Eye surgeries should be left to experts

Guest column by Dr. Michael Keverline:

In recent years, Virginia legislators have considered many proposals that would expand the “scope” of certain health care providers. This term refers to the level of care that a healthcare provider can provide based on education, training, experience, and state law.

For example, the scope rules prohibit your GP from doing brain surgery (and he probably wouldn’t want to anyway).

These bills were spurred by the shortage of the healthcare workforce — the need for more professionals to fill roles typically performed by physicians or peer providers. That’s why you’re often seen, for example, by a nurse or a doctor’s assistant in a family doctor or an orthopedic clinic for basic needs or pain.

But clinical limitations exist for a reason.

The Latest Scope Problem Coming To Virginia: Primary Care Physicians Looking To Perform Laser Eye Surgery. When Senate bill 375 and House bill 213 persist, they would lower professional standards of care without improving access, harming Virginians in the process.

Laser surgery, by medical definition and long-standing, time-tested Virginia law, is surgery. The Commonwealth’s Code is in line with the overwhelming majority of states: 43 to be precise, which do not allow optometrists to perform eye surgeries.

And for a good reason. Ophthalmologists — optometrists — are practitioners who diagnose eye conditions and treat vision problems. If you need a prescription for glasses or have problems with your eyes or vision, visit an optometrist. They play an important role in eye care.

Ophthalmologists are ophthalmologists and surgeons. They are doctors who can treat the whole body but specialize in eyes – not unlike doctors who specialize in gastrointestinal, orthopedic or neurology. In most cases, an optometrist will diagnose conditions such as glaucoma, cataracts, or retinal detachment and then refer the patient to an eye surgeon for treatment.

Similar and confusing names, with one big difference: training and education. Ophthalmologists require at least 12 years of college education – five of them in intensive surgical training. They accumulate nearly 20,000 hours of training before being certified to conduct operations.

Optometrists, on the other hand, can practice eight or nine years after high school. They do not go to medical school and receive no surgical training.

Should two bills pass in the General Assembly, optometrists, if certified by the State Board of Optometry, could perform laser eye surgery. It would bring Virginia into a small group of states that allow optometrists to perform eye laser surgery (the Department of Veterans Affairs prohibits optometrists from performing these procedures).

Lasers are powerful surgical tools that cut or burn human tissue. They are no different from a scalpel and in the wrong hands can cause major and lasting damage.

During laser eye surgery, patients rest their head against a forehead rest. With one hand, the surgeon holds a surgical lens over the patient’s eye. With the other, the surgeon maneuvers, focuses, and fires the laser for each individual laser shot.

Procedures are performed using a tool called a YAG laser, which fires a beam into the eye and vaporizes tissue. Essentially, we create microscopic explosions in the eye. And as with any explosion, both good and bad impacts occur within the blast radius.

Complications arise even with proper implementation. Poor execution can cause permanent lens damage that cannot be reversed. A qualified surgeon can predict the complications, recognize them when they arise, and have the skills to surgically correct the complication.

Providing safe surgical care to patients requires strict direction and years of supervised residency training. It remains unclear how optometrists would receive training before claiming that they are qualified to perform eye laser surgery.

Virginians don’t want that bill. An independent poll commissioned by the Virginia Society of Eye Physicians & Surgeons found that just 10 percent of voters in Virginia would approve of an optometrist performing laser eye surgery.

And Virginians don’t need that bill. Optometrists claim passage will increase access to these procedures. But even in states that allow laser surgery for optometrists, few offer it, and usually not in underserved areas. Eye surgeons are common throughout Virginia.

In fact, expanding the scope of practice can lead to overuse of laser eye surgeries, driving up the cost and need for corrective medical care.

Here’s what we know for sure: If this law passes, undertrained doctors will be performing eye surgeries.

dr Michael Keverline is President of the Virginia Society of Eye Physicians and Surgeons. He lives in Norfolk and practices in Portsmouth and Chesapeake.

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