Peter Schorsch
Florida’s Eyeball Wars rage on in Tallahassee, as optometrists continue pushing a bill allowing them to perform laser surgeries despite a potentially dangerous lack of medical training.
Richard Miniter, the chief executive officer of American Media Institute, broke down the issue in-depth with a three-part series co-authored with Joseph Hammond, in which he describes how optometrists have lobbied lawmakers to perform eye surgery in Florida, as well as the pushback from ophthalmologists, who argue that only trained and licensed medical professionals should perform such intricate procedures.
All three parts, which examine the dark side of money and influence behind the Eyeball Wars, also appear in the Sunshine State News.
On his Politically Incorrect Podcast, James Williams of News Talk Florida spoke with Miniter about the attempt by optometrists to pass HB 1037, a measure sponsored by state Rep. Manny Diaz Jr. currently making way through the Legislature. The bill, as well a Senate companion from Clearwater Republican Jack Latvala, seeks to give optometrists permission to perform certain types of laser surgery in Florida.
Miniter warns that the proposed state law could affect nearly all of Florida’s 20 million residents.
Kissimmee ophthalmologist Jaime Membreno tells Miniter: “If you live long enough, you will get cataracts and eventually need corrective surgery. Allowing optometrists to do this kind of surgical procedure is like allowing the mechanic to fly a fighter jet.”
Supporters of the bill disagree. As South Florida optometrist Salvatore DeCanio describes it: “The fact is we are the primary care for the optics of the eye. We know far more about optics and prisms in the eye than ophthalmologists. They have a different specialty.”
Nevertheless, optometrists insist passing the bill will result in a heightened risk to patients.
Dr. William Mallon of Vero Beach, a staunch opponent of the legislation, points out that even small mistakes during eye surgery can have devastating consequences, a risk that is minimized through proper training, education and experience.
“It takes a minimum 12 years of schooling and training to perform eye surgery,” Mallon says. “Medical school. Supervised residency … I know that if I lose focus for even a single second of surgery, my patient’s life could be permanently changed. I think about the stakes every time I walk into the operating room.”
Miniter also touches on possible motives behind this latest salvo in the Eyeball Wars: “Optometrists, who are now legally allowed to call themselves ‘optometric physicians’ in Florida, have long sought to put themselves on an equal footing with traditionally trained doctors. Ambition plays a role, too. Many optometrists have opened small chains — dozens of storefronts selling eyeglasses and eye care — that would further prosper with the added business. Ophthalmologists tend to have small practices and directly supervise all patient procedures; their boutique enterprises would suffer from big-chain competition.”
Also, optometrists have been the beneficiary of what Miniter calls “a complex web of dark money,” through “shadowy political organizations” behind their efforts, amassing nearly $2.1 million as well as the lobbying services of the brother of Florida House Speaker Richard Corcoran, among others.
“Optometrists greatly outnumber ophthalmologists in Florida, as they do in most states,” Miniter writes, “and usually outraise their doctor rivals by a large margin.”
“A lot of ophthalmologists in the state won’t join the Florida Society of Ophthalmology because they worry about losing their referrals from optometrists,” Mallon says. “We are having to go hat-in-hand to our national organization to get some money, but we can’t possibly catch up.”
Florida’s current Eyeball Wars are far from a new trend; the battle between optometrists and ophthalmologists has waged for decades.
“Optometrists have increasingly sought the prerogative to perform surgical tasks,” Miniter notes, “for which 47 states (including Florida) require a medical degree.”
The last truce in the Wars was in 2013, when a compromise was reached after years of lobbying by the Florida Optometric Association (FOA) and Nova Southeastern University’s College of Optometry, one of the largest optometry schools in the nation.
House Bill 239, signed into law by Gov. Rick Scott, expanded the scope of practice by allowing optometrists to prescribe a limited number of oral medications and expressly prohibits optometrists from performing surgery “of any kind.,” as well as setting up a precise definition of surgery modeled after the guidelines established by the American College of Surgeons.
But since then, politically active nonprofits in Florida has doubled from 67 to 155, partly as a result of the U.S. Supreme Court’s Citizens United decision in 2010.
“The Florida Optometry Eye Health Fund had the highest revenues during the previous tax year among 501(c)(4) nonprofit organizations based in Florida,” Laura Curlin tells Miniter. Curlin serves as data director at MapLight, a not-for-profit organization promoting political transparency.
In the final part of the series, Miniter also sheds light on the “dark side” of comanagement of care between ophthalmologists and optometrists, a high-stakes operation which some practitioners call “dangerously inadequate.”
“Rather than just the practice of an optometrist referring a patient to an ophthalmologist for care, comanagement is a fee-sharing arrangement where ophthalmologists perform surgeries and optometrists provide post-surgical care,” Miniter writes.
According to Kissimmee ophthalmologist Jaime Membreno: “If you say out of 100,000 cataract surgeries (costing between $600-$2000), that 20 percent are comanaged, that’s generating something like $50 million per year.”
