MDs, ODs work together at new Oklahoma laser refractive surgery center

Issue: November 1995

building --- TLC Tulsa facility.

TULSA, Okla. — In a state where optometrists have some of the broadest privileges in the country, ophthalmologists and optometrists have worked together to create a laser refractive surgery center, which is the first U.S. laser center created by the Canadian company, TLC The Laser Center Inc. If approved by state regulators, optometrists here could be permitted to perform excimer laser refractive procedures.

Tulsa was chosen as the site for the first of what could be 30 or more laser centers set up by TLC, which operates three refractive laser centers just across the northern U.S. border. The Canadian business was valued recently at more than $30 million by a leading financial firm in Toronto.

mugshot --- David Eldridge.

"This is the flagship for all the other TLC centers in the United States," said David C. Eldridge, OD, chair of the board of TLC U.S. The center director is David Talley, OD.

TLC's business strategy is to form a triangle that includes optometrists, ophthalmologists and business in the creation and operation of the centers. Eldridge estimates there will be at least 80 to 100 optometric referral sources for TLC Tulsa, which opened in September.

An ophthalmologist serves as the center's chief surgeon, with additional ophthalmologists becoming "privileged surgeons" with access to the center. "All these doctors are approved by physicians on our advisory board," made up predominantly of optometrists, Eldridge said.

TLC looks toward LASIK

The three existing Canadian TLC centers limit their practice to laser refractive surgery — photorefractive keratectomy (PRK) and excimer laser-assisted in situ keratomileusis (LASIK). To date, LASIK has not been approved in the United States, so it will not be performed at TLC Tulsa until they are approved.

However, once the Food and Drug Administration gives the green light, Tulsa will be set, trained and ready to go, according to Eldridge. "We could even become an investigational site for LASIK," he said.

Until then, the center will offer a full range of ophthalmic services and state-of-the-art equipment including ultrasound biomicroscopes, a nerve fiber layer analyzer, and corneal and retinal topography. Whether it will be optometrists who will perform refractive surgery using the TLC Tulsa lasers is still being debated.

Optometrists in the state won the right to perform some laser procedures in the most recent legislative expansion of their scope of practice. Over the past 17 years, Eldridge said, optometrists in Oklahoma have worked with state regulators and legislators to expand the optometric scope of practice.

"This is a rural state," he said. "Historically, ophthalmologists gravitated to the larger metropolitan areas, and it was the optometrists who were out in the smaller towns and communities treating patients. Yet before we passed our first law, we were not even allowed to legally use topical agents."

That changed with a diagnostic drug bill in 1981, which has been expanded over the years with additional bills and amendments. Now, Oklahoma optometrists can prescribe drugs, including oral antibiotics and Schedule 3, 4 and 5 drugs, and to provide additional treatment "for the relief of ocular abnormalities," according to Eldridge.

State has strict rules for ODs

"Every time we expand our treatment options, our state board of examiners sets down stringent requirements in education, review and certification," Eldridge said. "An optometrist must take certain courses, pass a test, be certified by the college of optometry where he or she was trained and then be accredited and certified by the board of examiners."

The state board has established guidelines outlining specific laser procedures optometrists are permitted to perform. Optometrists must be board certified to perform a laser procedure and must submit detailed follow-up outcome assessment reports on every case.

Eldridge has been using lasers for four years to perform posterior capsulotomy, iridotomy and argon laser trabeculoplasty. He and other Oklahoma optometrists have been involved in the creation of laser refractive surgery educational courses already offered by TLC in Canada in conjunction with Northeastern State University College of Optometry in Tahlequah, Okla.

Oklahoma optometrists regularly refer patients to TLC in Canada for LASIK and PRK, and a number of Oklahoma optometrists have extensive experience handling laser surgery follow-up cases, Eldridge said.

Instead of being a threat to optometrists, Eldridge said, laser refractive surgery can be a practice builder. "After seeing the excitement in our patients following PRK and LASIK," he said, "we realize they become fantastic referral sources for our practices."