Dr. Elizabeth Houle: Keeping Eye Surgery Safe for Vermonters

This commentary is from Elizabeth Houle, MD, a board-certified ophthalmologist who grew up in Danville, lives in South Burlington, and practices ophthalmology in Burlington.

Everyone cares about patient safety. We rely on our vision to navigate this world productively and independently.

Eye surgery is tricky. The consequences of the slightest misstep are potentially devastating.

As an ophthalmologist who regularly performs eye surgery, I am acutely aware that eye surgery has the capacity to benefit as well as the capacity to harm. My duty as a doctor is to minimize the risk of harm. Performing eye surgery safely requires thousands of hours of training and closely supervised practice on real human beings.

Ophthalmologists gain this rigorous hands-on training during four years of medical school, followed by four years of residency and, in many cases, an additional one to two years of postgraduate training.

There is currently a bill (S.158) before our state legislature which dramatically lowers the standards for who can perform eye surgery by expanding the scope of optometric practice. The training proposed in the bill does not require any hands-on experience or supervised surgery, meaning it would allow optometrists to operate on unfamiliar Vermonters without requiring that they have ever trained on live human eyes.

Learning surgery on a corpse or from a video is not even similar to operating on a living, breathing, sentient person. Not only are the tissues different, but a corpse does not become anxious, have difficulty standing still, or flinch. These are natural human reactions that can have serious consequences when a scalpel, needle, or laser is near eye tissues and are only properly addressed after extensive surgical training.

Even surgeries performed in the office that seem simple are not minor (especially from the perspective of patients on the other end of the scalpel/laser/injection needle) and can have complications and potentially disastrous results.

Moreover, this legislation does not take into account the experience, training and mentorship required to manage surgical complications which, as any surgeon knows, are unfortunately sometimes unavoidable. Managing surgical complications is often technically and emotionally more difficult than learning about the surgery itself.

If this bill passes, will optometrists who have never performed these procedures on real people be prepared to deal with the ensuing complications in their patients?

In 2019, in Bill 30, the General Assembly directed the Office of Professional Regulation to conduct an in-depth study to assess a proposal to similarly expand the scope of practice for optometrists. After conducting a thorough, evidence-based study, “The Office of Professional Regulation recommends that the optometrist’s scope of practice not be expanded to include the proposed advanced procedures. At this time, the bureau cannot conclude that optometrists have the education and training to perform these procedures safely.

I find it troubling that this legislation, which jeopardizes the eyesight and safety of Vermont residents, is currently being reviewed against the explicit recommendations of the Office of Professional Regulation.

Imagine allowing someone to fly a plane solo when they’ve only ever watched flight video, maybe even used a flight simulator, but never flown an actual plane. I would not knowingly be a passenger on this plane, just as I would never allow someone who has never lasered someone’s eye to laser my eye or that of a family member. Many people do not know the difference between optometrists and ophthalmologists and need to be protected from harm or improper treatment.

I want the safest surgery possible for my family, my friends, my patients and for all Vermonters. Patients who need eye surgery deserve the best trained doctors.