OD Q&A Michael W. Ohlson, OD, FAAO

How did you get into optometry?

I really don’t know. I was working in San Francisco, I had a biology and chemistry degree, I didn’t like what I was doing anymore and met an optometrist. I had good experiences in optometry in my hometown with Dr. Crouch, and I decided that I’d pursue optometry. It seemed like a good match in my interest in helping people and science.

What are the challenges of a rural practice?

The challenges are multiple and changing daily. Currently, I think the challenge facing rural offices like mine are diminished reimbursement. I really don’t mean that in a greedy sense at all-we’re just undergoing a time of increased costs and diminished reimbursement. You really can’t provide comprehensive eye care and first-class service if you aren’t appropriately reimbursed. You have to match those chair costs. The other challenges are great. I provide the entire gamut of optometry-diagnosis and treatment of vision disorders and ocular disease, management of related systemic conditions. You’re on call 24 hours a day, 7 days a week, and you never know what will walk in the door.

What tips would you give a new grad about a rural practice?

Be very flexible and be ready to learn constantly. The University of Houston gave me a great foundation, but practicing in a rural setting is very, very different, and you simply can’t learn it all in school or residency. We learn by doing. I managed an acute central retinal artery occlusion. There really isn’t any great treatment for that, so when you’re in the office all by yourself, you do everything you can do. I gave the patient oral acetazolamide to reduce the fluids in his eye and topical glaucoma medication to reduce the fluid pressure, and I did digital massage. On the way to secondary care, his vision came halfway back, and upon arrival it came all the way back. We can manage terrible things in rural settings.

Do we have eyecare-related poverty in the heartland, or is it more nuanced?

It’s more nuanced, I think. I certainly do see the working poor. Occasionally you can find resources, but you still can’t get the patient in the door. With children, we don’t require a comprehensive eye exam before they start school. And if you say you want such a thing, you’re very quickly accused of just wanting to get patients in the door or prescribe lenses for children who may not need them. And this is really asinine. The idea that these kids need to see to learn and don’t receive care is shocking, and I see that every month, sometimes more than once a month with undiagnosed vision problems. Many, many things go undetected. Even if you detect someone on a Head Start screening who has a problem and if [the parents] have vision coverage or eyecare health coverage, they still don’t bring them in. It’s shocking. I think it would take a prolonged, aggressive national approach at educating people how important comprehensive eye care really is.

What do you do for downtime?

[Laughs] I don’t have any down time. Maybe my wife and our beloved daughter. My daughter is a high school senior and will be going off to college and that would be the focus of my down time. Otherwise, I read voraciously and like to get out doors. I’d like to fish more and try to do some hiking. Northeast Iowa is a nice place to hike. We have some nice little hills and some nice little trout streams.

How did you get involved in optometric volunteering?

I have the passion for delivering care to people who really need it. That’s probably a good thing and bad thing. My experience in VOSH really stirred my passion. The idea that people go without basic eye care and how important it is them, how grateful they are, and what a privilege it is to provide such care really was driven home to me on my VOSH missions with the Iowa group. With InfantSEE, I simply got interested back when it was out of Tennessee and was called Operation Bright Start. I read about it and became fascinated so I was actually doing InfantSEE in Iowa before it was called InfantSEE. It’s been rewarding, we’ve caught several infants with some pretty significant problems. Head Start is an interesting population, these kids are certainly at risk and if you’re going to screen for vision, then you should do a very, very good job. We don’t do anyone any good if we have false negatives where we miss kids who have problems. You’re doing them a disservice because the family thinks they’re fine, the teacher thinks they’re fine; they’re not fine. We’ve really increased the screening efforts in northeast Iowa. So I’m proud of that.

You won the Iowa 2014 Optometrist of the Year award. Do you think awards help raise public awareness about eye care in rural America?

I’m waiting for them to come take it back any time now. In truth, I’m sort of the tortured soul-I’m half Swedish and we’re a little bit negative. To receive recognition…it actually makes me more self conscious. If we handled it right and it didn’t seem self-serving promote the practice....[Laughs] I really don’t try to promote my practice…if we could utilize it in some way, it might help. I think it’s combination of factors. I think the commercialism of health care-and that’s an explosive thing to say-as things have changed over decades not just in eye care but in health care, I think services are in some way discounted. And that’s a shame.

How is public health important in optometry?

Oh, how long do you have? Public health is huge in optometry. Whether you think of it in terms of the populations of patients we see: patients on Plaquenil; patients who are victims of abuse which I have seen and attempted to manage; related systemic conditions such as depression; ethanol abuse; injury; injury prevention; sports vision; safety; the topics go on and on into things that many optometrists and certainly the public and the medical system doesn’t expect or think about. In addition, I’ve been involved in regulatory affairs for many years now, and that’s always been a bit controversial. You can have some healthy friction with advocacy or other groups.

As the past president of ARBO, what’s the biggest challenge facing optometry today?

Our current topic of interest is accreditation of CE and changes to our current accreditation system. I would to see a bigger emphasis on improved knowledge, improved performance, and patient outcomes. That’s not my phrase, I didn’t make that up. We had a large conference in Chicago to bring attention to this matter. I think that’s the future of continuing education in the U.S. I think it’s good for the public, and I think it’s good for the individual optometrists.

What's one thing most people don't know about you?

I think my attorney advised me not to answer that. It probably gets back to the fact that I’m a bit of tortured soul. Actually, I don’t have any skeletons in the closet…uh…I don’t know, I’d have to think about the question. I’m uncomfortable speaking about myself.

What's the craziest thing you've ever done?

That one I also refuse to answer, I don’t wish to incriminate myself. I was waiting for that question, I did my homework and read some of your previous interviews. Honestly, I refuse to speak about mine. I think the cities of Houston and San Francisco were happy when I left-I raised a bit of a commotion for a few years in my life. I don’t think I’ve really done the craziest thing.

What would you change if you had it to do over?

Many, many things. I enjoy what I do, and I see great value in it. I’ve had many benefits from this profession. I get to treat diseases and manage conditions due to the efforts that colleagues and my scope of practice here. The rural setting has allowed me great opportunities to manage vision problems, eye disease, related systemic conditions. I’ve had a lot of time with my wife and my daughter-my daughter’s really the focus of my life. I have a great deal of independence, no one really tells me what to do; I do wear sneakers in the office, and I like it that way. But I would change many things. I feel limited in my scope at times. I feel my services to be slightly depreciated by society at times. I think it comes back to the commercialism and optometry not being well understood by the medical community. I don’t have all the answers for that-it’s not a pointed criticism so much as the way things are. So, I’m always looking for that next challenge, that next step.ODT