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Ron Melton, OD, FAAO

Ron Melton, OD, FAAO

Charlotte Eye Ear Nose & Throat Associates, P.A.

 

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QUICK LINKS:

Education  |  Licensure  |  Certifications  |  Positions of Professional Service  |  Post Graduate Professional Short Courses  |  Clinical Research Activities

Presentations of Continuing Education Courses, Research Papers and Special Lectures  |  Professional Publications  |  Achievements, Honors and Privileges 

Professional Associations

Education Anchor
Licensure Anchor
Certifications Anchor
Positions of Professional Service Anchor
Post Graduate Professional Short Courses Anchor
Clinical Research Activites Anchor
Presentations of Continuing Education Courses Anchor
Professional Publications
Achievements, Honors and Privileges
Professional Associations

EDUCATION:

O.D., Doctor of Optometry
Pennsylvania College of Optometry
Philadelphia, Pennsylvania
Graduation: May, 1981

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B.S., Bachelor of Science in Integrated Biological Sciences
Pennsylvania College of Optometry
Philadelphia, Pennsylvania
Graduation: January, 1979

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B.S., Bachelor of Science Biology and Business Administration
Greensboro College
Greensboro, North Carolina
Graduation: May, 1977

 

LICENSURE:

Indiana State Board of Optometry 
State of Indiana
July, 1981

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North Carolina State Board of Examiners in Optometry
State of North Carolina
September, 1981

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Oklahoma Board of Examiners in Optometry
State of Oklahoma
August, 1983

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South Carolina Board of Examiners in Optometry
State of South Carolina
August, 1987


CERTIFICATIONS:

  • Successfully completed the National Board of Examiners in Optometry, April, 1981

  • Successfully completed the International Association of Boards of Examiners in Optometry Examination on "Treatment and Management of Ocular Disease", April, 1986
     

POSITIONS OF PROFESSIONAL SERVICE:

Charlotte Eye Ear Nose & Throat Associates, P.A.
Charlotte, North Carolina
May, 2000 to present

 

Nalle Clinic
Charlotte, North Carolina
May, 1986 to April, 2000

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Private Practice
Oklahoma City and Tulsa, Oklahoma
September, 1984 to 1986

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Primary Care Optometrist
Hawley Army Community Hospital
Indianapolis, Indiana
August, 1981 through August, 1984
 

POST GRADUATE PROFESSIONAL SHORT COURSES:

Armed Forces Institute of Pathology Course in Ophthalmic Pathology for Ophthalmologists, Washington, D.C. Fall, 1982

 

CLINICAL RESEARCH ACTIVITIES:

Investigator - An Active, Drug-Controlled, Double Masked, Multicenter Study Evaluating the Safety and Efficacy of 0.6% Norfloxacin Ophthalmic Solution vs. 0.3% Tobramycin Ophthalmic Solution in the Treatment of Patients with Acute Bacterial Infections of the External Eye and Adnexa, Protocol MK-366, Merck, Sharpe and Dohme Research Laboratories, 1986 - Completed.

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Co-Investigator - Lovastatin Dose-Ranging Multicenter Study in Patients with Type II Hypercholesterolemia, Total Cholesterol 240-300 mg/dl with or without Other Risk Factors and with or without Evidence of Coronary Artery Disease, Protocol No. 022, Merck, Sharpe, and Dohme, 1987 - Completed.

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Co-Investigator - A Double-Blind, Randomized Study of THERAFECTIN (amiprilose HC1) 6 grams/day Arthritis Withdrawn from their Nonsteroidal Anti-Inflammatory Drug Therapy, Protocol RA/10, Greenwich Pharmaceutical Inc., 1987 – Completed.

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Co-Investigator - Tolrestat (AY-27,773) Prevention of Progression of Non-proliferative Diabetic Retinopathy: Effects on Retinal Morphology and Renal Function in Patients with Insulin-dependent Diabetes Mellitus, 1986 - Completed.

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Investigator - A Multiple-Dose, Double-Masked, Parallel Active Treatment Controlled Multiclinic Study of 0.25% Timolol-in- GELRITE and 0.25% TIMOPTIC in Patients with Elevated Intraocular Pressure. Merck, Sharp & Dohme. 1992-Completed.

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Co-Investigator - Evaluation of the Efficacy and Safety of Glimepiridie versus Glyburide in Subjects with Noninsulin-dependent Diabetes Mellitus, Protocol M/5220/0001 Upjohn. 1992 - Completed.

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Investigator - The Long-term Safety and Ocular Hypotensive Efficacy of Brimonidine Tartrate 0.2% in Subjects with Open Angle Glaucoma or Ocular Hypertension. Allergan, Inc. 1992 - Completed.

