literally perform hundreds or surgeries under supervision, prescribe thousands of medications, give hundreds of injections -- all under supervision. The Optometry groups keep saying, "Why can't we do what we're trained to do." We have yet to hear exactly what they want to do or what their training is. They say they are trained with surgery. But it is my understanding that their "training" in surgery consists of a weekend didactic lectures. There is no hands-on, supervised training with actual patients. Now, when I ask my own optometrist how many lasers, injections, surgeries he's performed on actually patients -- he dances around the question, because I presume he actually hasn't performed any. There is a huge movement in the practice of medicine today to improve quality and minimize errors. I think allowing optometrist's to perform procedures including lasers, injections or prescribe medications is a step in the wrong direction with quality of care, When I have any procedure performed on me no matter if it's on my eyes or anywhere else, I want to know how many cases they've done, what kind of complications they've experienced, and what are their qualifications to do the particularly procedure. I even want to know which facility or hospital is suited best. And, I am very disturbed that this bill may allow optometrists to perform procedures that they don't have any experience doing. I don't want anyone performing a surgery on me who only has a weekend of powerpoint presentations to learn from. Yes, I am willing to drive out-of-town, hours if needed, to have the more qualified doctor perform my procedure. And, having poorly quality care does NOT save money. It increases it --> particularly if there's a complication that they cannot handle. I say if you want to perform procedures, give injections, prescribe medication -- go to medical school and become a REAL doctor. | ||
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John, I did answer the basic question. I wanted to be an Optometrist....that's why I went to Optometry School. The basic premis of what is going on here is that we want to practice OPTOMETRY to the degree that we are trained and board certified to practice....just like medicine, just like dentistry, just like all other health care providers are able to practice to the level of the training, expertise and certification. That's all we want...no more, no less. If I wanted to practice medicine, I would reurn for more training. I want to practice OPTOMETRY...the field has EVOLVED...our licensure should be able to evolve with it....just like medicine, dentistry, etc. Get with the program or get out of the way. | ||
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The comments still don't answer the basic question: why don't you just go to medical school so you can practice what you want in the field that you want. Unless you are implying that somehow optometry school is superior to medical school? If I want to practice law, I go to law school and get a license. I don't create some parallel school specifically focused on "real estate law studies" and give myself a new degree called a RJD and call myself a realtor lawyer and claim it is the same. And then complain and try to use legislation to change the rules so essentially I can become a lawyer without going to law school. About the malpractice claim below. anyone who studies malpractice knows that it is not dependent upon the skill of the doctor. It is the personality and perceived care. I am guessing that your optometry scope does not usually result in loss of vision or permanent pain because you usually refer those patients to ophthalmologists to be operated on. Show me the last case where an ophthalmologist was sued on a nonsurgical case for any significant amount of money. And if you have been surprised by what some MD's have done then I can tell you countless stories about OD's who seem to care more about selling glasses than the medical problems the patient's have. | ||
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John, You are obviously missing the point. Optometry is a PRIMARY eyecare profession that is evolving....evolving just like "medicine". The antiquated law in WV does not allow the OD's there to naturally evolve with the profession. The new law which WILL BE PASSED will allow the natural evolution just as in medicine and dentistry. WV Optometrists prescribe all topical, oral meds as they apply to the eye and perform minor surgical procedures on a daily basis and have been for 30 years....yet there has been no increase in malpractice premiums over that time. How do you explain that? That is explained by the unparalleled care that WV Optometrists give their patients. It IS a turf war and you are losing. | ||
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I have seen some crazy work by many OMDs, some of which certainly left me scratching my head wondering how in the world did this person make it through medical school. You cant use the argument that med school training is far superior to optometry school training. Accept them for what they are....they are primary care training versus secondary and tertiary level training. That is the difference. And lets not kid ourselves, I dont think WV optometrists are asking only to be able to practice full and complete primary eyecare. If opticians had formal training through accredited schools of opticianry, then yes, I am all in favor of them practicing to the full extent of their education, whatever that maybe as long as it is formally regulated. But they dont.....so I am not sure the point you are trying to make with the opticians. Having recently gone through optometry school education, I can assure you it is every bit as comprehensive on the primary level as ophthalmology. | ||
