The eyes have it: ophthalmologists vs. optometrists at the state capitol

A simmering battle over expanding procedures for optometrists is likely to be one of the session’s most watched, literally, debates in 2019.

After an interim study looked at what other states have done in expanding the types of procedures that optometrists can perform for patients, supporters are ready to enact legislation. Ophthalmologists say not so fast.

“Allowing optometrists to perform surgeries on and around the eye is a bad idea because they are simply not trained to do them. The years of training that ophthalmologists go through are essential to ensuring quality surgical eye care for Arkansans,” said Dr. Scott Lowery, an ophthalmologist and president of the Arkansas Ophthalmological Society. “If optometrists had thousands of hours of post graduate training in eye surgeries, including years of operating room experience, then we could have a different discussion.”

“This bill would make narrow changes to the law, allowing doctors of optometry to provide a few additional minor in-office procedures that will ensure that optometrists are able to care for patients with the most up-to-date, cost–effective treatments available for conditions we already routinely treat,” said Dr. Belinda Starkey, president of the Arkansas Optometric Association. “These are basic services that our patients often expect to receive from us, and that optometrists are trained to safely provide.”

According to the dictionary and each group’s state or national web sites, ophthalmologists are physicians who “specialize in diagnosing and prescribing treatment for defects, injuries, and diseases of the eye, and are skilled at delicate eye surgery, such as that required to remove cataracts.” Ophthalmologists are trained providers of medical eye care, including the prescription of corrective lenses and surgical procedures, treating eye diseases such as glaucoma and macular degeneration, according to the Arkansas Ophthalmological Society.

Optometrists are “professionally trained and licensed to examine the eyes for visual defects, diagnose problems or impairments, and prescribe corrective lenses or provide other types of treatment.” Doctors of optometry have extensive, ongoing training to examine, diagnose, treat and manage ocular disorders, diseases and injuries and systemic diseases that manifest in the eye, according to the American Optometric Association.

In other states, optometrists have been successful in broadening their permissible scope of services. States such as Louisiana, Oklahoma, and Tennessee allow optometrists to perform various types of procedures once limited to ophthalmologists. Some states, such as Texas and Illinois, have ignited the debate, but not adopted any significant changes.

An interim study brought forward last year from Reps. Josh Miller, R-Heber Springs, and Jon Eubanks, R-Paris, examined an expansion of optometry services to include surgical procedures as well as to establish credentialing requirements to administer or prescribe certain drugs.

The interim study outlined that optometrists could not perform cataract surgery, but it did seek to allow optometrists to perform “ophthalmic surgery,” which includes procedures that could include injections, cutting, burning, freezing, sutures, vaporizing, coagulating or photodisrupting. The interim study said it would prohibit optometrists from performing retinal surgeries and surgeries of the “eyelid for suspected malignancies or for incisional cosmetic or mechanical repair.” It would allow for the removal of “benign lesions from the eyelid and around the eye,” according to the optometrists’ explanatory material.

POLLING
Ophthalmologists contend the procedures for which optometrists want licensure require extensive training and higher degrees of medical skill. They also suggest that public opinion polling on the matter supports their contention that optometrists should not be allowed to conduct such procedures.

A survey taken earlier this month by Impact Management Group on behalf of the Arkansas Medical Society showed that nearly 65% of Arkansas voters oppose legislation that would allow optometrists to perform eye surgeries with lasers and scalpels.

When survey respondents were given information about the differences in training and education required to become licensed as an optometrist and an ophthalmologist, opposition to the proposal increased to 79%, with 61% strongly opposed.

The questions posed were:

Q: In the upcoming Arkansas legislative session, there may be legislation to allow optometrists to perform more than a hundred eye surgeries using lasers and scalpels that they currently are not authorized to perform. Optometrists support this legislation, saying that new technology has made eye surgery less complex, that they are qualified to perform such surgeries, and allowing them to perform these procedures will improve patient access. Ophthalmologists oppose this legislation, arguing that any surgery that involves cutting human tissue on or close to the eye with a laser, scalpel, or other surgical instrument should only be performed by a trained medical doctor, and allowing non-medically trained healthcare professionals to perform eye surgeries would threaten patient safety.

Knowing this information, do you support or oppose legislation that would allow optometrists to perform eye surgeries with lasers and scalpels?

For 19%
Against 65%

Q: When it comes to eye care professionals, many people confuse ophthalmologists and optometrists. Ophthalmologists are medical doctors and surgeons who specialize in the treatment of eye diseases and eye surgery. They must complete 4 years of medical school, a 1-year hospital internship, and a 3-year surgical residency before practicing on their own. Optometrists are not medical doctors. They complete a four-year optometry school program studying eye care, but they do not attend medical school.

Now, knowing this information, do you support or oppose legislation that would allow optometrists to perform surgery on and near the eye with lasers, scalpels and other surgical instruments?

13% For
79% Against

“The results show that Arkansas voters recognize the importance of the training and expertise that ophthalmologists bring to their eye health,” said Arkansas Medical Society President R. Lee Archer, MD. “The voters do not want to see the standard of care diminished when it comes to the health of the only two eyes they will ever have.”

Starkey, the head of the optometrists’ association, said the poll did not properly portray what the legislation, soon to be proposed, would do.

“We believe the poll, presumably paid for by ophthalmologists who oppose the legislation, was an extreme mischaracterization of what this bill would actually do, and a mischaracterization of what doctors of optometry are trained to do. It would not allow optometrists to perform major eye surgeries,” she said.

LEGISLATIVE PROCESS
This isn’t the first controversial move between competing medical groups at the state capitol. The legislature has a system for requiring interim studies when it comes to potential expansion of scopes of practice.

The House and Senate will begin the week of Feb. 12 on what’s known as “scope of practice” week where debate may begin on measures like the optometrists’ push. While no bill is filed yet, Rep. Eubanks is expected to file one later this week.

“This is common-sense legislation that will allow optometrists in our state to offer the care they are trained to offer, and that they would be able to provide if they practiced in several neighboring states. We aren’t talking about major surgeries here – only a very narrow list of minor procedures many patients are surprised they aren’t already able to receive from their optometrist,” he said. “Not only will this bill enhance patient care, but it will safely provide better access to care for patients across the state.”