Optometrists who perform eye surgery? Radical bill vetoed over security concerns


California Governor Gavin Newsom this week vetoed a sweeping measure that would have allowed optometrists without the necessary training and education to perform complex procedures such as laser eye surgery and administering needle injections into the eye.

“I am not convinced that the education and training required is sufficient to prepare optometrists to perform the identified surgical procedures,” Newsom said. written in his veto message (PDF). “This bill would allow optometrists to perform advanced surgery with less than a year of training. By comparison, physicians who perform these procedures must complete at least a three-year residency program. For this reason, I cannot sign this bill.

The AMA, California Medical Association and other physician organizations urged Newsom to veto Assembly Bill 2236, which passed by a one-vote margin in the Assembly. State. This legislation crystallizes how creeping expansion of scope of practice can lead to threats to patient safety. The AMA is fighting legislation like this across the country and at the federal level to ensure that physicians remain the leaders of health care teams, what patients want and need.

“Human eye surgery is not without risk or ‘simple,'” AMA Executive Vice President and CEO James L. Madara, MD, noted in a letter this month asking Newsom to veto the bill. “Complex surgical procedures, such as laser eye surgery and needle injections administered into the eye, as AB 2236 would allow optometrists to perform, require specialized education and training, as well as medical supervision. during surgical preparation, performing the procedure and postoperative patient care.

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“This training must include not only the technical skills necessary to perform the procedure itself, but also the medical knowledge necessary to analyze when surgery may or may not be clinically indicated. Surgery on or around the human eye n “It’s not something to be taken lightly. Patient safety and the highest quality of care require that people who perform invasive procedures have the appropriate medical training,” added Dr. Madara, who had previously written (PDF) to a key California Senate committee chairman calling for opposition.

Tackling scope creep is a critical part of the AMA’s stimulus package for American physicians.

Patients deserve care led by physicians, the most educated, trained and skilled health care professionals. The AMA vigorously defends the practice of medicine against expansions of scope of practice that threaten patient safety.

As part of its far-reaching fight against scope creep, the AMA helped defeat several bills that would have expanded the scope of optometrists, including a similar bill in Alabama, as well as legislation in Utah and Washington that would have allowed optometrists to perform eye surgery and increase their prescribing authority.

The letter from the AMA clearly described the training differences relating to AB 2236.

“Training for ophthalmologists includes four years of medical training and an additional four to six years of postgraduate residencies and fellowships,” Dr. Madara wrote. “During this advanced training, physicians learn the most effective, safe and appropriate treatments, including surgical, pharmacological and other interventions based on each patient’s unique medical needs.

“In contrast, education and training in optometry rarely goes beyond the postgraduate level and focuses almost entirely on the examination of the eye for the prescription of vision, the dispensing of corrective lenses, and the performing certain eye screening functions,” the WADA letter reads. “Optometrists do not have the full medical knowledge needed to safely perform surgical procedures on patients. Students of optometry are not exposed to standard training in surgical procedures, aseptic surgical technique, or medical response to adverse surgical events as part of their training.

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While ophthalmologists must pursue four years of residency training — three years in a surgical residency program after a one-year internship, with many pursuing subspecialty training in a fellowship program — Dr. Madara noted that Optometrists are not required to participate in advanced postgraduate training. “This distinction is essential,” he wrote to the governor. “In short, there is no substitute for the level of experience and education attained by a fully trained ophthalmologist.”

The bill was amended to create a certification program with additional training requirements for optometrists wishing to perform these advanced surgical procedures.

But this modest change “does not replace the level of training of ophthalmologists”, stressed Dr Madara, calling the bill a “dangerous proposal” that failed to take into account the “unique and often more complex medical needs of certain populations of patient”. such as the elderly and children. Simply put, AB 2236 is failing to safeguard patient health and safety in California. »

The California Medical Association mobilized its local network of physicians “to ensure that Governor Newsom understood that this bill would leave patients at serious risk of lifelong consequences that could be devastating to their vision and their lives,” the association said in a press release.

“The CMA is grateful to Governor Newsom for recognizing that inadequate training stipulated by AB 2236 would expose patients to serious health risks, loss of vision or even life-threatening consequences,” said CMA President Robert E. Wailes, MD.

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