Are you in favor of the current AOA/JBCPT proposal for optometric board certification? Yes No No opinion or undecided If you do not receive confirmation of your vote, please click here to vote using the web-version of OP.

First, a few notes: Many of you using other than Windows-based computers were unable to vote in last week's poll. To ensure that your voice is heard, we are keeping the poll open. You may vote (or check to ensure your vote registered the first time) by using the web-based version of Optometric Physician, which works with all operating systems. It can be accessed by clicking here. I will post the results after everyone has had a chance to vote.

My sincere thanks to the more than 100 colleagues and friends who wrote to express their thoughts regarding last week's editorial and the AOA/JBCPT proposal. The volume was so overwhelming that I was unable to respond to many of you. However, I have posted all e-mails on OP Blog and encourage you to read what your colleagues are saying. I have posted all emails anonymously because a number of writers, some well recognizable, feared retribution, as sad as that sounds.

As I write this, state optometric associations are formulating their positions on this critically important issue. I urge you to contact your association, the officers and Executive Director to express your views. I also encourage you to share last week's editorial as well as the information provided by the AOA with your colleagues who may otherwise not have access to this information. Everyone should have the opportunity to formulate their decision based on the facts rather than just accepting that "it's good for the profession". I also recommend visiting www.ODWire.org, which has several active posts discussing this issue.

In the interest of providing additional perspective on the debate about the AOA/JBCPT "optometric board certification model" this week, Optometric Physician offers a counterpoint to several key "Frequently Asked Questions of the JBCPT" that has been posted on the AOA web site.

Q: How does the Joint Board Certification Project Team define or describe board certification in optometry?

A: The JBCPT defines board certification as: A voluntary process that establishes standards that denotes that a doctor of optometry has exceeded the requirement(s) necessary for licensure. It provides the assurance that a doctor of optometry maintains the appropriate knowledge skills and experience needed to deliver continuing quality patient care in optometry.

OP: Optometry is a legislated profession and the only body legally entitled to determine appropriateness of knowledge and or skills are our state boards. The North Carolina State Board of Optometry recently reaffirmed its sovereignty with this statement from its Board that specifically addresses "board certification". This raises significant questions about the legality of board certification in some states as well as infringement on state laws and rights.

In truth, any form of board certification regardless of merit, is unlikely to remain voluntary once enacted. Managed care plans, insurers, hospitals and government agencies may attempt to use board certification as an exclusion criteria, even if not recognized or legal by a state board.

Q: Why study board certification at all, and why now?

A: There is also a growing interest by managed care organizations and federal programs to address employer and patient inquiries regarding the quality of care offered. One option available to them is to consider requiring board certification for participation on a panel.

OP: This is at best conjecture and more a scare tactic then a likelihood. It is unlikely for any organization or agency to demand board certification of a provider group that does not have such a process. If that were the case, dental care would essentially cease being available in the U.S. There is a clear interest in assuring quality of care through maintenance of certification (MOC) and demonstrations of competency (DOC) metrics. AOA/JBCPT has focused on board certification. There are a variety of other options available to access quality of care. See the AARP position paper for more details.

The healthcare community is also seeing new legislative initiatives, most recently introduced in Virginia, to accomplish this end result. Legislation that was introduced in Virginia was not introduced by the profession or by the legislature. It was instead introduced by a local AARP affiliate. AARP, as you know, is probably the single most dominant citizen advocacy group today. These initiatives seek to ensure that health professionals have demonstrated ongoing competence.

OP: AARP recommendations, focus on state boards and DOC for re-licensure—not board certification. The full AARP recommendation encourages alternative means for MOC with no recommendation for board certification as a requirement. It should be noted that optometrists were not consulted during the VA AARP fact finding despite the importance of the AARP nationally.

There are also states that have started to propose laws for study commissions to look at requiring board certification as a condition of license renewal. In 2006, as a result of proposed legislation, the governor of Washington created a work group that is looking at requiring continuing competence for MDs. Additionally, in Oklahoma, discussions were held in the 2008 legislature to require board certification of pediatricians, though no action was taken.

OP: Notice the state focus and discussion regarding pediatricians and MDs. Recommendations for BC have had nothing to do with optometry. It is exceedingly unlikely that a state would demand board certification of a non-boarded state regulated and licensed profession, especially when implementation would likely raise the cost of care. The cost for BC over 10 years has been estimated at exceeding $25,000 not including time lost from practice.

Next week, I will finish up the Optometric Phsycian counterpoint to the JBCPT's "Frequently Asked Questions" on the AOA web site.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com

Want to share your perspective? Write to Dr. Epstein at artepstein@optometricphysician.com. Comments received may be published on OP-Blog at the discretion of the editor without attribution. Please indicate if you would like your thoughts attributed to you. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Publishing or any other entities or individuals.

A 33-year-old male keratoconus patient intolerant to rigid gas permeable contact lens in the right eye underwent intrastromal corneal ring segments (Intacs) implantation. At 2 years postoperatively, slit lamp examination of the right eye revealed superficial corneal vascularization inferotemporally, extending 1.5 mm from the limbus. At 3 years postoperatively, the slit lamp examination of the right eye revealed deep stromal vascularization extending to and arborizing along the temporal segment. Also, superficial vascularization was noted along the nasal segment inferiorly. The Intacs segments were then explanted.

On post-explantation day 10, the deep vessels regressed to ghost vessels with topical corticosteroid therapy.

The authors present a rare case where deep corneal vascularization was noticed 3 years following Intacs implantation for keratoconus. All patients having superficial vascularization away from the incision site need to be followed for this rare complication.