EYE DOCTORS AND HOW TO DEAL WITH THEM
OD's and MD's. An optometrist is a person who has completed four years of optometry school and has received the degree of Doctor of Optometry (O.D.). Two or more years of college-level training are usually a prerequisite to entering optometry school. In the past, optometrists have not been permitted to treat diseases of the eye or to perform surgery, but now some of them are doing corneal surgery. They have seen how much money the ophthalmologists are making doing this risky surgery and they have fought political battles to be allowed to do it too.
An ophthalmologist is a person who has completed four years of medical school and who then specializes in eye care. Such a person receives the degree of Doctor of Medicine (M.D.). Four years of premedical school are usually a prerequisite to entering medical school. Ophthalmologists are permitted to treat diseases of the eye and to perform eye surgery.
Both optometrists and ophthalmologists are licensed to test vision and prescribe glasses. An optician is a person who makes and dispenses the eyeglasses which they prescribe. Opticians are not licensed to treat vision problems.
In the United States, there are about twice as many optometrists as ophthalmologists. Although some countries - such as Britain, Australia, Canada, and South Africa - also have strong optometric professions, optometry is still in its infancy in other parts of the world, and most people have no choice but to consult an ophthalmologist. In some countries, opticians are permitted to prescribe glasses under certain conditions but they are not really trained in proper vision care.
There has always been a lot of feuding between O.D.'s and M.D.'s. Many O.D.'s say that M.D.'s are practicing optometry and should confine themselves to surgery and the treatment of disease. They are also disturbed by attempts by the medical profession to stigmatize optometric care as inferior. Conversely, many M.D.'s say that O.D.'s are not sufficiently trained in medical matters and that they are encroaching on the medical field by using drugs, etc. The truth lies somewhere between these two positions, which are motivated more by financial considerations than by concern for the customer's welfare. Both groups have their place and perform an important role in eye care.
An interesting episode, although it occurred some years ago, illustrates the kind of problems that have existed between O.D.'s and M.D.'s. In 1955, the American Medical Association passed several resolutions against the profession of optometry. Members of the AMA were prohibited from associating professionally with optometrists. The exact wording of Resolution 77, adopted by the AMA in June, 1955, is:
Resolved, that it is unethical for any doctor of medicine to teach in any school or college of optometry, or to lecture in any optometric organization, or to contribute scientific material to the optometric literature, or in any way to impart technical medical knowledge to nonmedical practitioners.
In addition to this boycott of optometry, efforts were made by the AMA to make the public believe that only medical doctors could examine eyes properly. Furthermore, ophthalmologists were not even allowed to hire optometrists to work for them, unless their true identity as optometrists was not revealed to the public.
These resolutions resulted in a $90 million lawsuit brought against the AMA and eight Chicago ophthalmologists on July 24, 1964, charging them with violation of the Sherman Antitrust Act. The lawsuit was brought by a group of optometrists, among whom the principal plaintiff was Cyrus Bass of Chicago.
Two important court decisions were decided in favor of the optometrists, forcing the AMA to dissolve its resolutions against optometrists. In 1967, when the boycott against optometry was removed, the lawsuit against the AMA was ended.
Although relations between optometrists and ophthalmologists have improved somewhat since then, the AMA would undoubtedly prefer to eliminate optometry as a profession, or at least to make optometrists subservient to ophthalmologists. It is fortunate for the cause of myopia prevention that this is not likely to happen, since the biggest obstacle to the widespread acceptance of myopia prevention techniques is the medical profession itself. By medical profession, I mean M.D.'s and not O.D.'s.
It has often happened that a progressive optometrist has prescribed reading glasses for a child in an attempt to control myopia, only to have the parent then consult an ophthalmologist who has said that the reading glass approach is nonsense. For some reason, the parent usually believes the M.D., with the result that the O.D. has lost a customer. The O.D. is often also subjected to strong criticism from the parent, who has never really understood the problem or the treatment because the O.D. has not taken the time or provided the written material needed to educate the parent. After several such episodes, the O.D. may decide, "If this is the thanks I get, why should I bother with the preventive approach?" Yet, not one eye doctor in this country makes this book or anything like it available to patients for loan or purchase. Therefore, the ignorance of the patient must be blamed on the eye doctors.
Everywhere one turns, the same obstacle - the medical establishment - is blocking the way. Our schools should be screening our children to detect beginning myopia so that it can be treated early when it can be easily eliminated. After all, it is the schools, which teach children to read, that should at the same time insure that this is done without ruining their vision. But since the school boards believe the M.D.'s, no measures are taken to prevent myopia. Actually, if a vision screening program does nothing more than to insure that myopic children are given concave lenses, the children would be better off without the screening program, since the concave lenses will only ruin their vision. That the medical establishment continues to hold fast to the discredited hereditary theory is almost unbelievable. They continue to fit glasses to eyes as if they were fitting shoes on feet, ignoring entirely the dynamic nature of the eye and its ability to adapt to a close environment.