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Co-Investigator - A Randomized Study Comparing the Safety and Efficacy of Two Doses or Oral Ganciclovir to Intravenous Ganciclovir for the maintenance treatment of Cytomegalovirus Retinitis in People with Aids. Syntex. 1993 - Completed.

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Investigator - A Multiple-Dose, Double-Masked, Active Treatment Controlled, Two-Period, Crossover Multiclinic Study of 0.5% Preservative-Free Timolol-in- GELRITE and 0.5% Timolol-in- GELRITE with Preservative in Patients with Elevated Intraocular Pressure. Merck, Sharp, & Dohme. 1994 - Completed.

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Investigator - A Double-Blind Double-Dummy, Acyclovir Controlled, Parallel Group Study to Compare the Efficacy and Safety of Famciclovir with Acyclovir in the Treatment of Patients with Ophthalmic Zoster. Protocol # BRL 42810-098. SmithKline Beecham. 1994 - Present.

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Investigator - A Parallel, Randomized, Double-Masked, Active Controlled, Multiclinic Study Comparing the Tolerability and Efficacy of 2% MK-507 Ophthalmic Solution and Orally Administered Acetazolomide in Patients with Ocular Hypertension or Glaucoma Receiving Concomitant Treatment with 0.5% Timolol Ophthalmic Solution. Protocol # 054-00. Merck, Sharp, & Dohme. 1995 - Completed.

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Investigator - A Parallel, Randomized, Double-Masked Study Comparing the 0.5% Timolol/2.0% MK-507 Combination Ophthalmic Solution .I.D. to 0.5% Timolol Ophthalmic Solution B.I.D. or 2.0% MK-507 Ophthalmic Solution T.I.D. in Patients with Elevated Intraocular Pressure who are Inadequately Controlled on Timolol Alone. Protocol # 064. Merck, Sharp, & Dohme. 1995 Completed.

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Investigator - A Four Month Multicenter, Double-Masked, Parallel Safety and Clinical Success Comparison of Brimonidine Tartrate 0.2% Versus Timolol 0.5% as Initial Therapy for Subjects with Open-Angle Glaucoma or Ocular Hypertension. Protocol # 190342-126- 00. Allergan, Inc. 1996 - Completed. 

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Investigator - A Three-Month, Multicenter, Triple-Masked, Placebo-Controlled, Adjunctive Therapy Study of the Efficacy and Safety of TID Dosed AL-4862 1.0% Ophthalmic Suspension in the Treatment of Patients with Primary Open-Angle Glaucoma or Ocular Hypertension Maintained on Timolol Therapy. Protocol # C-95- 38. Alcon Laboratories, Inc. 1996 - Completed.

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Investigator - A Parallel, Randomized, Double-Masked, Multicenter Study Comparing the Effect of Dorzolamide 2% to Pilocarpine 2% as Adjunctive Therapy to Timolol Maleate Ophthalmic Gel Forming Solution 0.5% in Patients with Elevated Intraocular Pressure. Protocol # 073-00. Merck & Co., Inc. 1996 - Completed.

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Investigator - SEE3 Extended Wear Soft Contact Lens Research Study # 1000.06A - Lotrafilcon A Hydrophilic Contact Lens. CIBA Vision Corporation. 1996 - Completed.

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Investigator - Safety and Efficacy of Ketotifen Fulmarate 0.025% Ophthalmic Solution Compared with Vehicle Placebo Control in the Allergen Challenge Model of Allergic Conjunctivitis. CIBA Vision (Novartis). 1998 - Completed.

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Investigator – A Six-Month, Multicenter, Triple Masked, Placebo-Controlled Adjunctive Therapy Study of the Safety and Efficacy of AL-6221 0.0015%and AL-6221 0.004% Ophthalmic Solution in Patients with Open-Angle Glaucoma or Ocular Hypertension Maintained on TIMOPTIC 0.5%. Protocol # C-97- 73. Alcon Laboratories, Inc. 1998 - Completed.

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Investigator – A Twelve-Week, Multicenter, Triple- Masked Study of the Safety and IOP-Lowering Efficacy of Levobetaxolol 0.5% Suspension Compared to TIMOPTIC 0.5% Solution in the Treatment of Patients with Open-Angle Glaucoma or Ocular Hypertension. Protocol # C-97- 67. Alcon Laboratories, Inc. 1998 – Completed

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Investigator – Clinical Comparison of Acuvue Bifocal Contact Lenses vs. Lifestyle Xtra Soft Multifocal Contact Lenses. Johnson & Johnson Vision Products, Inc. (Vistakon). 1999 – Completed.

