This commentary is by Elizabeth Houle, M.D., a board-certified ophthalmologist who grew up in Danville, lives in South Burlington and practices ophthalmology in Burlington.
Everyone cares about patient safety. We rely on our vision to navigate productively and independently in this world.
Eye surgery is delicate. The consequences of even the slightest misstep are potentially devastating.
As an ophthalmologist who performs eye surgery regularly, I am acutely aware that eye surgery has the capacity to benefit as well as the capacity to harm. My duty as a physician is to minimize the risk of harm. Performing eye surgery safely requires thousands of hours of training and closely supervised practice on real human beings.
Ophthalmologists acquire this rigorous hands-on training during four years of medical school, followed by four years of residency and, in many cases, an additional one to two years of fellowship training.
There is currently a bill (S.158) before our state Legislature that dramatically lowers the standards for who can perform eye surgery by expanding optometric scope of practice. The training proposed in the bill does not require any practical hands-on experience or supervised surgery — meaning it would allow optometrists to operate on unknowing Vermonters without requiring that they ever have trained on living human eyes.
Learning surgery on a cadaver or from a video is not even remotely similar to operating on a living, breathing, feeling person. Not only is the tissue different, but a cadaver doesn’t become anxious, have difficulty holding still, or flinch. These are natural human reactions that can have serious consequences when a scalpel, needle or laser is close to the eye tissues and are only properly addressed after extensive surgical training.
Even surgeries that are done in the office and seem simple are not minor (particularly from the perspective of the patients on the other end of the scalpel/laser/injection needle) and can have potentially dire complications and outcomes.
In addition, this legislation fails to consider the experience, training and mentorship required to manage surgical complications, which, as every surgeon knows, are unfortunately sometimes inevitable. Managing surgical complications is often technically and emotionally more challenging than learning the surgery itself.
If this bill passes, will optometrists who have never performed these procedures on real people be prepared to manage complications that ensue in their patients?
In 2019 in Act 30, the General Assembly directed the Office of Professional Regulation to conduct an in-depth study to evaluate a similar proposed expansion of optometrists’ scope of practice. After conducting a comprehensive, evidence-driven study, “the Office of Professional Regulation recommends against expanding the optometrist scope of practice to include the proposed advanced procedures. At this time, the office cannot conclude that optometrists have the education and training to safely provide these procedures.”
I find it troubling that this legislation, which jeopardizes the eyesight and safety of Vermonters, is currently being considered against the explicit recommendations of the Office of Professional Regulation.
Imagine allowing a person to fly a plane solo when they’ve only ever watched a video of flying, maybe even used a flight simulator, but never piloted an actual aircraft. I would not knowingly be a passenger on that plane, just as I would never allow someone who has never lasered a person’s eye to laser my eye or my family member’s eye. Many people do not know the difference between optometrists and ophthalmologists and need protection from harm or inappropriate treatment.
I want the safest possible surgery for my family, my friends, my patients and for all Vermonters. Patients who need eye surgery deserve the best-trained doctors.
