Vermont’s eyeball war began with a controversial request to let nonmedical doctors cut into eyes and eyelids. The battle ended Tuesday with a bureaucratic whimper.
The factions in this fight — two kinds of eye practitioners — disagree on who should have the right to cut into eyes and eyelids.
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 that non-physician practitioners can’t conduct these procedures safely.
But after hours of impassioned testimony — and accusations — from both sides, lawmakers on the Senate Committee on Government Operations on Tuesday reached a stalemate on S.158.
If passed, the bill would have granted optometrists the right to perform certain superficial surgeries, including injections of anesthetic, removal of skin tags from around the eyes, and certain laser procedures.
Committee members were locked 3-2 in favor of the bill. Sen. Jeanette White, D-Windham, who sponsored the bill, said S.158 couldn’t survive a floor vote without more buy-in.
“I’m very disappointed,” White, who chairs the committee, said at the hearing. “But I know that at some point we have to admit that we’re up against a brick wall and that this is the best we can do.”
The move effectively killed the bill for now, though lawmakers said they’d like to revisit the proposal in a future legislative session.
Vermont’s optometrists 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 those privileges could pose risks to patient safety and that there was “little need for, and minimal cost savings associated with” the expansion.
Ophthalmologists supported those findings, but optometrists said the report was incomplete and misleading because it neglected to mention the hands-on clinical practice that optometrists receive in school.
Senators asked the office on Tuesday to review and update its report in time for the 2024 legislative session. Lawmakers expect to send a letter to outline the contours of that request.
At the heart of this battle over surgeries is a turf war over medical privileges. 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 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 them to an ophthalmologist. However, in some states, including Oklahoma, optometrists have the right to perform minor surgeries — a privilege coveted by optometrists in Vermont. Other states, including Colorado and Wisconsin, are considering similar bills.
Optometrists and ophthalmologists spearheading the fight vowed to work with regulators at the Office of the Secretary of State ahead of the 2024 discussion.
“The landscape is changing,” said Lauren Hibbert, director of the state’s Office of Professional Regulation. “Perhaps Colorado would shift its scope. Perhaps Wisconsin would shift its scope. … I think it makes sense to put this (proposal) down for a minute.”
