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Our Opinion | Blurred vision: Legislators seek to cloud eye surgery standards

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A professor says going to an optometrist for delicate eye surgery is like letting “a shoe salesman operate on your feet.”

That’s a bit of an oversimplification, but we can forgive Dr. Woodford Van Meter his hyperbole in the name of protecting patients.

The University of Kentucky ophthalmology professor is sounding the alarm over two North Carolina bills that would allow optometrists, who earn doctoral degrees but are not medical doctors, to expand their scope of practice to include some laser surgeries.

Rep. Justin Burr, R-Stanly, and Sen. Ralph Hise, R-Mitchell, are backing efforts to blur the lines between ophthalmologists and optometrists. The legislators say House Bill 36 and Senate Bill 342 would increase access to care. But doing so could create considerable health risks like those Van Meter observed after a similar law was passed in his home state of Kentucky.

“Since our law passed, we have seen unnecessary surgery, inappropriate surgery and misdiagnoses,” Van Meter wrote in a News & Observer op-ed. “Using the kind of lasers allowed in HB 36 and SB 342, optometrists in Kentucky have performed YAG laser capsulotomies on patients who did not need it. We have seen complications after the procedure, such as a worsening of macular degeneration.”

The bills benefit from an overall lack of public awareness on the difference between optometrists and ophthalmologists. The latter group uses the colloquial “Eye M.D.” to distinguish themselves from optometrists — health care professionals who perform eye exams, prescribe glasses and can treat some eye diseases, but do not have medical degrees and are not trained in surgery.

A 2011 National Consumers League survey found confusion between the disciplines to be fairly common, but 95 percent of respondents said they would want only medical doctors to perform surgical procedures on their own peepers.

“Ophthalmology is among the most selective specializations in medicine,” Ford Vox wrote in The Atlantic magazine. “Yet despite having earned a reputation within medical science as one of its most advanced and storied fields, these days ophthalmology is challenged with its branding, of all things. Perhaps it’s the funny spelling?”

Lobbyists for both optometrists and ophthalmologists are slugging it out over the North Carolina bills. In some ways it’s a turf war — one health care vocation wants to grow its practice area, and one wants to preserve its niche. While we’re not overly fond of occupational licensing boards and the barriers to entry they create, we recognize a compelling government interest in regulating the practice of medicine.

Patients’ vision may hang in the balance. If optometrists get the green light to perform complex eye surgeries without the proper education and training, mistakes or complications could cost people their sight. That’s not a risk the General Assembly should take.

Optometrists are well-qualified to conduct vision tests, prescribe corrective lenses and even treat certain conditions. They are professionals in their own right, but they are neither medical doctors nor eye surgeons.

When it comes to surgical procedures, patients needn’t compromise. Lawmakers shouldn’t interfere with the established division of duties in this health care field.

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