Photo credit: American Optometric Association

by Dick Hall-Sizemore

One of the constants in the many years I’ve been around or after the Virginia General Assembly has been the fight between optometrists and ophthalmologists.

The legislative battles between these two groups provide a good lesson on two aspects of the legislative process: the politics of regulating the professions and the role of campaign money. This article will discuss the first aspect and a subsequent article will examine the role of campaign donations.

The ongoing battle of optometrists and ophthalmologists is over the treatment of eye conditions beyond vision defects. Ophthalmologists have been through medical school and specialize in diseases of the eye. Although they have the title of “doctor”, optometrists have not attended medical school, but have undergone training that allows them to examine patients for vision problems and prescribe corrective lenses. During their eye exams, if they detect any medical problems, they are supposed to refer the patient to an ophthalmologist.

It all started with the “eye drops” bill. The administration of “drops” in the eyes would allow optometrists to expand, beyond vision tests, the types of procedures they could perform. They argued that they were sufficiently trained to undertake such activities and that their ability to do so would improve access to eye care for the public. Ophthalmologists countered that only medically trained personnel should be allowed to perform such procedures.

It took a few years, but ultimately optometrists won. Since then, they have systematically and gradually expanded the scope of what they are allowed to do. In 2018, for example, the General Assembly enacted SB 511, authorizing optometrists to administer limited injections of Schedule IV steroids to treat a chalazion, a type of cyst in the eyelid, usually due to a blocked gland. . The legislation included language expanding the scope of the practice of optometry to include “the evaluation, examination, diagnosis and treatment of abnormal or pathological conditions of the human eye and its adnexa through the use of medically recognized and appropriate devices, procedures or technologies.” However, the wording specifically prohibited optometrists from providing “treatment by surgery, including laser surgery.”

The front this year in this ongoing battle is an attempt to violate the ban on surgery. SB 375 (Petersen, D-Fairfax) would authorize optometrists to perform three specific laser eye surgeries used to treat glaucoma and the effects of cataract surgery. According to coverage of the debate on the bill in a Senate subcommittee by the Richmond Times Expedition, the basic arguments have not changed. Optometrists pointed out that members of their profession have been licensed to perform these procedures in eight states. The success rate in these states demonstrates that optometrists are qualified to perform. Allowing optometrists to perform these procedures, the Virginia Optometric Association lobbyist argued, would provide patients with continuity of care.

Ophthalmologists appearing before the subcommittee argued that the bill was unnecessary because there is no shortage of ophthalmologists in the Commonwealth and there would be no cost savings for the patients. Additionally, because laser surgery is “extremely precise,” allowing practitioners other than trained physicians to perform the procedures “would put people’s eyes at risk.”

The subcommittee voted 5 to 3 to recommend to the full committee that the bill be reported.

This legislation can be seen from two angles:

  • A group, which has barriers to entry into its members, tries to maintain control over a lucrative area in the face of an attempted incursion by another group, with both groups claiming their positions are in the best interest of the public.
  • A continuation of the recent movement to allow non-physicians, trained in specific medical fields, to perform some of the procedures once reserved for doctors.

I do not consider myself sufficiently qualified to weigh in on this question of whether optometrists should be licensed to perform certain types of eye surgery. Also, I’m not entirely comfortable with legislators making those kinds of judgments. However, as Senator Saslaw, D-Fairfax pointed out, ophthalmologists have been protesting the broadening scope of optometry for years, predicting “the end of civilization.” And that just didn’t happen. Finally, I note that during my last eye exam, an optometric technician did most of the work that an optometrist had done before.