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Compassionate care

I enjoyed reading Dr. Ernie Bowling’s editorial “A common thread between two extremes” (September 2013) about sharing stories. About 3 years ago, I decided to start practicing low vision exclusively because there is such a great need for this care, and patients are often underserved. It was also an opportunity to spend time with each patient. The stories of low vision patients are priceless, and I love every minute of it!

I had a patient who had not read in more than 5 years and was depressed and withdrawn until her husband brought her in. We were able to get her reading again, and she started crying in my chair. She was a former registered nurse. There are so many more stories like this!

Thank you for sharing this very important reminder that optometry is all about providing compassionate care.


Lisa Limtiaco, OD

Los Angeles, CA


Optometry and the RUC

Medicare payment and the AMA/Specialty Society RVS Update Committee (RUC) have received much attention over the past several months, your November issue’s report on how Medicare payment rates are defined was particularly timely (“Defining Medicare payment rates”). While we appreciate the attention given to this important topic, the AOA must point out one serious inaccuracy that was included in the “Optometric Commentary” section on page 1. 

In the commentary it was reported that, “While the RUC may well by the headcount be heavier on specialists than primary-care providers, it does not go unnoticed that optometry does not have a seat at this table. Until we do, we are at the mercy of nameless, faceless individuals who may or may not have any idea about what we do or the value we bring.” This statement is false. Contrary to what was stated, optometry has participated in the RUC for the past 27 years in very significant ways. 

One of the ways that optometry has participated in the RUC is through the RUC Health Care Professionals Advisory Committee (HCPAC). AOA has had a seat on this committee since 1991. The HCPAC represents physician assistants, social workers, physical therapists, occupational therapists, podiatrists, psychologists, audiologists, speech pathologists, registered dieticians, and optometrists. The HCPAC was formed to allow for participation of non-MD/DO physicians and allied health professionals in the RUC process. 

In addition to optometry’s position on the RIC HCPAC, it is also important to emphasize the unique position that optometry plays in the RUC due to the fact that optometrists use many of the same codes as ophthalmologists. All of the codes that are reported by both optometrists and ophthalmologists are developed in conjunction with the American Academy of Ophthalmology (AAO) and presented by AOA and AAO to the full RUC. To develop valuation recommendations, the AOA coordinates its survey procedures and develops consensus recommendations with the AAO. This effort with the AAO is critical to ensuring that ophthalmologists and optometrists are not paid differently for performing the same services. 

Optometry is not at the mercy of nameless, faceless individuals at the RUC. Rather, optometry is well known and fully recognized at these meetings. Additionally, while there are many disagreements between optometrists and ophthalmologists on various topics, in the RUC setting, the AOA and AAO work closely together to identify fair payment for the services that both professions provide. This work over an almost 30-year time frame has yielded positive results. The hard work of AOA at the RUC in addition to the AOA’s efforts with CMS and Congress has resulted in substantial gains for optometry in Medicare payments during the last decade. 

The AOA would be happy to coordinate a meeting between your staff and the optometry representatives to the RUC so that accurate and complete information regarding optometry’s role on the RUC can be provided to your readers. 


Mitchell T. Munson, OD


American Optometric Association


Chief Optometric Editor Ernie Bowling, OD, FAAO, responds:

I appreciate the outstanding work the AOA does in advocating our profession to Congress and those entities that regulate the CMS and subsequently our reimbursement for our services. It is one of the many things our professional organization excels at.

Language and a slippery slope 

Once upon a time, near the end of a very long day, I made the faux pas of asking, ³Which is best, one or two?² The superannuated grand lady‹retired school teacher‹pushed the phoropter aside and responded with a horizontal remonstrating shake of the head on better, "Which is better, one or two?" I believe I apologized for the lapse of good grammar.

Every once in a while the Spanish only speaker, comes in with an "interprete," yet I continue with "¿Cual es mejor, uno o dos?" The longer I go on, the more the patient responds in English.

After instilling an anesthetic for tonometry, warning, "No ta limpia los ojos para media hora" (Don¹t rub your eyes for a half hour), the patient bristled as though I had issued an insult. Later I learned from my Spanish conversation teacher the five verbs in Spanish equivalent "to rub" each have an alternate very coarse meaning. One must wonder, why, after a very pleasant examination experience, one would be suddenly accused of very gross poor taste. 

Caveat: language may communicate or provide a slippery slope.

Albert Nemiroff

Panorama City, CA

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