Optometrists who perform eye surgery? Not a good idea – Capitol Weekly | weekly capitol



An ophthalmologist looks through a surgical microscope. (Photo: Dragon Images, via Shutterstock)

job 19.08.2022

Summer travel is back in full force. But would you get on a plane if you knew that the pilot’s only training was to practice in a simulator for about a week and then do a few test flights with an instructor? This is essentially what AB 2236 would require with respect to an optometrist performing eye surgery in California if the bill were to become law.

The bill would allow optometrists to perform scalpel and laser eye surgeries and drug injections after completing a 32-hour course offering lectures and practice on models — essentially an extended weekend — in passing a national test, also on models, and completing a small number of patient training cases.

This is far from the rigor that exists today for the training of ophthalmic surgeons in California.

The level of skill and safety for eye surgery simply cannot be achieved by the training plan of the equivalent of a weekend course and limited supervised practice.

As former chair of the department of ophthalmology at the University of California, San Francisco, I oversaw the training of dozens of eye surgeons during my career. Surgical residency training has evolved over the decades to meet today’s standards that require a carefully organized and closely supervised introduction to procedures performed on patients. Surgical training spans at least four years after medical school with national content and quality standards, and rigorous external oversight.

A cardinal principle is that even in the training environment, patient safety should always be the first priority. For all residents and graduate fellows, surgical competence must be achieved and demonstrated under supervised circumstances before independent practice is permitted.

This is a level of skill and safety for eye surgery that simply cannot be achieved by the training plan of the equivalent of a weekend course and limited supervised practice like indicated in the current bill. It could be argued that the many years of eye surgery residency is necessary to learn the full range of all the complex and delicate procedures that eye surgeons perform, whereas these courses only target a few specific and simple procedures that require far less training and monitoring.

However, there are two important counter-arguments.

First of all, the stakes are extremely high in eye surgery. Even for seemingly simple procedures, the tissues involved are extremely delicate, safety margins are tight, and surgical mishaps can be difficult or impossible to reverse.

Second, simply being proficient with the technical aspects of a given surgery is actually not enough. Determining if the patient really needs surgery, choosing the right technique for their situation, assessing the risk of complications, and managing any complications that arise must also be mastered.

It is also concerning that this bill places responsibility for regulating these surgeries not with the Medical Board of California, but solely with the California State Board of Optometry, whose members would currently have no experience in the surgical procedures they would regulate.

The public is often perplexed to learn that the rules establishing who can perform surgeries on us and the level of training they require can be changed with the stroke of a pen by lawmakers.

Californians deserve far better than the substandard training and potentially hazardous care that would be permitted under AB 2236; we can only hope that our legislators will not allow this plane to take off.

Editor’s Note: Dr. Stephen McLeod is CEO of the American Academy of Ophthalmology.

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