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Investigator – A Randomized, 5 - Year Postmarketing Safety Study of Xalatan Compared to “Usual Care in Patients with Open Angle Glaucoma Glaucoma or Ocular Hypertension. Pharmacia & Upjohn. 1999 – Present.

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Investigator – Evaluation of the Safety & Efficacy of Sterile Comfort Drops (AAC-002) When Compared to Boston Rewetting Drops (NOF002). Foresight Regulatory Strategies, Inc. 1999 – Completed.

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Principal Investigator – Acuvue 8.8 Non-I/O Lenses From Different Lots, CR-9908. Johnson & Johnson Vision Products, Inc. (Vistakon). 2000 – Completed.

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Principal Investigator – A Phase III Multicenter, Randomized, Double-Masked, Parallel Study to Compare the Safety and Efficacy of 0.3% Gatifloxacin Ophthalmic Solution with that of 0.3% Ofloxacin Ophthalmic Solution in the Treatment of Acute Bacterial Conjunctivitis (Protocol # SPCL-GFLX 3/02). Senju Pharmaceutical. 2000 – Closed.

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Investigator – A Multicenter, Double-Masked, Randomized, Parallel Study of the Safety and Efficacy of 0.2% Brimonidine Tartrate/0.5% Timolol Combination Ophthalmic Solution Twice-Daily Compared with 0.5% Timolol Twice-Daily or Alphagan Three-Times- Daily for Three Months (Plus 9-Month, Masked Extension) in Patients with Glaucoma or Ocular Hypertension (Protocol # 190342-013T- 01). Allergan, Inc. 2000 – Present.

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PRESENTATIONS OF CONTINUING EDUCATIONS COURSES, RESEARCH PAPERS AND SPECIAL LECTURES:

Lectured on the topics of pharmacology, ocular differential diagnoses, and medical management of eye diseases throughout the United States and internationally including Canada, Australia, Mexico, South Africa, and the United Kingdom

 

Professional Publications (Co-Authored with Randall K. Thomas, OD, MPH, FAAO):

  • "Pharmaceutical Agents Commonly Used to Treat Afflictions of the Eye and Adnexa", Southern Journal of Optometry, June, 1984.

  • "Pharmaceutical Agents Commonly Used to Treat Ocular Inflammations of the Eye and Adnexa", Southern Journal of Optometry, October, 1984. 

  • "Pharmaceutical Agents Commonly Used to Treat Infections / Inflammations of the Eye", Southern Journal of Optometry, October, 1984.

  • "How to Manage Viral Conjunctivitis", Optometric Management, June, 1991.

  • "Antiviral Drugs and Pharmacology" and "Conjunctival and Corneal Foreign Body Removal", Chapters in Clinical Optometric Pharmacology and Therapeutics, Editor: B.E. Onofrey, J.B. Lippincott Company, 1991. 

  • "Medical Management of Anterior Uveitis"; and "Grand Rounds Management of Corneal Abrasions", Chapters in Optometry Clinics - Anterior Segment Disease Update, Editor: J.G. Classe', Appleton and Lange, 1991.

  • “Dry Eye Syndrome and the Optometrist: Diagnosis and Treatment”, Publication from Roundtable Discussion, Allergan, 1991. 

  • “Use of Clinical Laboratory Testing in the Private Practice of Optometry”, Chapter in Optometry Clinics - Clinical Laboratory Testing, Editor: J.G. Classe', Appleton and Lange, 1992. 

  • “The Practical Guide to Therapeutic Drugs”, Optometric Management, May, 1992.

  • "A Review of Common Ophthalmic Antibacterial and Corticosteroid-Antibacterial Combination Drugs”, Chapter in Optometry Clinics - Ocular Pharmacology Update, Editor: J.G. Classe, Appleton and Lange, 1992.

  • “OD Dialogues: Ocular Surface Disease and Dry Eye Syndrome”, Publication from Roundtable Discussion, Allergan, 1992

  • "Pharmacology Questions”, Supplement to Optometric Management, January, 1993

  • “Does This Patient Have Glaucoma? Factors to Consider in Diagnosis and Management”, Eye Quest Magazine, January/February, 1993.

  • “When White and Quiet Turns Red and Angry - How to Relieve Contact Lens -Induced Inflammation”, Review of Optometry, April, 1993 

  • “2nd Annual Practical Guide to Therapeutic Drugs”, Optometric Management, May, 1993 

  • “Understanding Blepharitis”, Optometry Today, June, 1993.

