ÃÛÁÄÖ±²¥œQuick and painlessÃÛÁÄÖ±²¥ was the description given to a patient in Oklahoma by her optometrist right before her YAG capsulotomy laser surgery, a common procedure for cataract patients.
Oklahoma is one of the few states in the U.S. that lowered its surgical safety standards by allowing optometrists ÃÛÁÄÖ±²¥” who are not medical doctors or trained surgeons ÃÛÁÄÖ±²¥” to perform eye surgery. During the surgery, the optometrist mentioned that ÃÛÁÄÖ±²¥œthe laser wasnÃÛÁÄÖ±²¥™t working right.ÃÛÁÄÖ±²¥ The patient considered why the procedure wasnÃÛÁÄÖ±²¥™t stopped but reassured herself with the thought that the optometrist, being a ÃÛÁÄÖ±²¥œdoctor,ÃÛÁÄÖ±²¥ knew what she was doing.
Unfortunately, she experienced permanent blindness, which could have been avoided had she been treated by an ophthalmologist, who is a medical doctor specializing in eye surgery.
Sadly, this might be the new ÃÛÁÄÖ±²¥” and lower ÃÛÁÄÖ±²¥” standard of care for West Virginians soon as lawmakers in Charleston consider passing SB 565/HB 2975. This misguided legislation would lower surgical safety standards by allowing West VirginiaÃÛÁÄÖ±²¥™s optometrists to perform delicate laser surgery on the eye, posing a grave threat to the integrity of medical standards and the safety of our citizens.
Although essential in their field, optometrists lack the level of training requisite for performing surgery that ophthalmologists undergo. This disparity in training and expertise places patients at significant risk of complications and substandard care ÃÛÁÄÖ±²¥” and West Virginians need to recognize whatÃÛÁÄÖ±²¥™s at stake.
Optometrists complete a four-year program after undergraduate studies. Despite claims of ÃÛÁÄÖ±²¥œextensive training,ÃÛÁÄÖ±²¥ no required hands-on surgical residency is included in their curriculum. Furthermore, 23 out of 25 U.S. optometry schools are in states that prohibit optometrists from performing laser surgery. For instance, Ohio State UniversityÃÛÁÄÖ±²¥™s College of Optometry may offer a mere 32-hour survey course over an extended weekend. Besides the fact that it takes years (not hours) to be fully trained in surgery, the 32-hour crash course lacks the requisite hands-on experience to safely conduct these procedures. Proper training includes actually performing these surgeries over and over on live patients with real conditions. This legally cannot be done in Ohio ÃÛÁÄÖ±²¥” nor at 92% of all other optometry schools.
Ophthalmologists undergo extensive training before performing eye surgeries. This includes four years of medical school, a one-year medical internship, and three years of surgical residency, where they diagnose, treat, and observe patients. Many also pursue additional fellowship training. Altogether, this amounts to over 17,000 hours of specialized medical education and supervised surgical training over 8-10 years. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) regulate this rigorous educational process. These entities mandate that ophthalmologists demonstrate their competency and professionalism both during their training and throughout their careers. As watchdogs for the public, they ensure that citizens are being cared for by ophthalmologists who have met and continue to meet the national standard.
Passing a state law circumventing these lofty national standards would be a mistake.
Forty U.S. states, plus the U.S. Veterans Health Administration, prohibit optometrists from performing laser eye surgery. Unfortunately, when you look at the few states that have dangerously loosened their surgical safety standards, patients have experienced poor outcomes. Patients who undergo laser eye surgery by optometrists have an 189% increased risk of requiring additional surgery in the same eye compared to those operated on by an ophthalmologist. Furthermore, instances of misdiagnosis have led to unnecessary surgeries and, in some cases, permanent vision loss.
Optometrists maintain that expanding their scope of practice will improve patient access to care. However, nearly 90% of West Virginians are as close or closer to an ophthalmologist as they are to a Walmart. This suggests that granting surgical privileges to professionals with limited training only raises concerns about safety rather than improving accessibility.
State leaders are responsible for upholding high standards of patient care and protecting the residents of West Virginia. Therefore, I respectfully urge the Legislature to maintain the existing patient safety standards that ensure the well-being of West Virginians and reject SB 565/HB 2975, which would permit optometrists to perform these delicate surgeries after only a 32-hour weekend training course rather than through the comprehensive training required of ophthalmologists.
Charles Francis, M.D. is an associate clinical professor at the Marshall University School of Medicine. He is vice president of the West Virginia Academy of Eye Physicians and Surgeons and serves as West VirginiaÃÛÁÄÖ±²¥™s Councilor to the American Academy of Ophthalmology.