The field of orthokeratology is also being criticized by the M.D.'s, who were critical of contact lenses in general when optometrists first started using them. Many M.D.'s seem to have the view that if something is not initiated by them, it has no value. However, once contact lenses became popular, ophthalmologists started to fit them also.
The point of all this is that if you want to do something about preventing myopia, it is a waste of time to consult an ophthalmologist since it would be highly unlikely to find one who understands or has any interest in myopia prevention. The best course of action is to contact local optometrists to see if you can find one who uses plus lenses or takes other steps to prevent myopia.
Generally speaking, the M.D.'s specialize in those vision problems requiring drugs or surgery. The O.D.'s specialize in non-medical vision problems. Consequently, there is no more reason to turn to an M.D. for the treatment of acquired myopia than there is to turn to an O.D. for a problem requiring drugs or surgery.
When the use of preventive techniques has become commonplace, the medical establishment will undoubtedly join in and probably try to convince the public that this is another triumph of "medical science." Let it be understood now that they are not leading this revolution. They are fighting against it.
There are probably a large number of optometrists who know that they should prescribe bifocals or take other measures to prevent myopia, but they only do so if the patient or parent brings up the topic first. If a parent says, "I wish something could be done to prevent my child from becoming more nearsighted", then they might talk about the subject. The doctor may be fearful that patients will think they are being lured into something worthless that will cost them money, or the doctor may have other reasons for remaining silent. But, how is the patient to know there is such a thing as myopia prevention unless the doctor brings up the subject? It is the duty of the doctor to offer the patient a choice. It should be the patient's decision.
Furthermore, doctors who are not involved with a particular phase of eye care, whether it be myopia prevention, orthokeratology, or something else, are not likely to refer you to someone who is active in these areas. To do so would mean losing you as a customer.
Vision specialists have no difficulty finding reasons for not using preventive techniques. One of the favorite remarks is to say that there is no proof that myopia can be prevented. There is such proof, of course, but they ignore it. Even if there were no proof, why should they be waiting for someone else to prove this? They are the ones who prescribe the glasses. Every doctor has a certain number of patients who will try anything to save their good vision. By doing what we have been advocating for years, they can prove to themselves that these techniques work.
Many vision specialists feel that they cannot make a satisfactory income unless they sell eyeglasses and contacts in addition to performing vision examinations, vision training, etc. For this reason, many optometrists operate optical shops in conjunction with their practice. Ophthalmologists have not done this as much in the past, but even among them it is becoming more common to have a financial interest in an optical business.
Optometrists who make money selling glasses do so openly in most cases. Their financial interest is not hidden. Although some ophthalmologists operate in the same manner, there is among ophthalmologists a greater tendency to keep their financial interests hidden since they like to have people believe that they are too "professional" to be involved in the sale of eyeglasses. A case in Canada illustrates what goes on in many countries, including the United States.1
An established optician opened a new branch in another town. He cut his prices below those of the other opticians in order to boost business. Although the other opticians did not lower their prices, he did not notice any increase in his business. He asked the local ophthalmologists why they did not refer their patients to him. He was told that he would have to make some kind of payment to the ophthalmologists or allow them to own part of his business before he would get referrals from them. This matter was brought to light during an investigation by the Restrictive Trade Commission.
A "referral" occurs when a patient receives a prescription, and the doctor makes some such statement as, "I suggest that you get this filled at the optician next door. I know they do good work and their prices are reasonable." What is not said is that the doctor either owns part or all of the optical business or is getting kickbacks from the optician.
At the heart of the problem was the lure of excessive profits (as much as 400 to 500 percent) to be made on the sale of glasses. Because of laws in many states that prohibited the advertising of optical prices, those companies who were willing to sell at low prices were unable to make this known to the public. These laws were overturned in the United States by a 1978 ruling of the Federal Trade Commission, and we now see optical stores everywhere, competing for your business.
These restrictive state laws were passed years ago because of the political influence of the eye doctors themselves, and solely for their own financial benefit. Naturally, they fought strongly against the repealing of the laws. The state agencies, which are supposed to regulate such matters, are controlled by the very interests they are supposed to be regulating. They artificially upgraded the business of selling eyeglasses to professional status so that eyeglasses could be sold at higher prices.
Don't be afraid to shop around for the best price when filling your prescription. If you purchase glasses from the doctor who prescribes them, your bill should show a separate price for the examination and a separate price for the glasses. The 1978 ruling of the Federal Trade Commission also stipulates that the doctor is required to give you a copy of your prescription. Only with this information can you find out what you would have been charged if you had bought the glasses elsewhere.