  • “Take the Worry Out of Managing Uveitis”, Optometric Management, June, 1993

  • “Treatment of Blepharitis”, Optometry Today, July/August, 1993

  • “Pupillary Dilation: A View From the Trenches,” Guest Editorial, Journal of the American Optometric Association, September, 1993

  • “3rd Annual Practical Guide to Therapeutic Drugs”, Optometric Management, May 1994“Put Patient’s Interest First When Diagnosing Disease”,  Optometry Today, May, 1994

  • “A Practical Look at Clinical Dry Eye”, Optometry Today, May, 1994

  • “4th Annual Practical Guide to Therapeutic Drugs”, Optometric Management, May 1995

  • “Oral Medicines in Primary Eye Care”, Eye Quest Magazine, July/August, 1995

  • “Fluoroquinolones: A First-Line Treatment”, Primary Care Optometry News, September, 1995

  • “Understanding Today’s Glaucoma Medications”, Take Charge of Glaucoma Management - Supplement to Review of Optometry, September 15, 1995

  • “The Power of Prescribing”, Optometry Today - Eye Drug Update (Featured on Cover), October, 1995

  • “Nonspecific Conjunctivitis”, Optometry Today, October, 1995

  • “Open-Angle Glaucoma”, Optometry Today, October, 1995

  • “The 1996 Clinical Guide to Ophthalmic Drugs”, Review of Optometry, May 15, 1996

  • "linical Management of the Anterior Segment”, Optometry Today, August, 1996

  • “Clinical Grand Rounds of the World Wide Web”, Pacific University College of Optometry Center for Distributed Learning and Optometry Today, August, 1996

  • “Clinical Management of the Anterior Segment, Part II”, Optometry Today, September, 1996

  • “New Alpha-2 Agonist Offers Another Medical Alternative to Treat Glaucoma”, Primary Care Optometry News, November, 1996

  • “TPA Notebook”, Monthly Contribution to Primary Care Optometry News, 1997-1998

  • “Adenoviral Infections, Allergic Conjunctivitis, Bacterial Conjunctivitis, Chemical Keratoconjunctivitis: TPA Case Reports”, Practical Optometry, February, 1997

  • “Conjunctival and Corneal Foreign Body Removal”, Optometry Today, April, 1997

  • “Chlamydial Conjunctivitis in the Adult, Contact Blepharodermatitis, Corneal Abrasions: TPA Case Reports”, Practical Optometry, April, 1997

  • “The 1997 Clinical Guide to Ophthalmic Drugs”, Review of Optometry, May, 1997

  • “The Virtual Eyecare Clinic: Anterior Segment”, Lifelearn Eye Care CD-ROM Based Learning and Reference Modules for Eye Care Professionals, University of Waterloo School of Optometry, Ontario, Canada, May, 1997

  • “Corneal Foreign Bodies, Corneal Ulcers Versus Infiltrates: TPA Case Reports”, Practical Optometry, June, 1997

  • “Dry Eye Syndrome, Episcleritis: TPA Case Reports”, Practical Optometry, August, 1997

  • “How to Get More Out of Your Glaucoma Medications”, Review of Optometry, Take Charge of Glaucoma Management Supplement, September, 1997

  • “Herpes Simplex Keratitis, Herpes Zoster Ophthalmicus: TPA Case Reports”, Practical Optometry, October, 1997

  • “Forward”, in Drugs in Primary Eyecare, Editors: D.R. Woodard and R.B. Woodard, Appleton & Lange, 1997

  • “Hordeolum, Herpes Zoster: TPA Case Reports”, Practical Optometry, December, 1997

  • “Making All the Right Moves: Tried and True Strategies for Writing More Scripts”, Optometry Today, January-February, 1998

  • “Iritis and Iridocyclitis, Ocular Lymphangiectasis: TPA Case Reports”, Practical Optometry, February, 1998

  • “What’s the Best Medicine for This Glaucoma Patient?”, Review of Optometry, March, 1998

  • “Traumatic Hyphema, Parinaud’s Oculo-Glandular Syndrome: TPA Case Reports”, Practical Optometry, April, 1998

  • “Glaucoma Agents”, Section in Ocular Therapeutics Handbook: A Clinical Manual, Editors: B.E. Onofrey, L. Skorin, Jr., N.R. Holdeman, Lippincott-Raven, 1998

  • “Parinaud’s Oculo-Glandular Syndrome, Phlyctenular Keratoconjunctivitis: TPA Case Reports”, Practical Optometry, June, 1998

  • “The 1998 Clinical Guide to Ophthalmic Drugs”, Review of Optometry, June, 1998

  • “Superior Limbic Keratoconjunctivitis, Thygeson’s Superficial Punctate Keratopathy, Vernal Keratoconjunctivitis: TPA Case Reports”, August, 1998

  • “Blepharitis, Floppy Eyelid Syndrome: TPA Case Reports”, Practical Optometry, October, 1998

