Vermont’s eye practitioners are in the middle of a contentious turf war over the right to cut into eyeballs.
Optometrists, the primary care providers of the eye world, are asking for the right to perform some superficial surgeries in Vermont. Their medical counterparts, ophthalmologists, argue these non-medical practitioners don’t have the skills or training needed to conduct these procedures safely.
The latest installment of the yearslong battle played out at the Senate Committee on Government Operations Friday afternoon. If passed, the bill, S.158, would grant optometrists the right to perform certain superficial surgeries, including injections of anesthetic, removal of skin tags from around the eyes and certain laser procedures.
“You are the safety net, basically, for the people of Vermont,” Jessica McNally, president of the Vermont Ophthalmological Society, told senators on Friday. She asked them to think carefully about the health and welfare of Vermonters in their decision.
But most of the discussion veered away from the emotional and squarely into the technical world of eye care, with long lists of difficult-to-pronounce surgical procedures and accusations of contradictory or misleading statements on both sides.
Dean Barcelow, president of the Vermont Optometric Association asked committee members to trust the professional ethics and clinical judgment of his peers.
“We're not asking for big severe procedures here,” he said. “We're asking for things that take just a few minutes — minor. They're able to be performed chairside in the office.”
Baffled committee members intended to vote on the issue but decided instead to hand the bill to the Senate Committee on Health and Welfare for review before taking additional actions.
At the heart of the argument is a battle over medical territory. It’s an issue physicians have long been facing with nurse practitioners and physician’s assistants, professions that have gained some independence from doctors in recent years.
Ophthalmologists are medical doctors who perform eye surgeries. Optometrists, meanwhile, don’t go to medical school and are generally limited to eye screenings, annual exams and first aid for injuries.
When patients need surgery, optometrists generally refer to an ophthalmologist. In some states, including Oklahoma, however, optometrists have the right to perform minor surgeries — a privilege coveted by optometrists in Vermont.
Vermont’s optometrists first began advocating for surgical privileges in 2019. In that first go-around, lawmakers asked the Secretary of State’s Office to study the merits of the request. The resulting 2020 document concluded that granting optometrists these privileges could pose risks to patient safety and that there was “little need for, and minimal cost savings associated with” the expansion.
Optometrists have said the report was incomplete and misleading because it neglected to mention the hands-on clinical practice optometrists receive in school. The Vermont Optometric Association argued that the procedures they want to perform are taught at optometric schools in great detail.
Ophthalmologists, on the other hand, support the report. They say that even a simple surgery could cause irreparable complications that non-medical eye doctors simply aren’t trained to deal with.
David Herlihy, executive director of the Vermont Board of Medical Practice, the licensure office that oversees medical professions, sided with the ophthalmologists.
“Just because people are seeing artificial eyeballs and this is being talked about in optometry school doesn't mean that they should be doing this routinely,” he said.
“It probably does make them better optometrists … but as far as the board is concerned, more training is needed (for surgeries),” he said.
The Senate Committee on Health and Welfare is expected to review the bill in the coming weeks.
Don't miss a thing. Sign up here to get VTDigger's weekly email on Vermont hospitals, health care trends, insurance and state health care policy.