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Proposed N.C. legislation expands scope of practice to include certain laser procedures
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The Enact Enhanced Access to Eye Care Act, amending the scope of practice in optometry allowing for certain laser and surgical procedures in North Carolina was filed February 2, 2017, by House Rep. Justin Burr.
The bill would expand access to offer in-office procedures that do not require general anesthesia.
The four procedures of focus include: YAG capsulotomy, laser peripheral iridotomy, selective laser trabeculoplasty and removal and identification of skin lesions around the eye, according to the North Carolina Optometric Society.
“Eye care is rapidly evolving through advances in technology, pharmacology and biotechnology ... the health care profession of optometry is dedicated to providing patient-centered eye care of the highest quality ...,” the bill states.
The bill amends one current definition of optometry by eliminating the term “surgery” in its current context – as outside of the scope of practice for optometrists in NC.
“This bill serves to increase patient choice in their providers of eye care,” Jill Bryant, OD, president of the North Carolina Optometric Society said in an interview with Primary Care Optometry News. “In North Carolina, doctors of optometry have primary practice locations in 88 of 100 counties and branch office locations in 98 of 100 counties. Ophthalmologists have primary practice locations in only 60 counties which makes it very difficult for some of our citizens to receive the care they need.”
Oklahoma, Kentucky and Louisiana have similar legislation allowing these procedures, and have not seen a change in malpractice premiums, according to the North Carolina Optometric Society.
“Optometry in North Carolina has an exemplary record of safety and care,” Bryant said. “The three laser states [Oklahoma, Kentucky and Louisiana] also have an excellent safety profile. In Oklahoma over 25,000 procedures have been performed with great outcomes.”
“It will provide us with the ability to utilize existing technology to treat conditions that we already manage, and will eliminate a referral step that is currently necessary to treat these conditions,” Dustin L. Reece, OD, FAAO, said from his private practice in Concord, NC.
In the bill, the following procedures are not allowed under the practice of optometry, except for in preoperative and postoperative cases:
- Retina laser procedures, LASIK, and PRK.
- Nonlaser surgery related to removal of the eye from a living human being.
- Nonlaser surgery requiring full thickness incision or excision of the cornea or sclera other than paracentesis in an emergency situation requiring immediate reduction of the pressure inside the eye.
- Penetrating keratoplasty (corneal transplant), or lamellar keratoplasty.
- Nonlaser surgery requiring incision of the iris and ciliary body, including iris diathermy or cryotherapy.
- Nonlaser surgery requiring incision of the vitreous.
- Nonlaser surgery requiring incision of the retina.
- Nonlaser surgical extraction of the crystalline lens.
- Nonlaser surgical intraocular implants.
- Incisional or excisional nonlaser surgery of the extraocular muscles.
- Nonlaser surgery of the eyelid for eyelid malignancies or for incisional cosmetic or mechanical repair of blepharochalasis, ptosis, or tarsorrhaphy.
- Nonlaser surgery of the bony orbit, including orbital implants.
- Incisional or excisional nonlaser surgery of the lacrimal system other than lacrimal probing or related procedures.
- Nonlaser surgery requiring full thickness conjunctivoplasty with graft or flap.
- Any nonlaser surgical procedure that does not provide for the correction and relief of ocular abnormalities.
- Laser or nonlaser injection into the posterior chamber of the eye to treat any macular or retinal disease.
- The administration of general anesthesia.
- Procedures performed under general anesthesia.
“If one looks at the [above]18 barred procedures, it sets limits on what procedures an optometrist can perform,” Reece continued. “This includes anything associated with general anesthesia, all non-laser invasive procedures, and even some laser procedures.”
Reece received training and certification in laser and surgical procedures at Northeastern State University in Tahlequah, Okla., along with many of his North Carolina colleagues, he said.
He hopes his past training and certification would suffice to start performing the four procedures if the bill passes, but says he would pursue any further training that may be required by the Board of Optometry.
“Optometrists have the ability to learn and perform these procedures safely, and these procedures are already being taught in optometry schools. Health care is continuing to change and evolve with technology, and it is important for optometry to continue to evolve with it for the benefit of all of our patients,” Reece added.
If the bill passes, I believe the North Carolina Board of Optometry may form a credentialing committee to develop a protocol for proving optometric competence in these procedures, Bryant said. “As our regulatory organization, the N.C. Board of Optometry has an obligation to protect the public.”
The Board will enact a credentialing process they feel is appropriate, she said. This could include a proctoring process by practitioners experienced in these procedures.
North Carolina optometrists would only be required to undergo the credentialing process if they wish to incorporate the procedures into their practices, she continued.
Furthermore, the National Board of Examiners in Optometry is developing a national level, standalone LASER and Surgical Procedures Examination, to streamline to one metric which state boards could use to prove optometric competence in these procedures, she added.
The act would become effective January 1, 2018. Other primary sponsors to the bill are Reps. Jeff Collins, Josh Dobson and Julia C. Howard. – by Abigail Sutton
Disclosures: Reece reported no relevant financial disclosures. Bryant is president for the North Carolina Optometric Society and chief operating officer at the National Board of Examiners in Optometry in Charlotte, NC.
Source: www.ncleg.net