Opinion: Lawmakers can't take a shortcut to better eye health
As a physician and practicing ophthalmological eye surgeon with more than 33 years of clinical experience, I'll be among the first to tell you how important a different profession, that of optometry, is for overall eye health care. Optometrists perform valuable services, including routine eye exams and prescriptions for eyeglasses and contacts.
But optometrists are not medical doctors; they are not physicians. They do not have years of medical school education and post-med school residency or surgical training. Nor do optometrists have the direct clinical experience that helps ophthalmologists like me manage and avoid difficult, or even life-threatening, patient safety situations.
That is why we should be concerned with House Bill 2541, a bill under consideration in the Legislature. If passed, the bill would open the door for optometrists to perform a long list of surgical eye procedures. Included among the surgeries allowed by the bill are refractive surgeries, eyelid surgeries, surgeries involving needles and surgeries for emergency cornea punctures.
The bill further permits the use of new surgical modalities for optometrists, including scalpels, lasers, needles, ultrasound, ionizing radiation and the burning and freezing of ocular tissue.
HB 2541 would also remove the requirement that optometrists consult with ophthalmologists on complex glaucoma cases. This coordination of care is important, especially considering misdiagnosis or mismanagement of glaucoma can lead to permanent vision loss and blindness.
This is unprecedented and dangerous. There will be Oregon patients who suffer harm if this bill passes, perhaps irreversible harm.
This is exacerbated by the fact that the bill also removes regulatory oversight authority for practitioners of these procedures from where it is now, the Oregon Medical Board, and places it under the authority of the Oregon Board of Optometry. This board does not include medical doctors or surgeons, but instead is composed of four optometrists and one public member who, under HB 2541, make decisions regarding necessary education and training.
The bill creates a massive increase in scope of practice for optometrists, while effectively reducing the quality of regulatory oversight for complex and potentially dangerous surgical procedures. Any legislative conversation around scope and oversight must be done in a setting where legislators have full, comprehensive access to medical information and professional testimony. Deliberation is critical.
Yet, in this COVID-19 environment, legislative activity and deliberation have necessarily been disadvantaged by virtual committee meetings, related tech glitches and the inability to communicate in traditional fashion. Legislators are doing the best they can under the circumstances, but this is certainly not the session to be seriously considering complex scope-of-practice legislation.
We should all appreciate the valuable work of optometrists. They are important eye care team members. But there are no shortcuts for safe surgeries, and surgical expertise cannot be obtained under the current required curriculum for optometry or through "add-on" training courses. Surgical expertise, including expertise in managing serious complications, is only achieved through years of medical school, years of surgical residency and years of clinical training.
Allowing optometrists to perform eye surgeries who have not had the same training and experience is not the answer to providing better access to rural communities. Allowing patients in rural communities to have substandard surgical care is not a "win" for those communities.
If legislators want to assure the continued safety of Oregon patients, they will reject HB 2541.
Dr. Robert Bentley is a Portland ophthalmologist with more than 30 years of experience.
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