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The following is presented as part of The Columbian’s Opinion content, which offers a point of view in order to provoke thought and debate of civic issues. Opinions represent the viewpoint of the author. Unsigned editorials represent the consensus opinion of The Columbian’s editorial board, which operates independently of the news department.

Local View: Optometrists vital, but lack training for surgery

By Stephanie Cramer
Published: April 3, 2023, 6:01am

We all want the same thing from our medical care — the utmost safety, highest trained specialists treating us, and the best possible outcomes — especially when it comes to surgery. Safety is our most important priority as trained medical doctors. But a new and unnecessary bill (SSB 5389) in the Legislature poses a safety threat to one of our most delicate and precious body parts: our eyes.

With SSB 5389, optometrists are seeking to drastically expand their scope to allow them to perform a wide range of surgical procedures, including scalpel. It’s a bad idea that has been rejected in numerous states across the country.

Ophthalmologists are highly skilled and trained medical doctors who can treat the entire body but specialize in the eyes — no different than other MDs. Ophthalmologists receive at least 12 years of higher education — which include three to five years in intensive surgical training. They amass nearly 20,000 hours of training before they are certified to perform surgery. And they perform thousands of hours of closely supervised surgery with live patients to ensure their mastery.

Optometrists, meanwhile, receive far less education overall. They don’t attend medical school and receive no surgical training. The vast majority have no experience with live patients during subsequent training.

As ophthalmologists, we work closely with, and highly value, our optometric colleagues. We all rely on optometrists for eye exams, prescriptions for glasses and contact lenses, diagnosis of eye disorders, and many other vital issues with our eyes.

But when surgery is required, ophthalmologists and optometrists are worlds apart. None of us want our chiropractor performing back surgery. Or our psychologist doing brain surgery. There’s a reason clinical boundaries exist. As one of our mentors once said, “There are no shortcuts to being a surgeon.”

Here are the facts:

1. Access: Patient access is not an issue. Washington census data confirms 96 percent of patients are within a 30-minute drive of an ophthalmologist. The 4 percent who live farther are just as far from an optometrist.

2. Cost: Patient cost is not reduced. Optometrists use the same billing codes as ophthalmologists and are paid the same by Medicare, Medicaid, and all private insurers. States that have expanded scope report no significant cost savings.

3. Technology: Advancements in technology do not make it possible for non-surgeons without live patient training to perform surgery — a scalpel is still a scalpel. No advancement makes it safer to cut tissue without training.

4. Training: An ophthalmologist has, on average, 15,000 more hours of clinical training than an optometrist, including hundreds of hands-on, directly supervised surgical procedures. There are no similar standards for optometrists.

5. Complications: Reports of “no complications” in the states where optometrists are allowed scalpel or laser privileges are disingenuous and false. Even the most skilled surgeons can experience complications.

There’s a good reason legislative efforts to expand optometrists’ scope have failed repeatedly across the country: this legislation directly threatens patient safety. In fact, the governor of California vetoed a similar bill last year, citing concerns about optometrists’ lack of appropriate training.

We all have meaningful relationships with optometrists and work with them daily, but legislators need to know there is no such thing as a “sort-of-surgeon.” We’ll reiterate that optometrists play a vital role in the continuum of patient care. No one is saying they don’t. But it makes no sense to allow them to simply pick up a scalpel or laser and cut into a patient’s eye with minimal training and oversight. And when patients learn what’s at stake, it’s a safe bet they’ll feel the same way.

Stephanie Cramer of Vancouver is president of the Washington Academy of Eye Physicians and Surgeons.