California legislators considering reducing requirements to perform eye surgery

AB 2236, which would reduce the medical education, clinical, and surgical training requirements to become licensed in California to perform eye surgery. Trade organizations and other groups are stepping up to oppose the measure.

Lawmakers in California are considering AB 2236, which would reduce the medical education, clinical, and surgical training requirements to become licensed in California to perform eye surgery.

AB 2236 allows optometrists to perform anterior segment laser and minor procedures which involve the use of a scalpel or injections.

If approved, AB 2236 would mean that an individual would no longer be required to complete medical school and the required surgical training to become licensed to perform eye surgery in the state of California.

Stephen McLeod, CEO of the American Academy of Ophthalmology (AAO), wrote in Capitol Weekly, that AB 2236 would allow optometrists to perform scalpel and laser eye surgeries and medication injections after taking a 32-hour course offering lectures and practice on models, passing a national test, also on models, and completing a small number of training cases on patients. He pointed out that the proposal would be a drastic change from the requirements that exists for the training of eye surgeons in California today.

“As former chair of the Department of Ophthalmology at the University of California San Francisco, I have overseen the training of scores of eye surgeons over my career,” McLeod wrote in Capitol Weekly. “Surgical residency training has evolved over decades to today’s standards that demand a carefully staged and closely supervised introduction to procedures performed on patients. Surgery training extends over at least four years after medical school with national standards for content and quality, and rigorous external oversight.”

In opposing AB 2236, the California Medical Association maintains the measure does not require adequate training to assure competency of candidates who would be certified to perform these procedures, and actually has loopholes that undermine the training requirements of the bill. 

The American Society of Retina Specialists and Safe Eyes America this week stepped up to voice their opposition in advance of an expected vote on the proposal, pointing out that a reduction in surgical licensing requirements would be detrimental to patient surgical outcomes and safety.

According to a press release, the bill currently is under consideration in the California Senate.

"Every surgical procedure performed on the eye or eyelids requires education, training and experience to make the correct diagnosis, to make a decision on the best treatment be it surgery or not, and to develop the ability to perform the procedure,” Kurt Heitman, MD, a Safe Eyes America board member said in a statement. “These are skills developed over years and shortcuts are just not safe for patients. A mistake anywhere along the path to surgery could have vision or even life-threatening consequences for the patient."

Jeanette Moffa, a patient and Safe Eyes America Board member said in a statement the organization was pleased to have the support of ASRS and other groups.

“We're proud to have ASRS, America's retina specialists, join us in educating patients about the dangerous changes to the law present in AB 2236,” she said in the statement. “Lowering the licensing requirements to allow non-medical physicians (optometrists) to perform surgery is not safe. Californians need to know this.”