Three Idaho optometrists perform PRK

Issue: April 1996

BOISE, Idaho—Acting with the support of the Idaho Optometric Association (IOA), three optometrists are performing photorefractive keratectomy (PRK) here at the Idaho Refractive Laser Center.

Charles W. Stewart OD; James Dean OD; and Daniel Tiller OD, have performed seven PRKs as of mid-March, with Dean performing the first one on Feb. 29. Stewart said all the patients were within the parameters of the Food and Drug Administration requirements preoperatively: between -1.50 and -7 D and with -1.50 D of cylinder or less. He said the optometrists are handling the postoperative care and all the patients are doing "great."

The ODs considered the move to PRK as a natural progression. Tiller said: "Optometry is geared toward correcting refractive error anyway, and this provides us another way of doing that." Dean added, "I feel it's appropriate for optometrists with their education and background to utilize this kind of technology. It's a natural thing for optometrists to do."

IOA supports optometrists

IOA Executive Director Larry Benton said: "The association completely supports the optometric profession in Idaho being allowed to perform the procedure."

Optometrists in the state practice under the authority of the Idaho State Board of Optometry, he said, and "if the state board decides that optometrists are educated, trained and qualified to perform PRK procedures, then they should be allowed to do so."

The American Academy of Ophthalmology is preparing a challenge to this position. "The Academy will work with the state Board of Medicine and the Idaho Society of Ophthalmology to appropriately challenge the surgical use of lasers by optometrists," said Academy spokesperson Bob Dougherty.

"We consider PRK to be surgery, because it is the removal of tissue from the eye," he continued. "Our concern is for the protection of patients. We do not believe that the Idaho Board of Optometry can simply declare by fiat that optometrists are trained corneal surgeons."

Stewart has returned to the United States after spending a year in China, where he was the medical director for Shenzhen ClearVision Centre and performed more than 700 PRK procedures, he said. He has comanaged PRK patients worked with Canadian MDs since 1983.

Dean has completed 70 hours of continuing education in PRK, and has also received training in phototherapeutic keratectomy. He received wet lab training from Stanley Teplick MD, and was trained in hands-on use of the laser in Windsor, Canada under Jeffrey Machat MD, and David Talley OD.

Tiller has also had over 70 CE hours in PRK, with additional courses in therapeutic lasers at Northeastern University, Tahlequah, Okla., and in the excimer in Windsor. He received wet lab training from Teplick, and he took a course at the Jules Stein Eye Institute at UCLA.

Patient care the biggest issue

The issue is not who performs the procedure, Stewart said, but the care patients receive. "People are dwelling on the wrong issue," he said. "We need to concentrate on providing good patient care in a cost-effective manner.

"I don't think all ODs will be interested in taking on the added responsibility of providing the treatment itself, even where it's legal," he continued.

How do the ophthalmologists at the center feel about this? Stewart said when the plan for the center was assembled, ophthalmologists agreed that ODs would deliver care to the "highest extent that was legally allowed."

Tiller added, "I think when they start seeing the results of our patients, they'll be comfortable with it."