Oph­thal­mol­o­gist or Op­tometrist? Know­ing the dif­fer­ence can save your vi­sion

South Florida Times - - HEALTH - Marilyn Rumph By CUR­TIS BUNN Ur­ban News Ser­vice

Tears flow from the nearly sight­less eyes of Marilyn Rumph.

At 49, this hard­work­ing African-Amer­i­can woman is los­ing her abil­ity to read, drive and watch her chil­dren grow up. A few years ago, she had two work­ing eyes and am­bi­tions for the fu­ture. To­day, she strug­gles to see.

Just the thought of it makes her cry. Her con­di­tion, she be­lieves, could have been pre­vented.

A con­flu­ence of cir­cum­stances led the Palm Beach, Florida na­tive to this dark, un­for­tu­nate place: she says she was ig­nored, mis­treated and mis­di­ag­nosed by the one eye-care spe­cial­ist that she had trusted.

It is a place an in­creas­ingly num­ber of African-Amer­i­cans are find­ing them­selves th­ese days. The Na­tional Eye In­sti­tute says African-Amer­i­cans are more prone to cer­tain eye con­di­tions than other Amer­i­cans and the num­ber of low vi­sion cases in the black com­mu­nity could dou­ble by 2030. Add to that, the grow­ing num­bers of African-Amer­i­cans reach­ing re­tire­ment age, and the com­mu­nity is about to see record num­bers of eye prob­lems.

At stake are bil­lions of dol­lars of in­sur­ance, Med­i­caid and Medi­care pay­ments, which will flow to one group of pro­fes­sion­als or the other—op­tometrists or oph­thal­mol­o­gists.

To win some of that money, op­tometrists are de­mand­ing le­gal changes to al­low them to do the work once re­served for med­i­cal doc­tors—with­out get­ting the train­ing or su­per­vi­sion of med­i­cal doc­tors. Some op­tometrists want to per­form eye surg­eries, pre­scribe drugs and other­wise take the place of med­i­cal doc­tors. Some states, in­clud­ing Florida and Ken­tucky, are con­sid­er­ing mea­sures that will vastly ex­pand the role of op­tometrists, with­out nec­es­sar­ily telling the pub­lic that they are not ac­tual med­i­cal doc­tors. That may save the state and fed­eral govern­ment tens of mil­lions of dol­lars per year since the non-doc­tors bill at a lower rate than doc­tors, crit­ics say, but many pa­tients could lose their eye­sight in the bar­gain.

The op­tometrist po­lit­i­cal ac­tion com­mit­tee, a Florida lobby group, has spent as much as $400,000 urg­ing politi­cians to pass a bill giv­ing op­tometrists most of the priv­i­leges of doc­tors. The bill was adopted by Florida’s lower house and and is sched­uled for a vote in the state se­nate’s Health and Wel­fare com­mit­tee in the com­ing weeks.

Rumph’s case cuts right to the cen­ter of the con­tro­versy be­tween op­tometrists and oph­thal­mol­o­gists. While many pa­tients can­not tell the dif­fer­ence and some­times falsely be­lieve that op­tometrists are med­i­cal doc­tors. In fact, op­tometrists do not go to med­i­cal school or pass med­i­cal doc­tor state board li­cense ex­ams. In­stead, they earn PhDs in eye care—which is why they can legally call them­selves doc­tors, as any PhD holder can.

“The dif­fer­ence be­tween the two pro­fes­sions can con­fuse many Amer­i­cans who don’t have time to learn the dif­fer­ence,” said San­dra Greenberg, the pres­i­dent of the Na­tional Con­sumer League. She added that the sys­tem works best when op­tometrists and oph­thal­mol­o­gists work to­gether to help their pa­tients. Since op­tometrists are gen­er­ally cheaper, some in­sur­ance plans push peo­ple to non­med­i­cal doc­tors first.

