News Review for July 2000

AOA Suspends Plans for ABOP

The decision came at the AOA’s 103rd annual Congress last month in Las Vegas. While technically ABOP remains on the books, the delegates voted to stop implementation of the board certification process and provide no new funding for ABOP.

And former AOA president John A. McCall Jr., O.D., resigned as president and a member of ABOP.

The delegates did vote to have the AOA host a summit of national optometric organizations to discuss the need for board certification, but that’s not a given, either. Many of the invited organizations spoke against ABOP. Some said they would commit to sending representatives to the summit, though.

The National Board of Examiners in Optometry, which opposed ABOP, will attend, says NBEO president Donald R. Gordon, O.D. So will the Association of Regulatory Boards of Optometry, says James Vrac, ARBO executive director.

Also interested: the American Academy of Optometry, which “believes very strongly in the importance of continuing optometric education andclinical skills development,” says President Anthony J. Adams, O.D.

“However, such a forum must involve an open and thoughtful dialogu eof all the issues related to continuing competence and education as well as issues related to advancing the clinical competence of optometrists,” Dr. Adams adds. “It must also engage the strengths of the numerous optometry organizations who can bring their experience, insight and special resources both to identifying the issues and implementing any actions.”

The issue of board certification will remain for some time, says HarveyP. Hanlen, O.D., immediate past president of the AOA. “What we’ve learned is that, although the members aren’t sure of how to structure it, they don’t want it to go away,” he says.

For now, though, representatives of these national organizations have the next roll of the dice in determining standards for ongoing competency in optometry.

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Wis. O.D.s Defend Decision to do PRK John Murphy Senior Editor Ophthalmologists in Wisconsin aren’t crying over spilled milk.  They’re crying foul over who can use lasers for eyecare procedures. At press time, Wisconsin ophthalmologists, backed by the American Academy of Ophthalmology and American Medical Association, had filed a lawsuit to stop optometrists from doing PRK. The ruckus began when the Wisconsin Optometry Examining Board voted unanimously to interpret that laser procedures fell under its scope-of-practice statute. Prompted by a petition from the Wisconsin Optometric Association (WOA) about guidelines on optometric use of lasers, the vote was an impromptu straw poll that the board took to get the opinion of its members. But to put it on record, the board had to make a motion that the vote was made. This motion rocked the Badger State. Within days of the vote, ophthalmologists began a public outcry that Wisconsin optometrists had taken it upon themselves without a public hearing or the approval of the state legislature to do laser procedures like PRK. On May 30, the Wisconsin Academy of Ophthalmology, the State Medical Society and the AAO filed a suit to prohibit optometrists from doing laser procedures. Meantime, several optometrists had performed PRK procedures after the examining  board’s vote. Madison optometrist and former WOA president Scott Jens performed two procedures. He says optometrists can certainly be train- ed to do likewise. “Most all of us have been managing the pre- and postoperative care of those patients for years,” Dr. Jens says. The procedure itself is less complicated than many other tasks optometrists already do, he says, like removing a tricky corneal foreign body. Wisconsin optometrists who are prepared to do PRK procedures have taken upwards of 20 hours of supplemental coursework on PRK and the anterior segment, in addition to the course required by the laser manufacturer, Dr. Jens says. PRK procedures only equal about 10% of refractive procedures. But Dr. Jens says it’s not about the numbers. “It’s about optometrists becoming skilled providers of surgical eye care. Most optometrists would consider offering YAG capsulotomies or chalazion removal rather than PRK.” By comparison, he denies optometrists would be skilled enough to do something like cataract surgery just by taking classes. But why not snip lid lesions or remove sutures? PRK and some other procedures can be readily learned by experienced optometrists willing to put in the necessary training, Dr. Jens says. Not everyone thinks so. The original suit was amended last month and refiled. This time the AMA had joined the plaintiffs, and the suit mentioned each board member by name. It also named four optometrists who had done the procedure, including Dr. Jens. After the initial lawsuit, the Optometry Examining Board rescinded its original motion. It had planned to pursue a ruling under the Department of Regulation and Licensing for the permission of skilled optometrists to use lasers. At press time, the WOA hadn’t decided whether to pursue the ruling in light of the amended lawsuit. Nor had it yet formulated a response to the suit. Ultimately, it’s not so much a turf battle or a scrabble for private-pay revenue, although those issues are relevant. “It’s not about two or three doctors trying to do something that most of the rest don’t want to do,” Dr. Jens says. “It’s about making sure that any O.D. has the opportunity to give the patient that choice.” That is, to have the same doctor for both the procedure and management. top

First Drug from Brand New Class 
Of Antibiotics WinsFDA Approval

As the incidence of infections due to gram-positive bacteria rises, antimicrobial drug resistance is a growing concern, especially for nosocomial (hospital- acquired) infections. For instance, Staphlyococcus is growing increasingly resistant to available antibiotics, killing 60,000-80,000 people a year, according to Centers for Disease Control statistics.
Linezolid, under the brand name Zyvox, is from a new class of antibiotics, the oxazolidinones. It stops protein synthesis at the beginning of production—a novel attack for antibiotics. Without protein production, the bacteria die.

