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Many live near ophthalmologist office in states with expanded optometrist practice
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In three U.S. states where optometrists have expanded scope of practice, more than 40% of residents live within 10 minutes of an ophthalmologist office, according to a study.
“These sorts of analyses provide researchers and health policy makers with a stronger basis for evaluating whether legislation expanding the scope of practice of optometrists in these states is achieving its stated purpose, which was to expand access,” the study authors wrote.
Using 2010 U.S. census data, an American Academy of Ophthalmology member database and Medicare beneficiary data, the authors analyzed the estimated time of travel to an ophthalmologist for patients in Kentucky, New Mexico and Oklahoma.
All three states allow optometrists to have an expanded scope of practice that includes the ability to perform laser trabeculoplasty, laser capsulotomy, laser peripheral iridotomy, intraocular injection and eyelid lesion removal. The study also assessed travel to an ophthalmologist for Medicare beneficiaries who had received surgery from an optometrist.
More than 40% of residents in all three states were found to live within a 10-minute travel time to the nearest ophthalmologist office, while about 75% live within 30 minutes and more than 90% live within 45 minutes.
The breakdowns for race, ethnicity and age found similar results, with more than 75% of non-Hispanic white, non-Hispanic black and Hispanic people living within 30 minutes of an ophthalmologist office and 75.7% to 82.7% of both those younger and older than 65 residing within 30 minutes of an ophthalmologist.
“In considering the expansion of optometrist scope of practice to include surgery, policy makers must weigh multiple factors. First, ophthalmologists have considerably more training, experience and expertise in performing laser procedures, injections and eyelid procedures compared with optometrists, which might translate into higher quality of care,” they wrote.
Other factors to consider include drive time, insurance, how often surgery is performed and wait time for a surgical procedure.
“These quality-of-care and access factors must be assessed and subsequently balanced in deciding whether to expand optometrists’ surgical scope of practice,” the authors said. – by Rebecca L. Forand
Disclosure s : Stein reports he has received financial support from the American Academy of Ophthalmology. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Elizabeth Yeu, MD
Scope of practice can be an uncomfortable, and often polarizing, topic for both MDs and ODs. The key question when it comes to the care of patients is exactly that: How can we provide the best eye care for our patients?
To answer this, there are multiple important considerations, including clinical competence, availability of appropriate care and access to care. The latter consideration — the actual physical distance to eye care access — was broadly reviewed in a recent JAMA Ophthalmology article, “Access to Ophthalmologists in States Where Optometrists Have Expanded Scope of Practice.” In Kentucky, Oklahoma and New Mexico, more than 75% of the overall residents live within 30 minutes to the nearest ophthalmologist, whereas of those who underwent a procedure by an OD, between 49.6% and 58.3% of those patients were within 30 minutes from the nearest ophthalmologist. The results highlight one interesting finding, which is that upward of 50% of patients who require an ocular intervention have greater distances to an ophthalmologist in these very specific states. This is certainly one aspect to consider because it is in the best interest of patients to mitigate the travel time as a barrier to appropriate eye care access. I believe that the limited number of graduating eye MDs to serve an ever-expanding population is going to only further compound the “supply” and “demand” problem, and this serves as another important consideration: How do we responsibly grow the available pool of professionals who can provide appropriate care?
The third, and without a doubt the most important deliberation in scope of practice discussion, is the actual clinical competence and training. Ophthalmology spans all eye care — from primary medical care through surgical interventions — and this is unique in and of itself, as most medical fields are divided between primary and subspecialty care with other organ systems. This is beyond a tall order that will only worsen over the next decade. If we do not consider how to responsibly best serve our patients, utilizing all resources of eye care professionals, I believe that timely patient care will suffer in the years to come. To this end, the expansion of scope should only occur with a broadened academic curriculum that starts during training, hands-on skills transfer education and testing in order to confer clinical competence of specific skill sets.
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