Rumph said she trusted the ex­per­tise of her long­time op­tometrist, who could not ex­plain her painful eye or blurred vi­sion. He pre­scribed new eye­glasses, she said.

It was not un­til she got fed up and went to a sec­ond op­tometrist, who rec­om­mended she see an oph­thal­mol­o­gist, that she fi­nally saw an ac­tual med­i­cal doc­tor. As a oph­thal­mol­o­gist, he had a wealth of ex­pe­ri­ence of eye dis­ease, which learned as a res­i­dent physi­cian in a nearby hos­pi­tal. He quickly di­ag­nosed her with two de­tached reti­nas. By then, it was too late to save her vi­sion.

One retina was so se­verely dam­aged that it could not be cor­rected with surgery. The other was re­paired, but Rumph’s vi­sion is far from clear, she said.

At is­sue was the dif­fer­ence be­tween the eye care pro­fes­sion­als. An op­tometrist is a vi­sion pro­fes­sional, not a med­i­cal doc­tor. Once known as an op­ti­cian, as ex­plained by the Col­lege of Op­tometrists, he is “trained to ex­am­ine the eyes to de­tect de­fects in vi­sion, signs of in­jury, oc­u­lar dis­eases or ab­nor­mal­ity and prob­lems with gen­eral health, such as high blood pres­sure or di­a­betes. They make a health as­sess­ment, of­fer clin­i­cal ad­vice, pre­scribe spec­ta­cles or con­tact lenses and re­fer pa­tients to fur­ther treat­ment.” He does not per­form surg­eries.

An oph­thal­mol­o­gist is a med­i­cal doc­tor who is trained to per­form eye ex­ams, di­ag­nose and treat dis­ease, pre­scribe med­i­ca­tions and per­form eye surgery. They also write pre­scrip­tions for eye­glasses and con­tact lenses.

In Rumph’s case, ac­cord­ing to her, op­tometrist Dan Du­rante, whom she had been a pa­tient since 1992, ig­nored her con­cerns and did not re­fer her to an oph­thal­mol­o­gist. In­stead he in­creased the strength in her pre­scrip­tion glasses, she said.

“He told me, ‘You’re fine. It takes a while to ad­just to new lenses’” Rumph said. “The last time I went he was just an­gry and felt I was wast­ing his time when all I wanted was my abil­ity to see. I thought I was go­ing men­tal.”

Du­rante has run a suc­cess­ful prac­tice in Florida for many years and his Jensen Beach, Florida of­fice re­ceives 11 re­views on Yelp.com —giv­ing him a score of 4.5 stars out of 5. Still, the re­views also in­clude com­plaints from pa­tients. Sev­eral at­tempts to reach Du­rante, via phone and email, went unan­swered.

In se­vere cases like Rumph’s, quickly seek­ing out a rep­utable oph­thal­mol­o­gist can be the dif­fer­ence vi­sion and blind­ness, or day and end­less night.

Med­i­cal train­ing can be the de­cid­ing fac­tor. Even in Rumph’s case, the first op­tometrist missed her con­di­tion en­tirely and, while, the sec­ond op­tometrist cor­rectly di­ag­nosed a de­tached retina in one eye… he failed to no­tice it in her other eye.

The oph­thal­mol­o­gist de­ter­mined that vi­sion in one eye was 90 per­cent gone. But, he thought, with the care­ful surgery, he could save the other eye.

With his sur­gi­cal skills, he was able to re­store her eye­sight in one eye. Even then, she said, her vi­sion is of­ten marred by blur­ri­ness.

As a re­sult, her hus­band said, she suf­fers bouts of de­pres­sion.

The so-called “eye­ball wars” will grind on, go­ing from state to state, pit­ting op­tometrists against oph­thal­mol­o­gists. Get­ting lost in the fight over profits and pa­tients is the sim­ple fail­ure to dis­close the truth.

If Rumph had known her trusted op­tometrist was not ac­tu­ally a med­i­cal doc­tor, she might be see­ing out of two eyes to­day.



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