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What ophthalmologists are saying
MAIN ARTICLE: MDs react to OD PRK
Robert G. Wiley, MD Cleveland
"This issue is obviously a turf battle between ophthalmologists and optometrists. We, as ophthalmologists, want to protect our turf as much as possible. If we give in to PRK today, perhaps it will be cataract surgery tomorrow.
"However, I'm not opposed to ODs performing PRK. But the courts will have to decide whether PRK is surgery or not, and whether it is in the scope of one's practice. In any case, I'm for less regulation on what the state licensure says you can and can't do. In theory, anyone with an MD license is licensed to perform PRK, as well as brain surgery. Do I do brain surgery? No. I'd need additional training.
"From an ethical standpoint, I think people should be allowed to do what they've been trained to do. There are some optometrists who have been trained in PRK and can do a very good job in it. In fact, I was taught how to perform PRK in an extensive course given by an optometrist. Further, the first PRK I performed was under the direction of an OD. So that practitioner is certainly qualified to perform PRK."
Carol F. Boerner, MD Brookline, Mass.
"Although I don't approve of ODs performing PRK, I think it's a non-issue. Laser in situ keratomileusis (LASIK) is fast becoming the procedure of choice for photorefractive therapy and myopia because of its apparent superiority. And since LASIK involves making a flap, it is definitely a procedure that ODs will not be performing because they are not surgeons. In my opinion, as everything evolves, we won't even be doing PRK."
August L. Reader, III, MD Los Angeles
"The malpractice/liability issue is probably the most important consideration because PRK is not as cut and dried as many optometrists think. Many complications can occur. If you're off center just a little bit, you're going to cause a lot of problems. Complications are a lot higher than even the FDA studies are showing. So I think optometrists attempting PRK is really ludicrous.
"And as far as PRK being surgery, it is. You're cutting tissue. First of all, ODs don't have the background and training to know how to deal with abnormal responses in tissue as it is healing. They might not recognize complications. Many ODs perceive PRK as sort of a slam-dunk type of procedure. That's what it's been promoted as by the laser companies. And, of course, the laser company is going to be more than happy to sell a laser to anyone who wants to buy one. So I think there's also an ethical responsibility on the part of the laser company to limit to whom they sell."
Darrell P. Williams, MD Minot, N.D.
"The optometric profession has made tremendous advances with their use of therapeutics and treatment of primary care ocular conditions. The PRK issue could rekindle the battle between our professions and will be seen by some as sort of a 'Custer's last stand.' I personally have been very pro optometry in terms of patient comanagement. As for ODs performing PRK, I have extremely ambivalent feelings.
"Anyone offering refractive surgery should be in a position to offer RK as an alternative to PRK for low to moderate myopia. Those performing PRK should also be prepared to enhance patients with radial or arcuate incisions when indicated. Moreover, those practitioners should be prepared to perform LASIK in the future, as this procedure will likely become the best use of PRK.
"If optometry can truly provide comprehensive refractive surgical service, that's one thing. I would be concerned about marketing the use of laser exclusively for all individuals when some patients might be better candidates for diamond blade incisions or the use of a keratome with LASIK. As refractive surgery evolves, we will continue to develop a variety of tools and options with incisional techniques and laser, all of which should be available to patients in order to provide optimal care for each individual. None of us has a crystal ball, but my own best prediction at this point would be that RK will continue to be a popular treatment for low myopia and that LASIK will be the best option for high myopia. If that's the case, then use of PRK alone to treat myopia may fall by the wayside, and its use by optometry may as well."