  • “Bell’s Palsy: TPA Case Report”, Practical Optometry, December, 1998

  • “Nonspecific Conjunctivitis: TPA Case Report”, Practical Optometry, February, 1999

  • “The Great Contact Lens Debate: What’s the Best Medicine for Ulcerative Keratitis?”, Review of Optometry, April, 1999 

  • “Fungal Corneal Infection: TPA Case Report”, Practical Optometry, June, 1999

  • "Optometric Medicine: Delivering the Whole Package”, Optometric Management, July, 1999

  • “The 1999 Clinical Guide to Ophthalmic Drugs”, Review of Optometry, July, 1999

  • “Ocular Rosacea: TPA Case Report”, Practical Optometry, August, 1999

  • “Dacryocystitis: TPA Case Report”, Practical Optometry, October, 1999

  • “Acute Corneal Hydrops, Neurotrophic Keratitis: TPA Case Reports”, Practical Optometry, December, 1999

  • “Dacryoadenitis: TPA Case Report”, Practical Optometry, February, 2000

  • “Glaucomatocyclitic Crisis: TPA Case Report”, Practical Optometry, April, 2000

  • “The 2000 Clinical Guide to Ophthalmic Drugs”, Review of Optometry, May, 2000

  • “Blocking the Allergic Cascade” Panel Discussion, Supplement to Optometric Management, May, 2000

  • “Trichotillomania: TPA Case Report”, Practical Optometry, June, 2000

  • “Soft Torics Made Simple”, Panel Discussion, Supplement to Contact Lens Spectrum, June, 2000

  • “New Anti-Infectives Under Development Will Boast Broader Spectrum Activity”, Panel Discussion, Primary Care Optometry News, July, 2000

 

ACHIEVEMENTS, HONORS AND PRIVILEGES:

  • Awarded the “Glaucoma Educator of the Year” by the American Academy of Optometry, in cooperation with Randall Thomas, O.D., 1997

  • Appointed as a member of the Medical Advisory Panel, Piedmont Healthcare Alliance, Charlotte, North Carolina, 1997 - 2000

  • Appointed as a member of the Editorial Board, Primary Care Optometry News, 1995 - Present

  • Appointed as a member of the Adjunct Faculty, State University of New York College of Optometry, 1993 - Present

  • Appointed as a member of the Adjunct Faculty, Pacific University College of Optometry, 1993 - Present

  • Appointed as a Consultant of the Council on Optometric Education by the American Optometric Association, 1993

  • Appointed as a Clinical Examiner for the North Carolina State Board of Examiners in Optometry, 1992

  • Appointed as a member of the Adjunct Faculty, Pennsylvania College of Optometry, 1988 - Present 

  • Consultant Item Writer for the National Board of Examiners in Optometry, 1986-1987

  • Awarded the William C. Ezell Award For the Best Article Based Upon a Lecture Given at the Southern Congress of Optometry, in cooperation with Randall Thomas, O.D. and Carson Cox, , O.D., M.Ed., 1985

  • Fellowship, American Academy of Optometry, 1984

  • Appointed as a Regional Consultant of the Council on Clinical Optometric Care by the American Optometric Association, 1984 – 1993

  • Recipient of the American Optometric Association's & Optometric Recognition Award; for excellence in continuing professional education, 1984

  • Selected as a participant of the Health Professions Scholarship Program of the United States Army during training at the Pennsylvania College of Optometry, 1978-1981

  • Selected to serve as a member of the Student Optometric Service to Haiti (S.O.S. H.) Team, 1981

  • Student member of the Admissions Committee for applicants to the Pennsylvania College of Optometry, 1977-1979

  • Who's Who Among Students in American Colleges and Universities, Greensboro College, 1977

  • Graduated from Greensboro College with Magna Cum Laude Honors, 1977

  • Wall Street Journal Award from the Business Department at Greensboro College, 1977

  • Selected as a Broyhill Free Enterprise Scholar by Broyhill Industries, 1973

  • Selected as "Mr. Senior" high school student of the year in North Carolina by Greensboro College and awarded an academic scholarship, 1973


PROFESSIONAL ASSOCIATIONS:

  • American Academy of Optometry

  • American Optometric Association

  • North Carolina Optometric Society

  • Tri-County District Optometric Society - North Carolina

  • Contact Lens Section - American Optometric Association

  • Council on Optometric Education -Consultant - American Optometric Association

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The Optometric Cardiologist

 

