ODs performing intraocular surgery: is it practical?

Issue: July 2004

ByMichael D. DePaolis, OD, FAAO

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

Admittedly, the American Academy of Ophthalmology’s recent decision to ban optometrists from its annual meeting initially left me both a bit surprised and curious. Surprised that at a time in which there seemed to be increased communication, collegiality and collaboration between the two professions, such a mandate could occur. And curious as to precisely why the AAO had taken such a stance. Having now reflected upon the AAO’s position, optometry’s response and a variety of opinions from both professions, I now better understand. In short, I am no longer surprised or curious.

What underscores the AAO’s stance — and why optometry finds it so difficult to conceptualize this position — is a fundamental difference in philosophy and practicality. Philosophically, ophthalmology believes that the path to competency in performing an ocular procedure — read surgery — is medical school, internship and residency. And for good reason. This is the only model that ophthalmology knows, it has been proven effective and it has served the profession well.

Ophthalmology also feels that the recent signing of Oklahoma’s HB 2321, which clarifies optometry’s practice act to include the word “surgery,” is an overt attempt to practice ophthalmology — without the time-honored requisite training pathway. So the AAO initiates its annual meeting ban on the grounds that optometry could use this educational venue to “blur” the distinction between the two professions in legislative arenas. Philosophically, ophthalmology’s position is rational and defensible. But is it practical?

Conversely, optometry points out that few ODs attend the AAO’s annual meeting and, as a result, a ban does little to deter the profession’s educational initiative. Additionally, the profession has not used this venue to its advantage in expanded practice scope legislation. Instead, optometry has adopted the philosophy that no one has a “monopoly on knowledge.” And, by expanding the core curriculum and clinical patient care encounters in optometry educational institutions, an expanded scope of practice — including certain surgical procedures — is a logical progression.

To further substantiate that an “alternate” pathway to competency is viable, optometry is quick to point to the professions of dentistry and podiatry. Philosophically, optometry’s stance is rational and defensible as well. But is it practical?

From a practical perspective, which is what matters most to the public we serve, neither philosophy resonates well. For ophthalmology, sequestering knowledge just isn’t good policy. And is prohibiting optometrists from epilating eyelashes, removing superficial corneal foreign bodies and performing punctal occlusion really in the public’s best interest? Optometry has been satisfying a demonstrable need for these procedures for some time, safely and efficaciously. Referring these patients will only result in treatment delays as well as additional costs to a health care system already struggling with cost containment.

From the other perspective, does it make sense for optometry to train and legislate to perform intraocular procedures? This may be idealistically achievable, but probably not practical. Even if optometrists were licensed to perform intraocular procedures, is there really a need? Arguably, we already have a surplus in surgical capacity. In most communities certain ophthalmologists have surgical backlogs, while others have plenty of surgical time available. Given that surgical proficiency is often correlated with experience, is it in the public’s best interest to have a community of “occasional surgeons” in lieu of a few “highly experienced surgeons?” Adding optometry to the provider mix might only serve to further dilute the surgical experience.

Granted, philosophical differences will ensure that this controversy is not going to end any time soon. And while we’re all entitled to our opinions, one mandate should prevail: always do what is in the best interest of the patients we serve. Anything else is just not practical.