READERS VOICE THEIR OPINIONS
The Evils of Overabundance
* Vision Service Plan (VSP) is neither a friend nor a foe to optometry. VSP and managed vision care simply represent market forces driving down the cost of eyecare services in response to the excess supply of optometric manpower.
If it seems as though optometry's lacking in respect and appreciation, then consider this: The value of any commodity is a function of its scarcity. Optometrists are everywhere: Wal-Mart, Costco, Sears -what's next, gas stations? Few people attend optometry school with the intention of working at a Wal-Mart after graduation. Those who choose to do so are simply making the best choice based on the options available to them. The number of optometrists working in commercial settings is a good indicator of the excess supply of manpower relative to demand.
Imagine that 90% of all O.D.s mysteriously disappeared. There would be no optical chains, VSP, managed care, mail-order contact lenses or O.D.s working in warehouse clubs. People would wait months for an appointment and they'd happily pay several hundred dollars for an exam. So the foe of optometry isn't VSP, it's the optometry schools, which are producing an oversupply of O.D.s. They're producing essential manpower so Wal-Mart and VSP can continue expanding their businesses.
Barry M. Lebowitz, O.D., M.P.H.
Who's Really to Blame?
* I read Dr. Sherman's article ("Beyond Malpractice," September 2003) with great interest, as he always has thought-provoking perspectives.
In this article, it appeared that the burden of guilt for this man's missed diagnosis rested on the shoulders of his optometrist daughter. It seems reasonable that she would've been trained at a competent college of optometry to make the link between bilateral retinal pigment epithelium (RPE) hypertrophic lesions and intestinal polyposis, but many other manifestations are common with Gardner's syndrome that should have raised a red flag to his serious intestinal disease much earlier.
Gardner's syndrome is an uncommon condition; however, it usually carries with it other significant abnormalities. For example, osteomas of the mandible occur in about 70% of patients with this syndrome, and additional abnormal dental findings occur in about half of these patients. Because this syndrome is of autosomal-dominant inheritance, some expression of intestinal disease should show up in the family history.
The article didn't stress the importance of all family members having their eyes examined and having a comprehensive dental evaluation, as well as having colonoscopy evaluations. It would seem to me that this doctor's father would've seen other eyecare providers before she became licensed to practice optometry.
Because the RPE lesions associated with Gardner's syndrome are congenital, there was a broad window of opportunity for the man's previous eye doctors to make the discovery of the bilateral RPE spots. While the daughter certainly bears some responsibility, I think there is a much broader responsibility with the other healthcare providers that her father must have seen over the years.
Randall K. Thomas, O.D., M.P.H.,
Move Over Flaxseed
* In the "Prescribing for Dry Eye" supplement to the September issue of Optometric Management, all but one of the authors seemed to advocate using Omega-3 fish oil interchangeably with flaxseed oil. There is a difference between the two. Omega-3 fish oil contains EPA and DHA, two acids essential for the relief of dry eye. Flaxseed oil contains alpha linolenic acid, which the body must convert into EPA and DHA.
As we age, it becomes more difficult for the body to perform this conversion process and some people aren't capable of it at all. That's why I always recommend Omega-3 fish oil and not flaxseed oil unless the patient is allergic to fish or is a vegan.
E. Michael Geiger, O.D.
The number of O.D.s working in commercial settings is a good indicator of the excess supply.
Copyright Boucher Communications, Inc. Nov 2003
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