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Opinion | Proposed law puts your vision at risk

Optometrists play an important role in eye care, but they aren’t trained surgeons or even medical doctors.

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When Alabamians need surgery, especially on something as complex and important as their eyes, they should be able to trust that the medical professional providing their care is knowledgeable and highly trained. Yet Alabama legislators are now considering a bill that threatens to break that trust and put Alabamians’ eyesight at risk.

House Bill 349 (HB349) would allow optometrists to perform complicated eye surgeries that include scalpels, lasers and injections that, for good reason, can currently be performed only by trained surgeons. If legislators approve this bill, they’ll jeopardize patient safety without reducing healthcare costs or increasing access to care.

Optometrists play an important role in eye care, but they aren’t trained surgeons or even medical doctors. Optometrists are only required to undergo four years of optometry school, not medical school and not surgical residency. 

Ophthalmologists, on the other hand, are medical doctors and eye surgeons. Ophthalmologists undergo a minimum of eight years of training, including medical school as well as hospital residency and surgical training. Ophthalmologists are trained on hundreds of surgical procedures.

The human eye is amazingly complex and highly delicate. When it comes to your vision or the vision of someone you love, there is simply no such thing as “minor eye surgery.” A surgical error of mere millimeters can result in permanent vision loss in some cases.

But, HB349 would allow non-physician, non-surgeon optometrists to destroy tissue inside of the eyeball using lasers. It would allow optometrist to inject medication directly into the eyelid and to remove lesions from areas around the eye and on the face using a scalpel. 

Again, under HB349 all this would all be done by people who did not complete medical school and are not trained to perform surgery.

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So how can Alabama lawmakers possibly justify lowering the standard of patient care? Surely there must be some benefit that outweighs the potential risk. Sadly, there is not. 

Supporters of the bill argue that it will expand access to healthcare.  However, we do not have a problem with access to surgical eye care in Alabama.  More than 90 percent of Alabamians live within a 30-minute drive of a highly trained ophthalmologist.

Supporters of the bill also claim it will help lower healthcare costs. In fact, allowing optometrists to conduct surgery can actually increase healthcare costs. Research published in the Journal of the American Medical Association compared laser surgery outcomes performed in Oklahoma by ophthalmologists versus optometrists. The result? Surgeries performed by optometrists were more than twice as likely to require additional corrective surgery. 

That’s an increase in healthcare costs to patients, not a savings, no matter how you look at it. Lowering education and training standards for eye surgery simply lowers the bar for quality patient care. It does not lower costs.

So, if HB349 does not expand access and won’t lower costs, why take the risk? Why would anyone want someone performing surgery on their eyes who is not a trained eye surgeon? How could it be acceptable to provide a lower standard of care to someone just because they live in a rural community?

Rather than pushing dangerous legislation that attempts to pit optometrists against ophthalmologists, Alabamians would be better served if our legislators focused on promoting the highest standards of patient safety and care for all the people of our state. 

Dr. E.M. Brendan Wyatt, M.D., is president of the Alabama Academy of Eye Physicians and Surgeons.

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