The new antibiotic comes in intravenous as well as tablet and suspension oral forms. (Pharmacia is now doing a feasibility study on an ophthalmic form.) It’s intended for use against the hardiest hospital acquired and institutional infections, including vancomycin-resistant Enterococcus faeciuma nd hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus. Zyvox appears particularly strong against staph. and strep. skin infections.
Zyvox may replace cefadroxil and ciprofloxacin as the antibiotic of choice against MRSA infections, says Harvey Bonner, O.D., who watches new pharmaceuticals. Zyvox also replaces vancomycin as a last resort antibiotic for severe infections. It can also manage Staphylococcus epidermidis that may remain on surgical instruments.

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Genome Project Helps to Identify Colorblind Disease

The disease, achromatopsia (or rod monochromy), is characterized by photophobia, low visual acuity, nystagmus and a total inability to distinguish colors. Patients can only see in dim light. All three types of cones in the retinas of these patients are still alive, just not functional, Dr. Olof Sundin, of John Hopkins University School of Medicine, told the online publication Sightstreet News.

Achromatopsia, while typically rare, is common among the population of the Pingelap atoll in Micronesia. The population was devastated by a typhoon in 1775, then regrew from about 20 survivors. Researchers believe they have traced the mutation among the small population of the Pingelapese back to one man.

Dr. Sundin examined information provided by the Human Genome Project to identify the gene responsible for Pingelapese achromatopsia (CNGB3).His results are published in the July issue of Nature Genetics.
Identifying the mutated gene is the first step, he says, but treating the disease appears to be a long way off.

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Third-Party Plans Keep Lock on O.D.s

Last year the typical doctor responding to our survey participated in seven third-party plans. This year, it’s eight. Last year about half our National Panelists said they were seeing more patients from third-party plans. This year, about two-thirds say that. Panelists estimate that close to 20% of their patient base has Medicare, up about 25% over last year’s survey. About 15% of our panelists responded to this month’s survey.

The bad news is that while doctors are seeing more patients, they’re not seeing more revenue. Half of our responding doctors say third-party participation causes a decrease in income. Only a quarter say third-party plans grow their income.

One panelist from New York state found a solution: “Since dropping most third-party plans, I see fewer patients but make more money since I usually collect my full fees.”

Others see things differently. Harry Landrum, O.D., of Philadelphia,says that third-party plans mean that people come into the office more regularly. This has helped increase income in his practice.

Four out of five respondents say they can make up fee discounts through their dispensary volume. An O.D. in Massachusetts says that “all third-party plans want dispensary discounts.” Randolph Brooks, O.D., of Ledgewood,N.J, believes that, “you can’t lose money on every patient and make it up in volume.”

How do these practices make up the difference? Thomas Tucker, O.D., of Greenville, S.C., attributes it to “excellent staff who suggest AR, high index.” And a voice of optimism in North Carolina suggests, “Try to be fair in prices and offer good quality in frames and materials. People keep coming back and send their friends.”

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The Few, the Unproud, the Cheaters

Also cited in the optometric study is how unethical behavior translates to patient care. Of 1,092 optometric students surveyed, 25% had seen or heard about dishonesty concerning clinical findings.

D. Leonard Werner, O.D., who teaches at the State College of Optometry, State University of New York, led the study. “The most disturbing findings were those incidents of unethical behavior in the clinic,” Dr. Werner says.“Reporting of inaccurate information on record forms is something that affects us all.”

Alden N. Haffner, O.D., Ph.D., president of the SUNY State College of Optometry, says, “Any kind of cheating deteriorates the ethical standing of the individual. Such unethical behavior has no place in creating a professional atmosphere, and should not be tolerated.”

1. Werner DL, Heiberger M, Feldman J, Johnston E. The Prevalence of Unethical Student Behavior in Optometry Schools. Optom Ed 2000; 25(3):82-87.

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