This article is more than 5 years old. Information may no longer be current.
Approved motion for Wisconsin laser privileges rescinded following lawsuit
Click Here to Manage Email Alerts
MADISON, Wis. — A mere 3 weeks after the Wisconsin Optometry Examining Board (OEB) unanimously approved a motion stating that the use of lasers is within the scope of practice for optometrists, the OEB rescinded the motion in response to an eye surgery patient safety lawsuit filed by the American Academy of Ophthalmology (AAO), the Wisconsin Academy of Ophthalmology and the State Medical Society of Wisconsin and in an effort to clarify the intent of the original motion.
The lawsuit, filed May 30, asks the court to: a) issue an injunction to immediately invalidate the action of the OEB, pending final court decision, and b) determine that the OEB exceeded its authority by declaring laser eye procedures to be within the scope of practice of optometrists.
The Wisconsin Optometric Association (WOA), as part of ongoing research about scope-of-practice issues regarding lasers, had petitioned the board May 12 to go forward with rulemaking to determine who would be qualified to perform such procedures and safeguard the public, said Brian J. Hammes, OD, president of the WOA. Following some discussion, he said, the board decided to hold over the rule for consideration at the next meeting.
“In addition to this, the optometry board also spontaneously decided to pass a motion that simply stated their views on laser procedures, saying that they were in the scope of practice,” he said. “Of course, the WOA didn’t request that part of it, but the board did it anyway. This action caused a number of lawmakers to protest the action of the board. In response to this, on June 2, the board decided to rescind its motion and move forward with regular and ordinary rulemaking.”
Ken Tuck, MD, president of the AAO, said in a statement that he feels a review by the state legislature might stop the process. “I am confident that Wisconsin state senators and representatives, when given the opportunity to fully review the OEB’s action and request, will reconfirm that lasers remain outside the scope of practice of optometry and that, in the interest of patient safety, laser surgery should be performed only by medical doctors,” he said.
Dr. Hammes said that the petition presented by the WOA provides the OEB with what the association felt to be all the necessary criteria to determine the rulemaking. While it is likely that the rulemaking will be a topic of discussion at the board’s August meeting, he said, it is uncertain as to when the issue may be finalized. The average time for rulemaking in the state is 7 to 9 months, said Peter Theo, assistant executive vice president of the WOA.
Experiences with PRK
A few optometrists in Wisconsin had the opportunity to perform photorefractive keratectomy (PRK). Victor J. Connors, OD, WOA past president and American Optometric Association trustee, said that attending courses and hands-on training over the past 3 years made the procedure on May 15 a smooth one. “We were well prepared, the training was there and our clinical proficiency gave us a great deal of confidence,” he told Primary Care Optometry News. “My patient was very cooperative, and it was a straightforward case.”
Dr. Connors said that because it was his initial procedure, a surgeon certified on the Visx laser was present to proctor. “I was involved in all aspects of care,” he said. “I removed the epithelium with a transepithelial procedure with the laser. I used a spatula and cleaned off Bowman’s layer, then proceeded with a correction of 4 D of myopia.”
‘Very pleased’ with current TPA law
“Optometrists here enjoy full scope of practice under their therapeutic pharmaceutical agent (TPA) law, and the laser privilege falls under the scope of this law,” said Dr. Hammes. “Eleven years ago, we passed our therapeutic legislation. In addition to securing TPAs, we revised the Optometry Practice Act as well, chapter 449. We re-drafted our model after medicine statutes, which allows us to expand as time goes on if technology changes.”
Practitioners here may prescribe oral medications, controlled substances Schedules III, IV, V and glaucoma medications, with the provisions that optometrists consult with the patient’s primary physician before prescribing beta-blockers or carbonic anhydrase inhibitors and that closed-angle glaucoma cases be referred to the primary physician immediately for appropriate care. Dr. Hammes said that lasers are a natural addition to the law already in place.
Lasers necessary for advancement
Adopting the motion is a step in confirming that optometry, like other health care professions, is an ever-changing profession, said Dr. Connors. “It defines optometry as a learned profession that expands its scope of practice with advancements of technology and knowledge,” he said. “Scope advancement follows the validation that we have the clinical proficiency to move forward.”
Dr. Hammes said that while the issue of laser privileges was the “lightning rod” that sparked the attention, the real battle lies in optometry being in control of its own future. “It’s an exciting time, but, of course, ophthalmology is not pleased, because they feel they’re being eroded here a little bit,” he said. “But on the local level, ophthalmologists are pretty supportive. To us, it isn’t even a battle about lasers or laser privileges, it’s really all about whether our state board is going to control our practice or whether the AAO will control it.
“As technology changes — and it’s changing very quickly — we want to be able to move forward and not have to wait 3 or 4 years for the legislature to look over any technology,” he continued. “By then, it might be obsolete. We must be in the marketplace and be able to provide these services to our patients.”
For Your Information:
- Brian J. Hammes, OD, is president of the Wisconsin Optometric Association and is in private group practice. He may be reached at 221 North Peters Ave., Ste. #1, Fond-du-Lac, WI 54935; (608) 274-4322; fax: (920) 921-2388.
- Victor J. Connors, OD, is past president of the WOA, a member of the American Optometric Association Board of Trustees and in private group practice. He may be reached at Isthmus Eye Care, 6602 University Ave., Middleton, WI 53562; (608) 831-3366; fax: (608) 831-8470. The
- American Academy of Ophthalmology may be contacted at P.O. Box 7424, San Francisco, CA 94120-7424; (415) 561-8500; fax: (415) 561-8575; Web site: www.eyenet.org.