LETTERS & E-MAIL

Schools Need to Read Editorial on Dr. Borish

Editor: Kudos for your editorial on Dr. Irvin Borish’s comments at the East-West Conference (Editor’s Page, “Back to Basics, and Then Some,” November 1998). When will we ever learn the bitter lessons of history?

Dr. Borish, visionary that he is, was instrumental in gaining diagnostics and therapeutics for our profession. Unfortunately, along the way optometry seems to have lost its desire to care for vision, the source of 85 percent of all eye complaints.

Part of the problem stems from the decision to permit professionals and health suppliers to advertise. This changed the image of health professionals in the consumers’ eyes. We’re seen more as merchants. Young practitioners, shying away from the marketplace, have gravitated to medical eye care.

Optometric educators can take some of the blame, too. They’ve increased their emphasis on medical eye care at the expense of traditional optometric vision care. If the full spectrum is not presented, it will not become normal behavior.

Dr. Borish made another suggestion years ago that we become “data analyzers,” rather than “data gatherers.” Four-handed optometry has yet to become the mode of practice. Again, optometry schools are partly responsible. They still teach hands-on data gathering the way it was taught in the late 1950s.

All of us owe Dr. Borish the determination to become fully qualified in the full scope of eye care. Optometry schools must get on board and ensure that their end product is properly qualified in full-scope care, too.—Roland E. Gaudette, O.D., M.B.A., Naples, Fla.

What’s the Hang-up With State Boards, Anyway?
Editor: Thanks for Dr. Mont-gomery Vickers, who makes me laugh once a month. I can appreciate his feelings about taking the TMOD and licensing in general.
Ten years ago I decided to move from Oregon to Washington after 19 years in practice. I had to take the TMOD, and also a subpart of the National Board on Pharmacology.

Believe me, they weren’t as bad as the state board exam. On the first try, I misjudged one too many of the pathology slides. On the second try a year later, my technique on the binocular indirect ophthalmoscopy was judged to be unorthodox. The third time was the charm.

One of the examiners confided that he didn’t think he could pass the exam. It occurred to me that over a period of 19 years, I had conducted eye exams on patients from many states.

That prompted me to write a letter to the editor in which I noted that I could do an exam on a patient from Florida if he came to my office, but I could not go to Florida to repeat that exam on the same patient.

A few years after that, the then-new dean of Pacific University College of Optometry (Lesley Walls, O.D., M.D., currently the president of the Southern California College of Optometry) noted that he had received his license to practice medicine as an M.D. in Oregon in just one day, but had to wait to take the optometric board exam along with the graduates.

Apparently the medical profession is willing to accept credentials from another state, and the optometric profession isn’t. Why? Is it because of economics? We are certainly behind the times. Fortunately my patients from outside the Uni-ted States don’t have the same hang-ups as the state board members.—Richard Rue, O.D., Kent, Wash.

Real Snow Blindness Is a Photokeratitis
Editor: In the article “The Hazards That Await on Ski and Skate,” (November 1998), the author states that snow blindness is “the damage to the retina caused by excessive exposure to ultraviolet light ...” He then quotes Sandra Landis, O.D., as saying, “If you’ve ever seen somebody who has snow blindness where the retina has actually been burned from looking at the reflection of light from the snow, it’s very painful.”

Snow blindness is a photokeratitis, not a retinitis. It is caused by ultraviolet damage to the corneal epithelium. The term for solar damage to the retina is “solar retinopathy.” This is a thermal burn to the retina. It occurs from direct viewing of the sun, most commonly during an eclipse.

Retinal burns, tears, detachments, etc., do not cause pain because the retina has few, if any, receptors for pain. Pain associated with retinal inflammation is primarily due to the accompanying inflammation of the underlying tissues (for example, the choroid or sclera).

I have never heard of anyone getting a retinal burn from reflected light off a diffusing surface, such as snow or sand, but if this was at all possible, any pain they experienced would be due to the accompanying corneal, not retinal, damage.

— Thomas M. Wiley, O.D., M.S., vivaw@sandpoint.net, Sandpoint, Idaho.

Income Survey Numbers May not be What They Seem
Editor: The approach you take to your annual income and salary survey (“The O.D.s’ Big Squeeze: Higher Costs Pinch Margins,” December 1998)—using averages instead of medians—renders your survey worthless.

Averages are simply numerical manipulations, having no value in and of themselves. For example, if you take the average age of three people, one 100 years of age, one 90 and the other 1 year old, what does the average age tell you about the group? Nothing. If you took the median of the group, though, it would tell you much.
This applies to all statistical analyses which have human application. As it applies to your survey, the 10 percent of O.D.s who gross and net extremely high numbers totally skew “averages,” whereas they would have no affect on “medians.” This would also apply for those with abnormally low gross and net.

I believe the way you interpret the survey results make the average practitioner out there very paranoid.—Lonn G. Schwartz, O.D., East Stroudsburg, Pa., procom@ptd.net

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