Drew Wilson
The Florida Society of Ophthalmology (FSO) is urging lawmakers to nix a bill that would expand optometrists’ scope of practice.
The bill, sponsored by Rep. Alex Rizo (HB 449), would allow optometrists to “perform board-approved laser and non-laser ophthalmic procedures” and hold themselves out as “optometrists certified in ophthalmic procedures” in advertising.
Ophthalmologists and optometrists have battled for years over the scope of their respective professions, with the former staunchly opposing scope expansion for the latter.
Ophthalmologists are medical doctors who have completed a residency to specialize in eye care, including the diagnosis and treatment of all maladies affecting the eyes. Optometrists, while highly trained, do not attend medical school and are primarily focused on eyesight and the prescription of corrective lenses.
Allowing optometrists to perform more advanced procedures would endanger patients, ophthalmologists argue. Similar to other scope of practice battles, those backing the change say it would boost health care access.
“Optometrists play an important role in eye health care, providing essential services such as vision testing, prescribing corrective lenses, and detecting certain eye conditions. However, their scope of practice typically does not include surgical procedures involving lasers, scalpels, or injections on or around the eye. These advanced interventions require the specialized medical education, extensive surgical training, and clinical expertise of ophthalmologists,” said Dr. Raquel Goldhardt, the President of FSO.
“Patient well-being should remain the paramount consideration in any decisions affecting eye care practices. It is advisable to maintain the current system of collaborative care between optometrists and ophthalmologists, which has proven effective in providing comprehensive eye health services to patients.”
FSO pointed to research published in the Journal of the American Medical Association on a type of laser surgery to treat glaucoma. It found that patients who receive the treatment from an optometrist are significantly more likely to require additional surgery. FSO further cited incidents of “sight threatening complications” following optometrist-administered procedures in other states, including Oklahoma, Louisiana and Kentucky.
The association said that if a patient ultimately requires a second or subsequent surgery to rectify complications from the first, patients will invariably pay more for care.
“Health care costs are already high enough and this bill would increase incurred costs for patients, which could result in driving insurance rates even higher,” said Dr. Darby Miller, legislative Co-Chair of FSO. “We urge lawmakers to reconsider this costly legislation and ensure that patients can receive safe and affordable eyecare.”
The opposition stressed the heightened risk applies to all ocular surgeries, and that “non-invasive” is not analogous to “simple.”
“Even a procedure that sounds simple like chalazion removal, which would be allowed under this bill, still requires some level of anesthesia and incisions,” Goldhardt said. “Improper training and a lack of key medical knowledge can result in damage to a patient’s eyelid and even the eye – it is imperative that individuals conducting the procedure have the training to do so.”
FSO provided video of a chalazion removal procedure. The video may be unsettling to ommetaphobic viewers. It can be viewed here.
HB 449 is scheduled to go before the House Health Professions & Programs Subcommittee on March 20. It is the first of three committee references for the bill, which currently has no Senate companion.
