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Optometric surgery an issue worth fighting over
Chief Medical Editor says the scope of optometric practice should not include surgery.
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I am a long-time advocate of the positive role optometry plays in the care of the American patient. In my practice, 10 ophthalmologists, 12 employed optometrists and more than 200 referring optometrists cooperatively manage thousands of patients each year. I believe the quality of care we provide our patients is second to none. I supported the creation and serve on the editorial board of our sister publication, Primary Care Optometry News. By anyone’s definition over the past 25 years I have been optometry’s friend.
However, I cannot in good conscience stand silent as organized optometry attempts to expand its scope of practice to include surgery. I believe this effort by optometrists is misguided, dangerous to patients and potentially self-destructive to their own profession.
My position: The scope of optometric practice should not include surgery, period. (No, I do not consider epilation or the placement of a punctual plug surgery. Yes, I do consider argon laser trabeculoplasty, YAG laser capsulotomy, laser photocoagulation of the retina, PRK, laser epithelial keratomileusis and LASIK surgery.)
Surgery is a skill, like tennis or golf. It cannot be mastered by even the brightest and most diligent student by simply reading, watching a video or taking a 40-hour CME course. As with all skill sports, becoming an expert at surgery requires years of practice under the close supervision of an instructor skilled in the art. In surgery, we call that training period residency and fellowship.
The making of an eye surgeon is long, demanding, intense and expensive, requiring in the United States 3 to 5 years of full-time training, followed by a lifetime of continuing education and refinement. All of us who do ophthalmic surgery, and especially those of us who endeavor to train the next generation of eye surgeons, know there is no shortcut.
Self-destructive effort
I am concerned that organized optometry will find any attempt to expand the scope of optometric practice into surgery a lonely, expensive, fruitless and potentially self-destructive effort. To my optometric colleagues I say: Don’t do it; the risk/benefit ratio is not in your favor.
While thoughtful ophthalmologists may disagree as to the role of optometry in medical and postsurgical care, we are united in the conviction that eye surgery is for ophthalmic surgeons only. And we are not alone. The entire medical community, the majority of patients, and most third-party payers, regulators and legislators agree.
I fear the current skirmish over optometric surgery will expand into outright war, endangering the growing collegiality between optometry and ophthalmology that is evolving in practices like ours. I encourage my valued optometric colleagues to ask their leadership to call off this battle. The backlash from such a battle could be severe enough that in many states optometrists may find their scope of practice collapsing rather than expanding. It is not worth it to the typical optometrist who will gain nothing. The pain will be felt by many and the gain by only a very select few.
To my ophthalmologist colleagues I say, take note, as this is an issue worth fighting over. The only acceptable outcome must be unconditional surrender. Any compromise is unthinkable for our profession and our patients.