Optometrists and ophthalmologists fight over eye care bills

ByMartha R. Camara

Sep 23, 2022

There is an absurd disconnect in California’s efforts to provide universal health care. There are not enough doctors willing to accept small government fees to treat low-income patients.

It is therefore universal health care in name only – despite Governor Gavin Newsom’s repeated boasts about it – as millions of people are denied access to preventative medicine or treatment for their ailments.

There is a small, partial solution to the access dilemma on the governor’s desk — one of 680 bills as of Wednesday that Newsom must sign or veto by September 30. This measure, AB 2236, only concerns vision care – but would affect millions of patients.

It pits two feuding families against each other: primary care ophthalmologists and eye surgeons. The first are optometrists, the doctors you see for an annual exam. The latter are ophthalmologists, surgeons who remove cataracts, for example.

It’s a turf battle. Doctors want market share from surgeons.

Optometrists say the fight is about providing convenient care in the office and expanding patient access.

The surgeons, represented by the powerful California Medical Assn., argue it’s about safety – doctors performing procedures for which they are insufficiently trained.

“Kristine Shultz, executive director of the California Optometric Association, says of primary care ophthalmologists and surgeons, ‘They work together in the real world. It’s right in the State Capitol that they start fighting.

These are called “practice range” battles.

The bill, by Assemblyman Evan Low, D-Campbell, would expand the role of optometrists in eye care. The measure passed the Assembly with no votes to spare, 41 to 11 – with 28 MPs abstaining – after a heated debate just 10 minutes before the deadline on the final evening of the legislative session. There was bipartisan support, but also nervousness.

Under the bill, optometrists could not perform initial cataract surgery. But if the need for follow-up laser surgery developed later – perhaps years – they would be able to perform it.

They might also do laser surgery for glaucoma. Now they can only treat with eye drops. They might surgically remove eyelid tags. And they could cut a stye out.

Supervised personal training would be required for state certification.

But not enough training, say the opponents.

“It’s eye surgery. It’s easy to say it’s easy. But the complications are real. You can, if things go wrong, blind someone,” says Dr. Craig H. Kliger, vice -executive president of the California Academy of Eye Physicians and Surgeons and assistant professor at UCLA.

“The amount of training provided for in this bill is not enough to make someone competent to practice on their own. It is not safe for the public.

This is disputed by John G. Flanagan, dean of the UC Berkeley School of Optometry and Vision Sciences.

He says 10 other states allow similar procedures for optometrists “and there have been virtually no complaints or issues.”

In California, optometrists must earn a four-year college degree and then attend four-year optometrist school. Surgeons need a four-year degree, four years of medical school, and four years of residency.

The access problem stems primarily from the refusal of most surgeons to treat Medi-Cal patients, the bill’s supporters say. But most optometrists do.

Additionally, there is a severe shortage of surgeons in many rural areas, including the Central Valley. Thirteen counties have no surgeons, Flanagan said. Six counties have only one.

Look, I’m just a newspaper junkie. This kind of medical stuff is far from my bailiwick. But Newsom must have experts on his team who can advise him wisely.

I hope they will tell him that it is safe and sensible to allow optometrists to expand their practice and provide better access to patients – so the state can start doing what it claims to be doing by universal health care.

George Skelton is a columnist for the Los Angeles Times.