Actually, it is not always necessary to have a doctor's prescription to buy glasses. While it is against the law for an optician to examine your eyes and tell you what lenses you need, there is nothing wrong if you tell the optician what power lenses you want in the frame. If the optician won't do it without a prescription, find an optician who will.
Since it is so difficult to find an eye doctor who will treat your child properly, use the knowledge gained from reading this book to select your own lenses. Of course, it would be best to have your child's eyes examined so that you know the exact refractive error. However, even if you did not have this knowledge, you could hardly go wrong by purchasing a pair of ready-made + 1.5 D or + 2 D reading glasses for the child who is beginning to become nearsighted. Plus lenses will not harm the child's eyes. Only minus lenses ruin the eyes.
The sale of optical goods by the same person who prescribes them has both positive and negative aspects, and it is wise to understand both sides of the question.
On the positive side, the doctor who also dispenses the prescribed items is better able to control their quality and fit, and to be sure that the customer leaves the office fully satisfied. It is also more convenient for the customer to have to deal with only one establishment. An analogy can be found in dentistry where the dentist normally orders the required bridges and dentures from a laboratory and sells them to the patient after making sure that they do the job intended and the patient is satisfied. On the negative side, a dentist who knows that a lot of money can be made (and with minimal time expenditure) by selling dentures will have less incentive to practice preventive dentistry. By preventive dentistry I refer to such practices as scrupulously removing deposits from the teeth to prevent gum disease, performing root-canal work rather than pulling a tooth, and educating the patient in the necessity of eating unrefined foods to prevent decay. In the vision care field, the same thing applies. An eye doctor who earns money selling glasses and contacts will have less incentive to practice preventive eye care. By preventive eye care I refer primarily to the prevention of myopia.
While it would be preferable if eye doctors did not have a financial interest in the sale of eyeglasses, this factor alone does not determine the quality of care. There are doctors who sell glasses but who still have an interest in prevention. There are also doctors who do not sell glasses but who care nothing for prevention. It remains the customer's responsibility to take the time and make the effort to find a good vision specialist.
Dangerous dilating drugs. Another topic that you should know about when dealing with doctors concerns the use of drugs. Eye doctors frequently put drugs in the eyes of both children and adults before examining their eyes in order to temporarily paralyze the accommodation. The doctors who do so claim that by completely relaxing the ciliary muscle, they can get a more accurate determination of the actual refraction.
The truth of the matter is that an eye in a drugged condition is an abnormal eye bearing little resemblance to the normal eye. It is difficult to find any benefit to be derived in prescribing glasses based on the examination of an abnormal eye.
These drugs can cause irritation or a burning sensation to the eyes and in some rare cases have caused systemic poisoning and even death. In addition, these drugs have a tendency to raise the intraocular pressure in some individuals and can precipitate an attack of glaucoma. This danger, however, is of real concern only after the age of forty. Numerous children develop red or flushed faces when these drugs are used - a sure sign that the system is being poisoned.
The doctors, of course, would have us believe that these drugs are harmless. Yet, when it serves their own interest, they tell another story. At one time, only ophthalmologists could use these drugs, and optometrists were fighting for the right to use them also. When optometrists in Delaware were trying to get the right to use drugs, and House Bill 63 was being discussed, organized ophthalmology placed an advertisement in a Delaware newspaper that said, among other things, "If passed, HB 63 will permit optometrists to use potentially dangerous drugs to diagnose eye disease. Optometrists are not properly trained in the use of drugs nor in the treatment of their side effects. Serious side effects of these drugs include convulsions, high blood pressure, shock, asthma, retinal detachment, cataracts, glaucoma, and more".
The real reason for the widespread use of these drugs is that the doctors can take higher fees by making their customers believe that a more thorough eye examination is being made. Drugs are not necessary in routine eye examinations. If you do not want them to be used, tell your doctor so. It's your money and your health.
The above observations are intended to make clear to you the greed and self-interest that lie behind the choices your eye doctor gives you.
Take charge. Once you have read The Myopia Myth you will know more about myopia than most doctors. Finding out your refraction may be the only reason you have to visit a doctor. This prescription is used as a basis for selecting the lens power for reading glasses or the Myopter. Take charge of your visit to the doctor. The doctor works for you. Take this book to your doctor, lay it on the table, and ask "Why didn't you tell me about these things?" The response should be interesting. If you are not satisfied with the answers you are getting, leave the office and pay nothing.
Some of these doctors are pure evil. They know the truth but, like tobacco company executives, don't care how many horrors they inflict on people, even their trusting customers. It serves their purpose to conspire with the National Eye Institute, public "education" organizations, the media and others to hide the truth and prevent any research that might discredit the inherited myopia theory. Others just have the common human failing of believing what pleases them most, and then finding reasons, however illogical, to support that belief. Amazingly, this rationalization is so effective that they even destroy the vision of their own children, fully convinced that they are doing the right thing. And still others are just stupid. If you do not educate yourself, you will be their victim.