Who would you rather have operating on and around your eyes? Someone who went to medical school, trained under a surgeon, and has years of experience in the field, or someone who has not?
Optometrists, who are not medical doctors or trained surgeons, are asking the Legislature to change state law to allow them to perform eye surgery. If permitted, this will jeopardize the eye health of West Virginia patients.
Eye surgery is commonly performed to treat cataracts, glaucoma, tumors on the eyelid, and many other eye-related conditions. Many of these surgeries employ lasers which can cut, blast, and burn human tissue. These surgeries are advanced and delicate, requiring careful placement of laser energy into the eye. For example, YAG lasers turn liquid into gas by heating the tissue to 3,000 degrees for 4 nanoseconds. If not aimed carefully, it can have devastating results.
Let’s briefly review the training of eyecare professionals. Ophthalmologists are medical eye doctors and trained eye surgeons. Their proficiency is acquired through years of medical education and clinical training. After four years of medical school and a one-year hospital internship, an ophthalmologist-in-training then gains critical surgical expertise and judgment in a one-on-one three-year surgical residency program.
As part of this protocol, the resident trains by performing surgery on live patients with real conditions under the one-on-one supervision of an attending ophthalmologist. Following residency, many ophthalmologists then spend another one to two-years in a subspecialty fellowship, like glaucoma. That is a total of 8 years minimum and up to 10 years of postgraduate training, versus four years for optometry school.
Conversely, optometrists complete a four-year optometry school program focusing on basic vision care. While they are valued members of the eye care team, their education model does not provide a focused, in-depth surgical training for its students.
For example, 22 of the nation’s 24 schools of optometry (91%) are in states where optometrists are prohibited by law from performing laser eye surgery. It is impossible for an optometry student to properly train in performing these surgeries if it’s illegal in that state for optometrists to do them.
Medical education and proper clinical training are of utmost importance for patient safety. For example, a patient may develop skin lesions on the eyelid. Optometrists may refer to these as minor “lumps and bumps,” which is potentially a dangerous trivialization of complex pathology. These ‘lumps and bumps’ may be cancerous lesions masquerading as benign skin growths. Improper removal of a cancerous lesion (even those that look non-cancerous) may result in serious consequences such as local recurrences, spread into the eye socket or to other parts of the body, resulting in costly reconstructive surgery, loss of the eye, or even death. A 16-hour mini-course on incisional surgery in optometry school is not sufficient to understand, recognize and treat complications of these procedures.
There is good reason our state required those performing eye surgery to go to medical school and residency.
Unfortunately, some optometrists and their lobbyists want to circumvent this time-honored safety measure and convince the legislature to change existing law, empowering the Board of Optometry to police and approve their ability to do surgical procedures.
This is akin to the fox guarding the hen house. The optometry board and their lobbyists will attempt to chip away year after year asking the legislature to grant them more surgical powers, not through proper training, but through legislation.
We hope state policymakers see through these ill-fated efforts to weaken West Virginia’s surgical safety standards, placing the health and safety of our loved ones at risk.
I’d encourage you to call your legislators and urge them to vote down House Bill 4783 and other efforts to allow optometrists to perform surgery.
Dr. Charles Francis, MD is an ophthalmology specialist practicing in Hurricane, WV and has over 30 years of experience in the medical field. He serves as AAO Councilor for the West Virginia Academy of Eye Physicians & Surgeons