Should optometrists be allowed to perform surgeries?

Optometrists are the independent primary health care professionals for the eye; The current trends in optometry billing are driving down the reimbursement process. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. (Reference: American Optometric Association).

Optometry practice was legalized in 1901 starting with Minnesota and introduced as a university course for the first time in 1910. Optometrists hold ODs  (Doctor of Optometry) with 4 years of professional education in optometry that concentrate on the study of eyes enabling them to carry out eye examinations to diagnose any vision problems, prescribe contact lenses, eyeglasses, treat eye diseases by prescribing eye medication(excluding Massachusetts for glaucoma) without surgical intervention. Any treatment beyond the scope of OD education requires further training and testing as per law.

Often there is confusion between an Optometrist and an Ophthalmologist. An ophthalmologist is regarded as a trained medical doctor who has earned an MD (Medical Doctor) or DO (Doctor of Osteopathy) degree and who is licensed to surgically invade the eye. Like the Optometrists, they have typically spent four years in undergraduate studies, four years in medical school, but unlike optometrists, they have to spend another three additional years studying surgery and diseases of the eye.

Over the years as technologies and treatments advance, optometrists are getting more involved in going beyond eye exams and prescribing lenses and eyeglasses. As on date, three states in the United States Oklahoma, Louisiana and Kentucky permit optometrists to perform laser surgeries. ODs learn laser therapy and surgical procedure as part of continued education before they are legally allowed to perform laser surgeries in these states.

Based on a recent report by the American Optometry Association (AOA), optometrists (OD) perform 88 million comprehensive eye exams annually, comprising 85 percent of all eye exams, compared to only 16 million (15 percent) exams performed by ophthalmologists (MD)]. These statistics, although based on unverified methodology, yet still demonstrate that most Americans rely on optometrists for their eye care needs

As recently as March 2017, there has been what is known as the “Eyeball Wars” between Optometrists and ophthalmologists. The pros and cons have been debated a lot. So let’s review the contention between the optometrists and the ophthalmologists: Optometrists maintain the proposal is an access-to-care issue it would allow optometrists who receive special training to perform certain kinds of surgery in which “human tissue is injected, cut, burned, frozen, sutured, vaporized, coagulated, or photo disrupted by the use of surgical instrumentation; while ophthalmologists argue it would endanger patient safety.

Advocacy of allowing the optometrist to perform surgeries come from the fact that patients would have improved access to eye care in rural areas where optometrists outnumber ophthalmologists. Optometrists as a practice perform laser surgeries for treating ocular abnormalities, minor procedures of removing foreign body removal, draining a stye or epilating lashes. All these falls under the surgical procedure category. These are urgent in nature, as patients cannot wait for long periods to get appointments from an ophthalmologist, and especially have faster access to an optometrist within a day or two. This also indirectly reduces Medicaid costs as fewer referrals and visits (to ophthalmologist).

One of the cons here is, ophthalmologists will not treat patients who are on Medicaid, while optometrists care for patients who are on Medicaid or who are indigent- The complexity of medical billing.

Both sides have also pointed to evidence to support their view: Oklahoma, which has allowed expanded work for optometrists the longest, there were only two reported complaints for more than 25,000 procedures. On the other hand, Ophthalmologists pointed to a research paper that found glaucoma patients who had a certain type of laser surgery returning for treatment on the same eye 35.9 percent of the time when an optometrist did the work, as opposed to 15.1 percent of the time when an ophthalmologist conducted it.

However, as per the news, the optometrists have had strong political backing and waiting for House Bill 36 to pass would probably be just a matter of time. Caution is of course required among optometrists, given that ophthalmologists have advanced training in the “surgery” tasks and the years they put in before practicing.

However, if certain conditions, under which optometrists can practice certain eye surgeries, are laid down and certain certifications and audits implemented, this would then be a win-win for both parties, given certain circumstances that would be disadvantageous to the patients. Delivery of care and its efficiency for the patient is the crucial point here- and it is for the policymakers to take this to the receivers and enquire what is required and how. Although, integrated care practices that involve both the optometrists and the ophthalmologists are slowly emerging given the overlapping of eye care pre and post- the debate on who can do what may take a while till the short-sighted details are worked for a more far-sighted vision!