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This is not a turf war. It should be clear to anyone that a doctorate in medicine is different than one in optometry, dentistry, or philosophy. The training itself is more selective, longer, and more complete and just not on the eye. The residency is more in depth covering all the medical and surgical issues with the eye. Just as the optometrists object to opticians dispensing glasses or treating eye disease because of their training, MD's feel the same. As I have always said, if you want to manage all the medical issues of the eye than go to medical school. If you want to be a police officer go through the academy. Why are there parallel courses of training if the objective is the same? Because the original objective was not to have optometrists prescribe medications or do surgery. They want to expand their scope of practice. Just because they decided to teach it in optometry school does not mean it should be expanded. We have a system to train doctors in medicine, it is called medical school. Go to medical school if you don't want anybody controlling your scope. The cost argument is not significant. You can always get cheaper care from those less trained. A cosmetician should not do dermatology skin grafts, a podiatrists should not do a knee scope, a nurse practitioner should not perform surgery, a dental assistant should not perform oral surgery, etc. Train for what you want to do. Otherwise the next article will be about opticians pushing to expand into glasses and contacts and ultimately into therapeutic eye care. Heck, you don't even need to go to college to be an optician. | ||
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This issue will surely subside over the years as many MD's and DO's are now schooling side by side with dentistry and optometry. The main underlying proliferation of anti optometric sediment is the lack of MD's understanding of the current high level of medical optometric training. I'll be glad when the lesser informed members of the medical community either retire off, or get with the times. Bottom line: the current exemplary track record of optometrists already practicing full scope, proves that allowing OD's to practice as trained, has improved patient care. And isn't that what this is all about? | ||
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It is obvious that many of the opposition have no clue about the education of an optometrist. Optometrists spend the first two years of education studying a very similar curriculum as most students in medical and dental school, with a significant emphasis on the eye and its adjacent structures. The last two years is spent entirely on the eye and its adjacent structures. A residency is optional following optometry school, most being one year but some being 2 years. OMDs spend the first 2 years similar to ODs, but with less emphasis on the eye, and the last 2 on rotations studying all aspects of medicine. They do not receive any OMD training until their residency. The critics of this legislation simply assume that ODs want to perform all ophthalmic procedures, and do so without any training. If you take the time to read the proposed legislation, it states that we basically want a law that keeps up with the advancing technologies and one that permits us to practice in a way we have been trained. I have performed several injections involving the eye, but all were during my training in optometry school. As the current law states, I cannot perform this type of treatment. OMDs are simply worried and paranoid about optometry taking their market share, not the public safety. And once the facts from both sides are placed on the table, it will be easy for the public and legislatures to see the real truth about optometry, not the continued misrepresentation that MDs want you to believe. And by the way, who regulates medicine and denistry? You got it, medicine and denistry. So this idea of the optometry board, which is not made up of just ODs, regulating itself is not a new concept and one that has worked well for MDs to corner the market. | ||
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Define "surgery" in the context of these bills. Is it in reference to epiretinal membrane peels, cataract surgery, corneal transplants, and the like? My guess is no. The changes to optometry laws in the rest of the country in years past have preserved or given optometrists the legal authority to prescribe topical and oral medications for treatment of eye disease and perform relatively nonivasive procedures such as punctal plug insertion, epilation, corneal and conjunctival foreign body removal, etc. Does this mean that optometrists suddenly stopped referring disease patients to the proper specialists when necessary? Of course not. It simply allowed optometrists to perform their jobs to the full scope of their training. It is well within an optometrist's training to perform these tests and procedures. This is obvious if one simply looks at the track record in those states (which is a majority of them) where