This commentary is by Jessica McNally, MD of Montpelier. She is a comprehensive ophthalmologist at Central Vermont Medical Center, and the current president of the Vermont Ophthalmological Society.
A patient who needs surgery expects it will be performed by a trained and skilled surgeon. That makes sense. Yet, when it comes to your most sensitive organ — your eyes — some are lobbying Vermont lawmakers to legalize optometrists to do laser and scalpel surgery. I am a Vermont ophthalmologist, a medical doctor and surgeon specializing in eye care, raising the alarm about the safety risks of lowering standards for performing invasive eye surgery.
The training between ophthalmologists and optometrists is very different. All ophthalmologists are physicians (medical doctors) and surgeons. They attend four years of medical school and complete a four-year supervised, hands-on surgical residency program. They then can go on to complete a fellowship for further experience in surgery on specific parts of the eye. Optometrists complete a four-year optometry program with no required further training and are not medical doctors or surgeons. Optometrists provide primary vision care by performing routine eye exams and providing straightforward medical eyecare. They are trained to refer to an ophthalmologist if further care or intervention is needed. They are not trained to do surgery.
In Vermont, with something as precious as eyesight, we should not take unnecessary risks. But that is exactly what a special interest business lobbying group is pushing state lawmakers to do.
As part of a national drive to expand their business, the Vermont optometry lobby is making the false claim that there are not enough ophthalmologists to take care of patient needs. In Vermont we are extremely fortunate in that we have enough ophthalmologists to provide all scalpel and laser surgical care in and around the eye. If a Vermont patient needs urgent eye surgery, they can get the care they need right away from a trained physician surgeon.
A recent report from the Vermont Office of Professional Regulation (OPR) on the controversy reveals the weakness of the optometry lobby’s key claims. The report concludes: “OPR is unable to determine whether expanding the optometric scope of practice would improve patient access to care.” The report also invalidates the claim that lowering safety standards would save patients money. “OPR cannot determine the impact expansion of the optometric scope of practice would have on costs.”
I recently testified in the Legislature to make sure our lawmakers know that, according to OPR’s website, there have been 26 newly licensed optometrists in Vermont in the last six years. And yet anyone who has tried to get a routine eye exam lately by their optometrist knows that there is often a several months’ wait. It is difficult to understand how expanding the workload of an already overworked optometrist to include surgeries could possibly improve access to primary eye care.
I also raised my concern about the real potential of a primary eye care provider performing surgery on a patient without having the underlying knowledge base and expertise to do so. Just last week a Vermont optometrist made an incorrect diagnosis for which the treatment would have been a laser potentially allowed by optometrists in OPR’s report. Thankfully, the patient ended up in an ophthalmologist’s office. The correct diagnosis was made of an infectious disease, not only saving the patient from a surgery that would have been ineffective and could have harmed them, but also protecting the patient and our community by treating the disease. This type of misdiagnosis leading to harmful use of laser surgery could be devastating.
For the safety of our patients, I plan to vigorously oppose any bill in the Legislature that risks patient safety. It is a startlingly dangerous proposal by the optometry lobbying group to push for risky surgeries, all to garner more business. Our eyes are one of the most sensitive and precious organs in our body. I will not remain silent as our lawmakers consider allowing optometrists, who have no standardized surgical training, to perform scalpel and laser eye surgeries on vulnerable Vermonters.