      Cardiologists are superbly trained medical practitioners of the heart, and cardiothoracic surgeons are superbly trained in heart/chest surgeries. These two medical specialties work together as smoothly as a well-oiled machine or as finely tuned instruments in an orchestra. Why, then, is this not the case with ophthalmologists and optometrists in eyecare? There may be several reasons – a couple follow, and the dynamics here can be highly complex: One reason is that general ophthalmologists are by and large heavily focused on cataract and refractive surgeries. Since many have not (through professional “racism”) enjoined the community optometrists as surgical referral sources, ophthalmologists have to see an abundance of general care patients to glean their surgical patients . Ophthalmologists are heavily, procedure-oriented by definition and by choice; they are eye surgeons. Being procedure-oriented, they are not bastions of medical eyecare. There is no analogous medical specialty in ophthalmology, only a surgical residency. Note that it is a high bar to be competent in both medical and surgical aspects of any specialty. To wit:

Neurology and neurosurgery 

Sports medicine and orthopedic surgery  

Rheumatology and orthopedic surgery  

Internal medicine and general surgery 

Gastroenterology and general surgery

Nephrology and urology

Pediatrics and pediatric surgery 

Audiology and otolaryngology 

There has always been a major sequestration between medicine and surgery, as they are clearly two distinct elements of patient care.

 

      Optometrists, at least traditionally, are heavily focused on refractive correction of ametropias with eye glasses and contact lenses. Ophthalmic medicine has not, until recently, held sway in professional training and competency. As a profession, we have not historically been trained to be a medical eye physician. So, from both an ophthalmologic and optometric perspective, “medical eyecare” has been relatively ignored. Now, optometry is continuing to grow in its embrace of medical conditions of the eye, and ophthalmology, though trained in eye medicine and eye surgeries, is now far more keenly focused on surgical procedures.

      If eyecare can continue to evolve in parallel to every other aspect of medicine, optometrists should become the cardiologists of the eye, and ophthalmic surgeons will be fully ophthalmic surgeons. Of course, this will require the continued revision of optometric curriculum to more comprehensively embrace the entire spectrum 

 

The Optometric Cardiologist: Page 2

 

of medical eye disease, and to ophthalmology devoting itself exclusively to meeting the coming “baby boomer” demand for cataract and refractive surgeries.

 

      Finally, in addition to the American Academy of Ophthalmology, there is a huge meeting and journal exclusively dedicated to “cataract and refractive surgery”. There is no huge meeting or journal dedicated to “medical ophthalmology,” nor should there be, especially if the profession of optometry rises to fill this relative void in human patient care. 

 

Optometry as a Commodity

 

      Optometry has experienced glorious growth in the scope of professional practice over the past few decades. Interestingly, those who practice in small towns may have gained more from the broadening of services offered than those in more urban areas. There are many hundreds of optometrists who truly function as comprehensive eyecare physicians delivering state-of-the-art eyecare. There are also many thousands of optometrists who function as glorified refractionists, mostly in urban, retail type settings. These optometrists are relegated (either by choice or by necessity) as “refract and refer” practitioners. Like it or not, most ophthalmology offices have a team of well-trained high school graduates who perform excellent refractions, and the ophthalmologist (s) serve as the “quality control officer” who oversees their findings and performs the balance of the comprehensive eye examination.  

 

      It seems a deplorable waste of four years of postgraduate training, time, talent and money, only to spend one’s professional life doing the same tasks that most high school graduates can be trained to do in six to twelve months.

 

      From an optometric perspective, this situation is likely to worsen as a tide of new optometry schools flood the market, driving up competition for positions while diminishing potential incomes. It may not be long until new graduates, burdened with increasing college debt, will find less opportunity to land desirable positions with desirable remuneration.

 

      Refracting technology devices have rapidly evolved, and their level of accuracy is now well within visual acceptance standards. We can see the day when refraction will be offered at kiosks in shopping malls for $25 to $50; the patron will simply sign an electronic “release from liability” statement that may read something like: “This prescription for eyeglasses does not constitute a comprehensive eye examination. You should be examined by a licensed ophthalmologist or optometrist to assure that an eye disease/condition such as glaucoma, cataract, or macular degeneration, is not present.” I assure you, the statement will be filled with all the correct legal jargon. Currently, tobacco, alcohol, and a myriad of other products and services are sold with similar warnings. All such disclaimers minimally affect human behavior, but medicolegally, these statements in most instances serve well to protect the entrepreneur.      

 

      Physical care doctors – and you have to decide if you bear the honor of such a mantle – should have the patient’s very best interest at heart. Unfortunately, many “doctors” in the eyecare profession  are in essence, “eyeglass salespersons”, and are violators of the Golden Rule. Courses and articles that instruct one on “how to up-sell your optical” are a disservice to the consumer and to the eyecare professions as a whole. These 

 

Optometry as a Commodity: Page 2

 

tactics are not compatible with the concept of “doctor” and they violate our duty and responsibility to be a trusted healthcare provider to other humans who count on us for help. 

