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Randall Kean Thomas, OD, MPH, FAAO

Educators in Primary Eye Care, L.L.C.

 

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QUICK LINKS:

Marital Status  |  Education  |  Certifications  |  Positions of Professional Service  |  Honors  |  Externships  Internships  |  Post Graduate Professional Short Courses  |  Consultations and Professional Lectureships  Professional Publications  |  Professional Associations

Marital Status
Education
Certifications
Positions of Professional Service
Honors
Externships
Internships
Post Graduate Professional Short Course
Consultations and Professional Lectureships
Professional Publications
Professional Associations

MARITAL STATUS:

Married Wife: Cheryl W. Thomas
Daughters: Lauren and Susan

 

EDUCATION:

O.D., Doctor of Optometry
Pennsylvania College of Optometry
1200 West Godfrey Avenue
Philadelphia, Pennsylvania
May, 1981

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M.P.H., Master of Public Health
Department of Health Administration School of Public Health
University of North Carolina
May, 1976

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B.S., Bachelor of Science
Biology
Appalachian State University
Boone, North Carolina
May, 1973

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A.S., Associate in Science
Western Piedmont Community College
Morganton, North Carolina
May, 1970


CERTIFICATIONS:

  • Successfully completed the National Board Examination in Optometry. April, 1981. 

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

  • Licensed by the State Board of Examiners in Optometry in North Carolina, September, 1981; Oklahoma, August, 1983; Tennessee, July, 1988.

 

POSITIONS OF PROFESSIONAL SERVICE:

  • Group practice of optometry and ophthalmology, Concord, North Carolina -- June, 1993 to present.

  • Private practice of optometry, Thomasville, North Carolina -- March, 1990 to June, 1993.

  • Group practice of optometry, Fayetteville, North Carolina -- June, 1988 to March, 1990.

  • Private practice of optometry and associate practice with ophthalmology. Tulsa, Oklahoma -- August, 1984 to May, 1988.

  • Clinical Optometrist, Bolling Air Force Base Medical Clinic, Washington, District of Columbia -- July, 1981 to July 1984.

  • Consultant, Appalachian District Health Department, Boone, North Carolina, 28607 -- Summer, 1978

  • Request: To develop guidelines for the delivery of primary health care services by area health departments, and participate in departmental administrative activities.

  • Research Assistant, Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina -- July, 1976 to July, 1977.

  • Policy Analyst, Department of Health, Education and Welfare: Medical Services Administration, Division of Program Planning and Evaluation, Washington, District of Columbia -- Summer, 1975.

  • High School Biology Teacher, Anson County Board of Education, Wadesboro, North Carolina -- August, 1973 to June, 1974.


HONORS:

  • Presented with the 2014 "Vincent Ellerbrock Clinician Educator Award" by the American Academy of Optometry.

  • Appointed as "Civilian National Consultant for Optometry" by the U.S. Air Force Surgeon General, 2005.

  • Granted medical staff privileges at Carolinas Medical Center – Northeast, Concord, NC 2004 till present.

  • Honored by the Cabarrus Family Medicine Residency Program with the "Ambulatory Teaching Award" for 2006.

  • Awarded "Glaucoma Educator of the Year" by the American Academy of Optometry, 1997.

  • Granted Fellowship in the American Academy of Optometry, 1984. 

  • Appointed as a member of the Adjunct Faculty, Pennsylvania College of Optometry of Salus University 1988 through 2014

  • Ocular Pharmacology Consultant, Blue Cross and Blue Shield of North Carolina, Pharmacy and Therapeutics Committee, 1995-2000.

  • Awarded the William C. Ezell Award "For the Best Article Based on a Lecture given at the Southern Congress of Optometry", 1984.

  • Selected by the National Board of Examiners in Optometry as a consultant in constructing questions in ocular disease and ocular pharmacology for the National Board Examination, 1985.

  • Recipient of the Optometric Recognition Award in Continuing Education by the American Optometric Association, 1985.

  • Appointed as a Regional Consultant to the Council on Clinical Optometric Care of the American Optometric Association, 1986 through 1998.

  • Selected "Outstanding Young Men of America", U.S. Jaycees, 1983.

  • Appointed as a member of the Hospital and Nursing Home Practice Committee of the American Optometric Association, 1983 through 1993.

  • Air Force Commendation Medal Recipient for Meritorious Service, 1984.

  • Appointed as Captain, Biomedical Science Corps, United States Air Force, 1981 through 1984.

  • Elected into the Gold Key Optometric Service Honor Society, 1981.

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

  • Who's Who Among Students in American Colleges and Universities, Appalachian State University, Boone, North Carolina, 1973.

 

CONCURRENT EDUCATION TRAINING:

 

Externship Training:

Fourth Professional year, Pennsylvania College of Optometry, Philadelphia, Pennsylvania, 1980 to 1981.

 

Private Practice of Steven Greenberg, M.D., Moshe Adler, M.D., and Bruce Pierson, O.D., Brookville General Hospital, Brookville, Pennsylvania.

 

Alaska Native Medical Center, Anchorage, Alaska, Yukon-Kuskokwim Delta Public Health Service Hospital, Bethel, Alaska.

 

W.W. Hastings Indian Health Service Hospital, Tahlequah, Oklahoma, Lesley L. Walls, M.D. served as preceptor.

 

Internship Training:

Second Professional Year, School of Public Health, University of North Carolina, 1976.

Health Committee of the House of Representatives, North Carolina General Assembly, Raleigh, North Carolina. This Study was taken entirely on location at the State Legislature Building. While an intern, I sat with the Committee and participated in most of the affairs of the Committee.


POST-GRADUATE PROFESSIONAL SHORT COURSE:

Armed Forces Institute of Pathology, Course in Ophthalmic Pathology for Ophthalmologists, Washington, District of Columbia, 1982.


CONSULTATIONS AND PROFESSIONAL LECTURESHIPS:

I have lectured at over 800 continuing medical education conferences throughout the world. These lectures are all related to ocular pharmacology, ocular differential diagnosis, and medical management of eye diseases.

 

PROFESSIONAL PUBLICATIONS:

I have co-authored over 100 articles on widely Co-Authored with diverse topics in the field of medical eye care. (Ron Melton, O.D., F.A.A.O. - Charlotte, N.C.)
 

PROFESSIONAL ASSOCIATIONS:

  • American Optometric Association

  • American Academy of Optometry

  • North Carolina State Optometric Society

  • Life Member of Alumni Association, School of Public Health, University of North Carolina at Chapel Hill

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All Rights Reserved.

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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