State Politics

Surgeons don’t want optometrists laser-cutting eyes

Rep. Justin Burr is sponsoring a bill that would allow optometrists to do some eye surgeries
Rep. Justin Burr is sponsoring a bill that would allow optometrists to do some eye surgeries N&O file photo

The state’s optometrists want to perform some kinds of eye surgeries. Eye surgeons say it’s a bad idea.

Proposed legislation filed last week in the form of House Bill 36 would allow optometrists, best known for eye exams and prescriptions for glasses or contact lenses, to expand their practices to include laser surgery and other surgeries performed by ophthalmologists.

Rep. Justin Burr, the bill’s lead sponsor, said allowing optometrists to perform more procedures would open access to eye care for more residents. Burr, an Albemarle Republican, said optometrists would be able to perform four procedures they can’t now: two laser procedures for glaucoma, one type of laser surgery for cataracts and removal of benign lesions around the eyes.

“Two have to do with pressure in your eye,” Burr said. “You don’t want pressure building up in your eye.”

Public pressure to kill the measure is already building. An online petition signed by more than 1,200 people – some from outside North Carolina – said allowing optometrists to do the work of surgeons compromises patient health and safety.

Eye surgeons said the bill would allow optometrists to perform more than four kinds of surgery. The bill lists 18 procedures that optometrists would be barred from performing, but that leaves hundreds that they would be able to do, ophthalmologists said.

“This opens a complete door,” said Dr. Daniel Briceland, an ophthalmologist from Arizona who is a member of the American Academy of Ophthalmology board of directors.

Three other states, Oklahoma, Louisiana and Kentucky, have similar laws that expanded the work optometrists can do. Optometrists have tried to pass such laws in at least two dozen other states in recent years.

“Legislature after legislature has turned this down, after they pulled down the curtain, after they look at the real facts,” Briceland said.

Dr. James Bryan III, an ophthalmologist in Chapel Hill, said optometrists and eye surgeons cooperate in patient treatment, but optometrists don’t have the three or more years of intensive surgical training that eye surgeons do.

“The big issue is with patient safety,” he said. People mistakenly think automated lasers require less training to properly operate, Bryan said. “These lasers have to be aimed and fired by a surgeon,” he said.

Laser procedures are part of the curriculum at optometry schools, said Dr. Jill Bryant, who works in Charlotte for the National Board of Examiners in Optometry. “We are proud of our education,” she said.

If the bill passes, the N.C. Board of Optometry would form a credentialing committee to outline required training, she said. All procedures could be done in a doctor’s office.

Allowing optometrists to do some surgeries would increase patients’ access to care, give them more choices and cut down on time and expense, she said.

Bryan, the ophthalmologist, said state residents already have good access to eye surgeons. In the county where it’s hardest to get to an ophthalmologist, Dare, there are nine within 50 miles of Manteo, he said.

Optometrists are a politically active group and once had a powerful supporter in Jim Black, a former House speaker who was a practicing optometrist. Black, a Mecklenburg County Democrat, was at the center of a political corruption scandal and served three years in federal prison.

The N.C. Optometric Society PAC gave about $270,000 to state politicians in 2015 and 2016, spreading donations to Republicans and Democrats in both chambers. Individual optometrists contributed about $194,000 to state political campaigns over the last two years.

Both optometrists and ophthalmologists point to experiences in Oklahoma to support their positions.

Bryant said that in Oklahoma, which has allowed expanded work for optometrists the longest, there were only two reported complaints for more than 25,000 procedures.

The ophthalmologists point to a research paper published last October in the medical journal JAMA Ophthalmology that found that patients who had a certain type of laser surgery to treat glaucoma had to go back for treatment on the same eye 35.9 percent of the time when an optometrist did the work, as opposed to 15.1 percent of the time when an ophthalmologist did it.

The study looked at treatment of Medicare patients in Oklahoma from 2008 through 2013.

Database editor David Raynor contributed

Lynn Bonner: 919-829-4821, @Lynn_Bonner

Optometrists vs. ophthalmologists

Optometrists and ophthalmologists are doctors specializing in eyes and vision, but are educated and trained differently. Ophthalmologists graduate from medical or osteopathic school, then do at least four more years of training as residents. Optometrists attend four years of optometry school after college, and some voluntarily do an additional year of training.