 

      One measure of optometric productivity is the “currency” of our patient census. If we measure our productivity in “eye exams,” we will be doomed by technology. If, however, we measure our productivity as the “number of patients seen,” there is hope. Many optometrists see 25 to 30 patients per day, and perhaps half of these patients are indeed, “healthy eye exams,” but the balance are problem-oriented visits for such conditions as posterior vitreous detachments; acute red eyes; dry eyes; blepharitis; shingles; trichiasis; contact lens-related problems; foreign body; abrasions; glaucoma; Plaquenil toxicity; contact dermatitis/rosacea; epiphora; headache; temporal arteritis; optic neuritis; diplopia; cataract; hyphema; glaucoma (repeated with intention);  symptomatic tarsal conjunctival concretions; episcleritis; and the list goes on and on! “Refract and refer” optometrists may wither on several levels, but true comprehensive, patient-centered optometric physicians should flourish. Established optometrists,  and particularly those contemplating optometry as a career, should thoughtfully weigh the concepts and perspectives set forth in this article.

 

      In summary, with excellent externships, it is possible to complete a four-year, doctorate-level, single-organ system program with sound clinical competence. Refractionists will be relegated to “factory work,” while comprehensive optometric physicians can have an exciting, diverse clinical life full of satisfaction and yes, financial success. The former will be sales-oriented; the latter, patient-oriented. The former’s practice could be dampened by refractive technology advancements; the latter can look forward to a career enhanced through advances in diagnostic technology and therapeutic options.  It’s up to you.

 

 

 

Our Perspective on the Future of Our Profession

 

If something unsightly is stuck between your front teeth, it is a true friend who steps outside his or her own comfort zone to tell you, so that further embarrassment is avoided. In like manner, we are stepping outside of our comfort zone to offer our perspective on the future of optometry. There needs to be a clear awakening regarding our collective mode of practice before we cross the threshold into professional disaster.  There are several observations that we share:

  1. Refraction. Once the epicenter of optometric practice, refraction is actually a technical procedure that can easily be delegated to bright high school graduates after several weeks of training.  Let’s put this into real time perspective: ophthalmologists have huge practices, and commonly see twice the number (or more) of patients per day than do optometrists. People flock to ophthalmology practices because there is the strong perception that ophthalmologists are “real eye doctors” and the public harbors great trust in the belief that they receive higher quality of eye care at these practices; although in many of these practices, trained high school graduates do indeed provide the refractive portion of the examination. So, if “refraction” is such a high-value service, how can this procedure be so successfully delivered by high school graduates?! Now, granted, the physician, either optometric or ophthalmologic, has a duty and responsibility to oversee the entire patient care process and provide rock-solid quality assurance. Further, and perhaps even more importantly, “technology” is like a two-edged sword – it has advantages and disadvantages, such as one’s level of competency in the use of that technology. 

Autorefractors are now able to provide highly exact prescriptions.”Online (or kiosk) refractions” are likely to soon become a reality. Of course, these devices/websites will carry a disclaimer stating something like this: “Receiving a glasses prescription from this device/website does not constitute a comprehensive eye examination, and all persons should receive a formal eye examination from an optometrist or ophthalmologist periodically” – or some similar statement that will be largely ignored, as are the health warnings on alcohol and tobacco products. Moreover, 3-D printers can now generate eyeglasses, and this technology will only continue to improve.

 

  1. The American Aging Population. The American population is ageing, while ophthalmology residency programs are being reduced. There will be a growing need for all aspects of medically-related eye care in the coming years.  Ophthalmologists love performing microsurgeries, but many have little or no passion for nonsurgical eye care. Since ophthalmologists will have their hands full providing cataract and refractive surgeries to our older citizens, there will be a major void of clinicians to care for those patients in need of nonsurgical eye care services. The optometric profession could easily fill the gap. 

 

Our Perspective on the Future of Our Profession: Page 2

 

  1. Specialty Contact Lens Care. Specialty contact lens care is likely to endure as a needed professional service, but most of these contacts will likely be purchased online at a competitive price. However, basic soft lens care could be provided by optical dispensaries or contact lens technicians in ophthalmology offices.

