Ophthalmologists are winning the battle for eye surgery scope of practice
California optometrists lost their latest bid to expand their scope of practice when the state’s governor recently vetoed a bill that would have allowed them to perform laser and scalpel eye surgeries, long the field of ophthalmologists.
Assembly Bill 2236 sought to enable optometrists who treat glaucoma to perform advanced procedures, including excision and drainage of small lesions, corneal cross-linking, administration of injections for blocked glands in the eyelid, and use therapeutic lasers.
The California Optometric Association has stated that the expanded scope of practice would improve access to eye care services, especially for Medi-Cal enrollees where rural eye doctor shortages have “created major bottlenecks in care for one in three Californians,” many of whom are people of color.
Opponents of the legislation — including the American Medical Association, California Medical Association, California Academy of Eye Physicians and Surgeons, and American Society of Retina Specialists — have expressed concerns about scope drift (broadening scope of practice of non-physician health care professionals), patient safety, and unforeseen surgical complications.
While the bill outlined additional training requirements, including 32 hours of continuing education and the performance of 43 surgeries on living human patients, its passage would have reduced education and training requirements to perform a eye surgery in California.
To obtain an optometry license in California, a person must complete a 4-year college degree and complete a 4-year optometry program. Ophthalmologists need a 4-year undergraduate degree, 4 years of medical school, and at least 3 years of residency.
California Governor Gavin Newsom cited the difference in educational requirements in his decision to veto the bill.
“I am not convinced that the education and training required is sufficient to prepare optometrists to perform the identified surgical procedures,” Newsom said in a statement. Press release. “This bill would allow optometrists to perform advanced surgical procedures with less than a year of training. By comparison, doctors who perform these procedures must complete at least a three-year residency program.”
In a statement released before the veto, another opponent of the bill, the American Academy of Ophthalmology, said “California people deserve far better than the substandard training and potentially dangerous care that would be allowed under the AB 2236”.
More States Revising the Scope of Practice for Optometrists
The scope of practice of optometrists varies by state. Most states allow optometrists to prescribe oral steroids and administer injectables, although the latter is limited to the treatment of anaphylaxis in 20 states.
This year, new laws in Virginia, Mississippi and Colorado now allow optometrists to use lasers to treat eye conditions, bringing the number of states with this expanded scope of practice to 10. Similar legislation has been passed by the State House in Utah and is pending review. in the State Senate.
According to National Conference of State Legislatures Databaseoptometrists in California are limited to:
perform procedures related to the removal of foreign bodies and the examination, evaluation, diagnosis and treatment of the human eye;
administration of vaccines and all pharmaceutical agents for the diagnosis and treatment of eye diseases, including oral steroids and self-injections of epinephrine to counteract anaphylaxis; and
prescribe Schedule III-V controlled substances and hydrocodone or Schedule II hydrocodone combination drugs.
Steph Weber is a Midwest-based freelance journalist specializing in health care and law.