Surgical authority of optometrists in the United States

Lawmakers in Cheyenne are considering amending what optometrists can do with the goal of opening up eye care in rural communities.

“It’s a frustrating thing for us optometrists because we’ll have people that need something done, a very basic procedure, and because of our scope of practice, the law dictates we can’t do it even though we’ve been trained to do it,” said Dr. Chad Roberts of Hole Family Eyecare.

Opponents of the bill say the changes put patient safety in danger.

Optometrists have varied surgical authority across the country. According to the American Optometric Association, optometrists in Wyoming, South Dakota and Nebraska have no surgical authority, but in Montana, Colorado and Utah some do with authorization from a state board. In Idaho minor surgery is allowed.

Senate File 55, which would allow optometrists to conduct noninvasive surgical procedures if they have the training and prescribe narcotics, sailed through the Senate in January with a 22-7 vote. Sen. Mike Gierau, D-Teton, voted against it. It will now be heard in committee by the Wyoming House of Representatives.

Lawmakers said they introduced the bill because optometrists can be more accessible in remote areas than ophthalmologists. There are 166 licensed optometrists in the state but only 54 licensed ophthalmologists. Of the 54, only 11 have Wyoming mailing addresses — the others are licensed in Wyoming and surrounding states and likely live elsewhere. The Wyoming Board of Medicine said that mirrors the overall trend of how many doctors live in Wyoming as opposed to providing care here: There are roughly 4,400 doctors licensed in the state, but only about 1,200 live here.

Simple surgeries allowed

Under the legislation, noninvasive surgical procedures allowed are defined as “any optometric procedure that does not penetrate beyond the cornea or the sclera.” It lists as examples procedures such as yag laser capsulotomy, a laser treatment that improves vision after cataract surgery, and laser trabeculoplasty, a form of laser surgery that lowers fluid pressure inside the eye.

Optometrists could provide such procedures only if they have “training on each authorized procedure from an accredited college of optometry program including actually performing the procedure on patients while being supervised by a trained professional.”

Roberts said he’d likely have to take continuing education courses on laser technique, for example, if the legislation passes.

“I’d probably have to get retrained again,” he said. “But I was trained in school, and [lasers] are really not that difficult to use.”

Things “as silly as taking a little bump off the eyelid,” Roberts said, or a secondary growth after a cataract surgery now has him sending patients to Idaho Falls.

Although Jackson has one ophthalmologist, Dr. William Ramsay of Teton Eye Clinic, he no longer does surgeries.

“It’s kind of a hassle for people,” Roberts said.

As proposed the legislation would still bar optometrists from doing most of what only their ophthalmologist counterparts can do, including retina or corneal laser procedures, cataract surgery, any surgery performed with general anesthesia and a full list of nonlaser procedures that involve incision of other parts of the eye.

Although the bill would allow optometrists like Roberts to prescribe hydrocodone, a highly addictive narcotic, he’d rather send patients to Urgent Care for those pills.

“Personally, I don’t even want to do that,” he said.

Opponents raise safety doubts

Opponents say the bill expanding surgical authority is unsafe. The Wyoming Medical Society says the bill puts patients at risk, and the Wyoming Safe Surgery Coalition, an advocacy group, is running Facebook and radio ads against it.

The main distinction, the coalition says, is that ophthalmologists have a medical degree and more extensive surgical training. Optometrists don’t.

“The Wyoming House of Representatives is considering dangerous legislation (SF55) that would give optometrists — who are not medical doctors or trained surgeons — a blank check to perform upwards of more than 100 types of delicate eye surgeries with lasers, scalpels, and other surgical instruments,” the coalition’s website reads.

But that isn’t a new take — the American Academy of Ophthalmology has urged colleagues for years to block the passage of state legislation designed to expand the scope of practice for optometry.

Local ophthalmologist Ramsay is writing legislators and speaking out, too.

“My viewpoint,” he said, “is that we should all be concerned with one another’s health — and for the best procedures to be done ... by the best people that we can have.”

Ramsay said the legislation would allow optometrists to “do many different procedures that don’t make sense for somebody with their training.”

“They want to be able to use lasers ... to do various procedures within your eye where you can literally go blind if that laser is directed in the wrong place,” he said. “With no experience and no training, it does not make sense.”

Ramsay said his opposition to the legislation isn’t economic.

“I’ve been around a long time, people will keep coming to me,” he said. “But it’s not the best for patient safety. It’s not the best for patient safety anywhere in our state or our country.”

Roberts echoed a similar sentiment, but on the opposing side.

“It seems more monetary driven than patient care,” he said of the opposition. “What’s best for the patient? It’s not going to eat into their [ophthalmologists’] pocket books.”

While the relationship between optometrists and ophthalmologists has “always been really polarized,” Roberts said, he likes working with local and regional ophthalmologists for follow-up care. Ramsay complimented local optometrists as well.

One thing they both agree on is the general public generally doesn’t know the difference between the two fields.

“They think, ‘Everybody’s an eye doctor, so therefore, they’re all the same,’” Ramsay said.

Contact Kylie Mohr at 732-7079, or @JHNGhealth.

Kylie Mohr covers the education and health beats. Mohr grew up in Washington and came to Wyoming via Georgetown. She loves seeing the starry night sky again.

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