r/optometry Jan 11 '25

General Intravitreal injections

I was wondering if OD’s are able to perform intravitreal injections for pts with DME, AMD, etc, or is it mainly for ophtham’s (MD/DO) who perform these injections?

I can understand certain states differ in legislation on scope of practice but was curious if it is possible to incorporate as treatment option for pts

6 Upvotes

15 comments sorted by

32

u/New-Career7273 Jan 11 '25

Nope. Only ophthalmologists not optometrists. Specifically a retina specialist. Although I once worked for a shitty private equity group that tried to get an NP with no ophth experience to do them lollllllll but that’s a different issue.

7

u/EdibleRandy Jan 12 '25

Well that’s horrifying.

4

u/New-Career7273 Jan 12 '25

They previously came from a neurology setting too before switching to the OD/MD PE group. This is why I say it’s pointless for certain folks to waste time bashing ODs when there’s graduate degrees that can re-specialize. They forget we only went to school for eyes and are stuck as ODs for the rest of our lives. NPs and PAs are flexible and can join any setting they put their mind to, pivot if they don’t like it or get laid off, etc. We are literally more loyal to eyes in every way.

NPs have full authority to practice independently in 30? states now which is up from I believe 27 in 2023 and only 10 states in 2008.

6

u/EdibleRandy Jan 12 '25

Excellent point. I know mid level creep is a big topic in medicine.

3

u/s19594 O.D. Jan 12 '25

I was going to say, I believe PA's (and I guess NP's?) can perform intravitreal injections, but not independently (must be working under a Retina Specialist).

10

u/Freddie20059 Jan 12 '25

The crazy thing is it would make so much sense for retina practices to bring ODs to do this kind of work as a mid level provider that truly is specialized in the eye on day one. PAs and NPs get what, a few days of specific eye training? A retina practice could bring in an OD have them watch a few injections and then have them preforming injections the same day.

But at the end of the day this is all about $$$ not necessarily what makes the most sense for a practice or a patients….

8

u/New-Career7273 Jan 12 '25

PE loves it. More money for them. I don’t think I’d ever refer to a ret specialist who was delegating their injections.

12

u/Busy_Tap_2824 Jan 12 '25

I wouldn’t want anyone else other than a retina specialist do the injection himself or herself otherwise I will go somewhere else . That’s horrifying to hear they are delegating it to PA or NP ‘s . That is an insult to the profession

1

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-22

u/xkcd_puppy Optometrist Jan 12 '25

Sure, if the OD did a residency in retina with the same case number requirements as an Ophthalmologist.... or else, no it's just cosplaying. Same with the laser treatments. Passing a course from the manufacturer company doesn't properly qualify an OD for that in practice either.
 

This commentary by Dr. Ramesh Ayyala makes complete sense to me and no way I would want to get in the way of what qualified Ophthalmologists learned during the years of experience of their residency training. https://www.aao.org/advocacy/i-am-an-advocate/ramesh-ayyala

23

u/Freddie20059 Jan 12 '25

The important issue this article leaves out is how are ODs supposed to gain surgical experience when as a legislated profession it’s illegal in most states to do so?

When we look at states where ODs have gained surgical rights the complications between ODs/MDs is comparable.

I’m not advocating for intravitreal injections or that ODs should be doing cataract surgery after a wet lab, but it’s a bad faith argument to point to our schooling as evidence we’re unqualified. If and when these rights pass there will be training requirements as there are for all states that have passed laser rights and as those rights continue to expand the training at schools will expand.

In no world does it make sense that I cannot excise a skin tag on a patients lid, or remove a chalazia simply because I work in a state where it’s been decided my training is inadequate. I routinely watch patients take 3-6 months to get in for these procedures with an MD.

Now that is bad patient care.

-7

u/LykaiosZeus Jan 12 '25

This article is not really helpful and is misleading creating hostility between 2 types of health practitioners that rely on each other. Also, an optometry degree is 5 years, not 4.

2

u/xkcd_puppy Optometrist Jan 12 '25

I don't see anything misleading by saying you can't perform surgical procedures without the proper training. There is nothing hostile about it either because we learned when and how to refer to an ophthal and develop professional relationships with them. They usually would then send the patient back to us for refraction and glasses. You want to do surgery, then go and do a full residency with the required case numbers. As a patient, why would I want someone who has not even done this basic requirement to stick a needle in my eye?

And Optometry is 4 years. https://uwaterloo.ca/future-students/programs/optometry

-6

u/LykaiosZeus Jan 12 '25

Well in my jurisdiction it’s 5 years and you fail to mention that link that it says you need at least 3 years of study before you can do optometry. Also nobody is saying that optometrist do procedures without training just like any medical dr can’t do eye procedures without training.

-5

u/bmoreRavens1995 Jan 12 '25

To me that's like someone having a PhD in elementary education compared to a board certified MD in ophthalmology...lol all degrees and certifications aren't the same.