Invasive surgery debate likely to continue

Issue: February 2005

ByMichael D. DePaolis, OD, FAAO

Michael D. DePaolis, OD, FAAO [photo]
Michael D. DePaolis

In the December 2004 issue of Primary Care Optometry News we featured two commentaries addressing the merits of optometric surgery. Our contributors — arguably two of optometry’s most accomplished peers — Louis Catania, OD, and John McCall Jr., OD, provided different views concerning how our profession should proceed in this highly volatile arena. While we anticipated this initiative would spawn lively debate, never could we have imagined such a firestorm of controversy. [Click here to read the commentary by Dr. Catania and click here to read Dr. McCall's commentary.]

We continue to receive e-mails and letters almost daily, arriving from all over the country and representing a wide practitioner demographic. Some of the correspondences are succinct while others are lengthy, some are emotionally charged and others are quite analytical. Though they truly run the gamut, all share a common denominator: conviction. No doubt, the topic of optometric surgery has polarized our profession. [To read the letters received so far on this topic, click here.]

Little reason for invasive surgery?

On one hand, Dr. Catania provides a very compelling point of view. Long recognized for his efforts in transforming optometry from an optical trade to a full-scope primary eye care profession, Dr. Catania feels we are best suited to serve the public in this capacity. And, as primary eye care providers – much like primary care physicians – there is really very little reason to perform invasive ocular surgery.

In support of this position are three fundamental arguments. First, is the fact that many ophthalmologists are not operating at capacity implying an existing surgical surplus? Adding thousands of optometrists to the mix will only foster surgical mediocrity as well as increase the rift between our professions.

Second, there is the issue of competency. While optometry has an impeccable record of legislating for increased scope of practice, we have always done so based on demonstrable claims of educational competency. Can we be certain that our training programs and postgraduate continuing education courses will provide competency in performing invasive surgery?

Finally, there is the matter of best serving the needs of the public. While our patients appreciate the primary eye care we provide, will they feel the same about invasive surgery? Or, will the public – as well as the health care community and legislators – view this initiative as self-serving and an example of optometry having gone too far? Simply put, optometrists performing invasive ocular surgery might prove to be our profession’s greatest tactical error.

Surgery necessary for tomorrow’s OD?

On the other hand, Dr. McCall offers an equally compelling perspective. As a former American Optometric Association and Texas Optometric Association president, Dr. McCall is no stranger to politics — locally, statewide and nationally – and the role they play in determining optometry’s future.

Dr. McCall is quick to point out that our profession is at another crossroads, not unlike when we embarked upon therapeutic legislation a quarter of a century ago. Just as therapeutics have been an invaluable addition to today’s optometric practice, so might surgical privileges in tomorrow’s optometric practice.

Certainly, technology is changing at an ever-accelerating rate, and surgery is no exception. It is entirely possible that the future provides an effective, safe and relatively easy-to-perform refractive surgery procedure, a technique well within the capabilities of an appropriately trained optometrist. Furthermore, given our conservative nature and propensity for making prudent clinical decisions, it is unlikely that optometrists would abuse any surgical privileges.

Given these circumstances, Dr. McCall contends that optometry must continue legislating for “as taught” licensure and to exist as an autonomous profession capable of governing itself. Settling for anything less might prove to be optometry’s greatest tactical error.

Controversy will continue

For certain, this controversy is not going to end anytime soon. While the most suitable solution will evolve over time, one thing is for certain. This debate won’t occur in a vacuum. Whether we agree with it or not, ophthalmology, medicine, health insurers, government and our patients all will have something to say. As a profession, it is essential that our actions be favorably perceived by the community in which we practice. Anything less might prove to be optometry’s greatest tactical error.