Allowing optometrists to perform surgeries may put patients at risk

Jul 22 2011

Medical Organizations Call for Significant Changes to Protect Patients from Undue Harm

Proposed regulations for a new state law which allows optometrists, who are not medical doctors, to perform a broad range of surgical procedures on the eye, fail to properly define the education, training and oversight necessary for this new scope of work that is typically performed by medical board-certified physicians. These failures put Kentucky patients at risk. The Kentucky Board of Optometric Examiners is holding a public hearing to receive comments on the new regulations today.

"On nearly every level, these regulations fail to ensure that Kentuckians will receive the highest standard of eye care," said Woody Van Meter, president, Kentucky Academy of Eye Physicians and Surgeons. "This is a law that the public didn't want, as demonstrated in more than one poll. Because of the controversy when the SB 110 was passed last February, the Kentucky Board of Optometric Examiners should now be emphasizing patient safety with these new regulations. The proposed regulations have little substance, do not specify details of training nor qualifications of teachers, and conceivably allow optometrists to start performing surgical procedures after a weekend course. This current draft should be withdrawn and the process should be started anew to ensure that patients are protected."

Just five months ago, SB 110, the bill that would allow optometrists to perform various eye surgeries, was needlessly rushed through the legislature in 13 business days without the full and fair hearing of other bills. It was signed by the governor in late February. The new law authorizes optometrists to use lasers, scalpels, needles, ultrasound, ionizing radiation and tools that burn and freeze tissue. It also gives optometrists authorization to inject almost any drug, except controlled substances classified as Schedule I and II.

Despite the bill's swift passage, there was little public support for it.  A poll conducted by cn/2 found that nearly 80 percent of Kentuckians want any eye surgery to be performed by ophthalmologists—even citizens in rural areas felt this way.

According to the proposed regulations, in order to be certified for these surgical procedures, an optometrist must go through "some" instruction; however, it does not define how long the instruction course needs to be, the time devoted to each subject, or the qualifications of the instructors. Most worrisome, however, the regulations fail to specify how many patients need to be treated before an optometrist can be certified. In as little as a few hours, a practicing optometrist, who is not a surgically trained medical or osteopathic doctor, could be certified for a broad range of delicate surgical procedures authorized by the legislation, including removal of potentially cancerous eyelid tumors, a wide array of glaucoma laser surgery, and a laser to clear up cloudy vision after cataract surgery, each of which can have significant – even blinding – complications.

Ophthalmologists, who are medical or osteopathic doctors, spend eight years or more honing their surgical and medical skills through a process that includes four years of medical school, a one year hospital internship, followed by three years of surgical residency and then completing more than 17,000 hours of supervised, hands-on clinical training before they are licensed to perform surgery by themselves. On the other hand, optometry training consists of a four-year program focusing on basic services such as eye exams and contact lens fitting.

"At UK Health Care, there is a very prescribed credentialing and privileging process in order for any physician to be allowed to perform surgery," said Michael Karpf, M.D., executive vice president for health affairs, University of Kentucky. "The curriculum described in these regulations are simply not specific or complete enough to bestow surgical privileges to an individual."

Van Meter added, "There are no short cuts to gaining a medical degree, which is why this law and its regulations are so flawed. Patients should always ask about the credentials of their eye doctor."

Moreover, the law gives the Kentucky Board of Optometric Examiners, the governing body for optometrists in Kentucky, sole authority to determine which eye surgery procedures optometrists may perform and the level of training required to do so without any outside regulation or oversight from medical doctors.

"The power given to the Kentucky Board of Optometric Examiners is of great concern to physicians because it has significant implications for quality of care.  The members of the Kentucky Board of Optometric Examiners will have no more surgical training, experience or education than the optometrists they will be certifying to perform delicate surgeries on patients in Kentucky," said Preston Nunnelley, MD, legislative chairman, Kentucky Medical Association.

To ensure patient safety, KAEPS, the Kentucky Medical Association and the Kentucky Osteopathic Medical Association are calling for this law and its regulations to be completely re-examined with the input from the medical community.

"The needs and safety of patients must come first," added Larry Suess, DO, Ph.D., president, KOMA.