Are optometrists going back on their word in ‘Eyeball War’ truce?

For nearly two decades, Tallahassee was the front line of an epic battle — the so-called “Eyeball Wars” — between Florida’s optometrists and ophthalmologists.

On one side were optometrists — college educated to provide diagnoses and correct vision problems — fighting to perform surgery and prescribe medications beyond topical ointments and creams. Ophthalmologists, supported by the influential Florida Medical Association, argue that optometrists lacked sufficient credentials and training as medical doctors to perform such intricate procedures.

After years of legislative wrangling, a truce came in 2013 in the form of HB 239, an agreement between optometrists and ophthalmologists intended to end the Eyeball Wars. The agreement allows optometrists to prescribe and a specific, limited number of oral medications under certain conditions. They must complete additional training, pass an examination and carry the same level of medical malpractice coverage as medical doctors; and are required to report all adverse medical incidents the same way that ophthalmologists and other practitioners are required. They are also mandated to refer patients with severe glaucoma to an ophthalmologist within 72 hours.

While March’s legislative session is still a few months away, it seems the Eyeball Wars may be coming back to Tallahassee. FloridaPolitics.com reported in August that the Florida Optometric Association and associated organizations have geared up for battle with more than $2.1 million donated to committees and candidates statewide.

OD-EYEPAC, the political arm of the Florida Optometric Association, gave more than $1.1 million to committees and candidates through the end of July. The Florida Optometric Association gave $535,000; the Florida Optometric Eye Health Care Fund gave $260,000.

Recipients of this largesse at the time included $125,000 to the Republican Party of Florida and $10,000 to the Florida Democratic Party. Other committees received more than $1.1 million.

With that amount of money being spent on campaigns, it’s easy to see the optometrists are looking to make a move this legislative session.

The next likely step? Optometrists want to perform surgery. Movements such as this require a thorough explanation as to why ophthalmologists will be forced — once again — to mount a new offensive and possible return of the Eyeball Wars.

Currently, optometrists are allowed to perform surgery in Louisiana, Oklahoma, New Mexico, Iowa, Kentucky, and Tennessee. However, searching for cases of reporting an optometrist is a difficult task. These states don’t require reporting incidents.

With that, the most prominent case of neglect comes from California, where The Orange County Register reported an optometrist in 2009 caused blindness in several veterans who were seeking treatment at a Veterans Affairs hospital.

While optometrists argue that many Floridians don’t have access to an ophthalmologist, numbers simply do not bear that out.

Most eye surgeries are not considered emergencies; they are generally considered preplanned, except with severe and accidental eye injuries. In that case, injuries should be treated in a hospital.

For example, if a patient were to go to an optometrist for minor eye trauma, an optometrist currently can triage the patient until an ophthalmologist can see them for further diagnosis and necessary surgery.

By falsely claiming patients have limited access to ophthalmologists, patient safety is jeopardized. Among Florida’s 20 million residents, only a small percentage — 22,660 people in all — live more than 40 miles from an ophthalmologist.

Can optometrists perform surgery? The short answer is no. Florida allows only licensed ophthalmologists to perform delicate surgical procedures on the eye. And only board-certified ophthalmologists are permitted to perform surgery.

“Eye care in Florida is better when patient safety is paramount,” said Dr. Charles Slonim, then-president of the Florida Society of Ophthalmologists, in a 2013 interview with the South Florida Sun-Sentinel. “And there is a good professional working relationship between ophthalmologists and optometrists.”

But that good relationship may be under fire this March, especially if the Eyeball Wars flare up once again.