 

  1. Optometric Education.  In truth, we probably have way too many optometry schools. Why “probably”? If the educational institute’s purpose is to provide training in medical eye care, then terrific. There will be a huge number of necessary services that their graduates can fulfill. However, if the facility is just another “me, too,” traditional, refractive-centric school, they are pathologically flooding a market in which the mode of refractive eye care services appears to be changing. As schools produce a glut of freshly minted optometrists, the salaries for optometric services will be suppressed. It may be that ophthalmology practices could hire a “basic” optometrist at only a slightly higher salary than that of an ophthalmic technician. However, we believe a well-trained, medically competent optometrist should be and would be a highly valued asset to medical/surgical systems. Just something to think about.

 

  1. Optometric Curricula. Optometric  curricula and our “Board” examinations need to immediately be modified to reflect this new age of need for medical expertise within our profession. These two institutions (the schools and the boards of examination) need to evolve in parallel fashion so that training and testing  share the parallel goal of total competence in specialty contact lenses and comprehensive medical eye care, as we believe these will be critical for our professions meaningful  survival in the future.

 

The time is now for all interested parties in healthcare and optometric care to give actionable thought to these concepts and perspectives we have set forth. We will be retiring in a few years, but we have a deep desire to see our profession continue to advocate for enhanced public health. Our current status is in need of a major paradigm shift. We stress that anything we do to strengthen our profession cannot be self-serving. Our profession will thrive because of our collective effort as well-trained, dedicated doctors of optometry to provide broad-based, expert patient care.  

 

 

 

 The BEST Way to Stay Current (It’s NOT With a Lecture Format!)

 

      The best way to stay current is quite simple: get four to six area colleagues to each subscribe to a single journal or magazine. Then get together over a nice meal once a month to share the pertinent highlights of each month’s journals. This should take about two hours, and will make all of you much better doctors.

      The journals we subscribe to, and recommend are as follows:

  • Ophthalmology 

  • American Journal of Ophthalmology 

  • JAMA – Ophthalmology 

  • Survey of Ophthalmology  

Beyond these essential four, there is Review of Optometry, Primary Care Optometry News, Optometric Management, and many others from which to choose.

Simply Google these publications to subscribe. The meals and subscriptions are tax-deductible; the education and fellowship is priceless!

 

 

 The Eye in Public Health

 

      Politically-oriented ophthalmologists so enjoy railing against optometric scope of practice legislation, alleging potential harm to public health. They are so terribly wrong. We all know how poor eyecare is at “quick care/urgent care” centers, and even in hospital-based emergency departments and primary care offices. All optometrists and ophthalmologists are fully aware of the substandard eyecare rendered in these facilities. Not all urgent or emergent eye problems occur during regular office hours, so we have some sort of general safety net for these after-hour patients –the hospital-based emergency department at least fills the “first responder” role for these events.

 

      Now, regarding protecting the public health, IF the eyecare professions, and especially ophthalmology, truly cared about the public’s health, rather than devote energy to trying to limit optometric services, wouldn’t the common good be better served by developing guidelines, policies and protocols, and legislation advocating that patients with eye and vision problems preferentially be seen by eye doctors? It should be quite obvious that steering eye patients to practitioners who can provide higher levels of care could enhance public health. The time is now to cease such hypocrisy and duplicity, and focus on measures to enhance the eyecare of the citizens we profess to serve. Something to think about.

 

 

CE: Continuing Education or Infomercial?

 

            The reality is that many continuing education lectures are a sham; a commercial for one or more companies.  There are several reasons for this: continuing education would be significantly more expensive were it not for industry sponsorship dollars; some optometrists are present only to “get my hours,” and simply want to get their ticket stamped and get home; state associations may care more about their budgets than they do about the true education of  their members, and these associations therefore tend to seek “sponsored” lecturers. That is, some state associations may be willing to sacrifice the quality of education for financial stability. Some optometrists may not be current with the scientific/medical literature, and so may be easily manipulated by company-sponsored lecturers.

 

      The misleading statement, “the speaker has no financial interest,” is grossly misleading! While the speaker may not own stock in a specific company, she/he is most assuredly under obligation to promote the product/device of the sponsoring company. If the speaker does not perform to the sponsoring company’s expectation, that speaker will rapidly be replaced by a more compliant lecturer. Thus, lecturers speaking for any company have a very real financial interest in the content, purpose, and delivery of the lecture.  For instance, if a sponsored lecturer speaks factually about the virtues of a Lexis, then that is fine because it’s true; but if a lecturer portrays lesser quality care as equal in value or ability, then an egregious disservice is perpetuated against the audience.  As lecturers ourselves, we speak regularly on behalf of Bausch & Lomb Pharmaceuticals, yet we share the truth of the clinical benefits of these products. We do not “sell,” but truly educate our audiences with the goal of enhancing patient care.  It is fully ethical to urge the use of a product when it truly enhances patient care, but when a product has either marginal or no benefit to patient care, such a lecturer is fully unethical.

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