‘Optometry must retain its autonomy’

Issue: December 2004

ByJohn A. McCall Jr., OD

John A. McCall Jr. [photo]
John A. McCall Jr.

I have read many letters and editorials recently and I’ve watched as ophthalmology has aggressively opposed optometrists performing surgery because of the laws in Oklahoma and because of one optometrist at a VA hospital in Kansas. Much of what has been said and written about this issue by ophthalmology — and indeed the entire medical community – has been completely false. No optometrists in any state, including Oklahoma, are talking about performing or enacting laws that allow optometrists to perform major, invasive surgical procedures such as cataract surgery and muscle surgery.

In all of these discussions, it’s important for us to distinguish what is considered “surgery.” No one in optometry is advocating that we should be performing invasive surgical procedures. However, many procedures categorized by CPT as “surgery” do not involve penetrating the globe or orbit. Epilation, chalazion removal and corneal débridement for recurrent erosion are examples of procedures that fall into this category.

The battle is about control

So what is this battle about? On the surface, it is about lasers, but it goes much deeper. Ophthalmology is fighting over lasers because they make money using lasers. Ophthalmology also depends on referrals from pediatricians, hence their opposition to any legislation mandating children’s eye exams. They’re afraid of losing the referrals. Ophthalmology is afraid to compete with us in these areas in their obvious attempt to control all eye care.

Optometrists in Oklahoma have been using lasers since 1988, so why is all of this surfacing now? Because ophthalmology knows that technology is making laser procedures easier to perform. In some high-volume surgical practices, nonphysicians are now creating flaps using the IntraLase technology.

OD schools are teaching lasers

Ophthalmology also knows that optometric education is evolving with technology. Ambulatory surgical centers and training programs are already in place or are being established at State University of New York – State College of Optometry, Illinois College of Optometry, Southern California College of Optometry and University of Houston College of Optometry. These programs include instruction in using lasers.

Lasers and other new technologies will shape the eye care delivery system in ways that we have yet to imagine. If we do not gain control of our profession by passing optometric practice acts that give optometry control over what they do, just like medicine and dentistry have, then we will lose our autonomy, and ophthalmology knows that. Why doesn’t every optometrist know this? Soon, eye care will involve the medical treatment of myopia and gene therapy, and optometry will be on the outside looking in. Think hard about that statement before you form your opinion on the issue.

ODs must embrace new advances

We cannot rely solely on glasses and contact lenses. Our profession must advance. However, we cannot leave a vacuum behind us. Wavefront technologies have been embraced by ophthalmology, yet they are truly within our purview. We must also seize these technologies, become experts in them and apply them to all forms of vision correction.

Many of the letters coming from optometrists that speak against any movement into surgery by optometry sound a lot like the letters that came in years ago against optometry moving into medical eye care. Those letters defended optometry as the “drugless profession.” And those optometrists have been proven wrong. They were just as wrong as those who speak out today against minor surgical privileges.

We look at their shortsighted views back then, when they were presuming to speak for the majority of optometrists, and we know now that it would have been a mistake for the optometric leadership to follow their advice. They were, in fact, not speaking for the majority of optometrists.

Optometry’s role will expand

Optometry has embraced its primary care role and excelled at it. Optometry will embrace its expanded role in the health care delivery system of the 21st century. We just have to pass the laws to enable us to do so. Ophthalmology is frightened because they believe we can and will do both.

In my past 25+ years serving this profession at the state and national level, I truly thought that “organized” ophthalmology could no longer surprise me. I was wrong. This year’s banning of optometry from the educational seminars of American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery proves their arrogance has reached a level that even I underestimated. They are unable to admit that our advancement into the medical and surgical arena of eye care has evolved from our fine teaching and clinical institutions. They assume we must have peeked through their educational doors to arrive at our current level of competence.

They are sadly mistaken and, once again, this arrogance will help optometry in securing legislation to better serve the public. The state legislators will recognize this for what it is: a selfish attempt to suppress competition, without regard for patient care or patient cost.

In the final analysis, optometry is best served by providing the optometrists who care for the majority of Americans with the tools they need to provide that care in a state-of-the-art manner. Changing the paradigm is always painful, but the growth that accompanies it is essential to both the survival and the prosperity of the optometric profession.

For Your Information:

John A. McCall Jr., OD, is a member of the Editorial Board of Primary Care Optometry News and is in private practice in rural East Texas. He can be reached at 711 E. Goliad Ave., Crockett, TX 75835; (936) 544-3763; fax: (936) 544-7894; e-mail: vsourcejam@aol.com.