Viewpoint: Be an advocate for surgery by surgeons, urges physician

Ophthalmologists are being openly challenged by optometrists for more control of patient treatments without the benefit of education, said Dr. Johnston at the organization's annual meeting here.

"The optometric objective is to create an optometric surgeon via legislation and regulation and not by education and training. This puts patient safety at risk," said Dr. Johnston, assistant clinical professor of ophthalmology, University of Wyoming, Cheyenne. "Yet, over the last 40 years, optometrists have gained authority to prescribe diagnostic and therapeutic eye drops, and they are currently seeking to extend this authority to cover oral and injectable medications.

Dr. Johnston shared some recent statements from the current and past presidents of the American Optometric Association (AOA). Current AOA President C. Thomas Crooks III, OD, said, "The AOA supports any state association seeking to expand privileges. When an affiliate seeks to expand optometrists' scope of practice, we support the affiliate to the level its leadership requests."

Harvey Hanlen, OD, past president of the AOA, said, "Seeking out a surgeon isn't hard, but it is somewhat difficult getting an experienced one who will travel. The most critical part is that the optometrist must control what happens. Pay the surgeon per procedure, pay for the laser per procedure, control your pre- and postop care, and control the facility fee, which is where the money is."

Dr. Johnston said that at the recent Optometry 20/20 Summit, goals for the profession were outlined, including "nationwide uniform self-regulated licensure with available residency programs in optometric surgery; deliver care through the use of the best available eye-care products and technology with no restrictions on scope of practice or physical location; and be recognized as the professional authority that defines guidelines and policies for all eye and vision issues in health care."

One of the biggest challenges to ophthalmology has been playing out in Oklahoma. In May, two victories for ophthalmology occurred there with the signing of the "Children's Vision for Excellence Act," which is endorsed by AAO, the American Association for Pediatric Ophthalmology and Strabismus, and the Oklahoma Academy of Ophthalmology. This law calls for vision screening for all children entering kindergarten and the first and third grades.

Also signed by the Oklahoma House and Senate was the state employee benefits bill, by which Oklahoma ophthalmologists scored a victory for patients.

"Before completing action on this bill, the conferees deleted an optometric provision that in essence would have severely inhibited ophthalmologist participation in state employee vision plans," Dr. Johnston said. "The objective was to create an all-inclusive optometric-driven vision plan for Oklahoma state employees."

Testimony was given by AOA Trustee David Cockrell, OD, before the Oklahoma legislature supporting the ability of optometrists in Oklahoma to perform scalpel surgery. Dr. Cockrell's testimony was countered by David Parke II, MD, who provided effective testimony on optometric surgical misadventures, such as needling and removal of glaucoma filtering blebs in the mistaken notion that they were conjunctival cysts, anterior chamber paracentesis to lower pressure in open-angle glaucoma, incomplete removal of malignant skin tumors, and use of systemic steroids in management of orbital cellulitis, according to Dr. Johnston.

A new group has been formed in optometry, the Optometric Retina Society, that states as its goal "educational activities on retinal disorders in support of development of a retina specialty within optometry."