these laws are already in place or at the curriculum of any optometry program in the nation. If the optometrist has to send out every conjunctivitis or corneal abrasion patient that walks in the office who needs basic primary therapeutic eye care, of course it will drive up costs, and it is not best for the patient. Comparing the expansion of optometric scope of practice to chiropractors performing hip replacements or aestheticians performing plastic surgery is comparing apples to oranges, and it confuses the issue being addressed. These procedures are the ocular equivalent of retinal detachment repair, cataract surgery, and corneal transplants. This is obviously not the issue at hand. This type of statement is nothing more than a scare tactic. Good luck to the ODs in WV. Professionals should be able to practice to the full scope of their training. They are not asking for more than that. Look at the issue for what it is. | ||
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I think the practise of optometry should be limited to prescription of glasses and contact lenses. They are not physicians. Giving of injection around the eyes should be done by an ophthalmologist or an ophthalmic nurse. Bringing down cost should not be at the detriment of the patient. Optometrists are very important, but they should know their limit. | ||
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Opponents of the bill are deflecting the issue by using disinformation and scare tactics. The bill would allow Optometrists to practice additional procedures only if they are a) taught by an approved College/School of Optometry b) approved by the Board of Optometry c) pass through the WV Legislature "Rules" process and d) if they are individually certified by the Board. Note also that the Schools/Colleges are under federal education restraints in what they can teach. Therefore, this is in fact MORE rigorous oversight than is currently in place. Opponents cannot logically refute this so they stoop to the disinformation and scare tactics. | ||
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this will never bring costs down,,anyone who believes that is not in touch with the reality of insurance and billing ...this bill creates more providers to bill insurance companies,,but the services performed will be at a much lower standard of care, and by a group with a much lower level of education.who would never qualify for admission to medical school..and with supervision by the optomeriy board, there will be far less accountability.,once optometrists are able to do what the m.d.'s are doing, they will be paid by the insurance carries the exact same price.,,the utilization will rise, and the quality will fall...,, the costs to the payors will rise, not fall..next let your manicurist do podiatry, ...a dental hygeinist extract teeth, | ||
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Get serious! "Optometrists should be able to practice under their scope of practice that they decide, not what another profession decides." Should any group be able to decide what their scope of practice is in treating medical illness? Should we let chiropractors decide they would like to perform total hip replacements? How about "aestheticians" performing plastic surgery? This is about training and patient safety! Would you want someone that is trained to fit glasses and contact lenses performing any type of surgery on your eye? I think we should poll the politicians that are voting on this and see what they say. In fact, you should poll the optometrists and see who they would prefer to perform their eye surgery! This is a special interest group that is trying to get around education by legislation. I know many MD ophthalmologists who started as optometrists and they are quite vocal about the major differences in training level. Optometrists are not subjected to the same rigorous scrutiny for medical malpractice as MD physicians. The "standard of care" is set by the Board of Optometry, hence the lower malpractice claims. They want to practice medicine, but without the long years of training and without the same accountability as physicians. | ||
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This comes down to one thing and one thing only. Lack of patients. Ophthalmologists are surgeons and optometrists are primary eye care providers. Ophthalmologists that arent busy enough are the loudest here in these debates! Ask most ophthalmologists that are busy enough who they hire! | ||
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If you look at the medical malpractice claims against Optometrists in the states that allow Optomerists diagnose and treat diseases, the claims are much, much lower against the Optometrists. This anti-Optometry legislation is being presented as to protect the public against poorly trained doctors, but it is nothing more than a turf war. They are trying to attract the same patients that the Ophthalmologists do, and are correct in stating that the Optometrists drive down health care costs via competition. Also, when a state university like The Ohio State University, Indiana University, U Cal Berkely etc. grant to doctoral level degree to Optometry, Medicine, and Dentistry, how can one be less than the other? The scope of practice can be different but the Optometrists should be able to practice under their scope of practice that they decide, not what another profession decides. | ||