Governor says signature broke no new ground

Oklahoma City-Brad Henry, governor of Oklahoma, says he saw no reason not to sign regulations approved by his state's Board of Examiners in Optometry. Henry signed the regulation in late October that gives optometrists the authority to perform surgery with a scalpel.

"This rule simply allows optometrists to continue to perform the same procedures that they have been performing for years under state laws approved by previous legislatures," Henry said. "No new practices are authorized."

The regulation had been approved in early October by the Board of Examiners in Optometry. Optometrists in Oklahoma already had the authority to perform certain laser surgical procedures. The decision has nationwide ramifications since Oklahoma-licensed optometrists have been permitted to perform surgical procedures in Department of Veterans Affairs (VA) hospitals in other states.

However, the VA has implemented a policy that requires laser surgery be performed only under supervision of an ophthalmologist. Still, this policy has fallen short of a requirement that would exclude all but ophthalmologists from actually doing the surgery.

"The VA agreed there is a risk when an optometrist does laser surgery, but we are concerned that it did not go far enough," said Catherine Cohen, vice president for governmental affairs at the American Academy of Ophthalmology (AAO). "It is a bizarre idea to allow [optometrists to perform surgery]."

The current concern, though, is more specific to scalpel surgery. And ophthalmologists, their organizations, and allied physician groups are even more-not less-upset than they are about the question of laser use by optometrists.

In early 2004, Drew Edmondson, Oklahoma's attorney general, issued an opinion that optometrists did not have the authority to perform scalpel surgery. That was followed by an optometry lobbying effort in the Oklahoma State House to gain approval to perform scalpel surgery. The Board of Examiners in Optometry then approved the regulation.

The AAO sent representatives to Oklahoma City to testify at hearings against the regulation. Still the governor signed the document.

"The governor's decision ignites the academy's determination to inform the public, lawmakers, and government leaders about what this regulation really means," said Ann Warn, MD, president of the Oklahoma Academy of Ophthalmology. "Unknowing consumers will now be placed in a situation to have delicate surgical procedures performed on their eyes by people who have not graduated from a 4-year medical or osteopathic training program."

Dr. Warn said the regulation allows more than 100 types of surgery, including the use of a scalpel to cut the eyelid to remove cancer lesions or to cut the eye surface for lesion removal, and the injection of botulinum toxin type A (Botox, Allergan) around the eye.

Henry said he listened to all sides in the matter and examined the issue in great detail. His conclusion: The rule did not expand the scope of practice optometrists had prior to the attorney general's opinion.

However, Henry did not say why he specifically decided to lend no credence to Edmondson's opinion.

"When legislation was passed to address the attorney general's opinion through the [optometry board's] rule-making authority, I discussed the issue with representatives of the ophthalmologists and the optometrists," Henry said. "We all expressly agreed that the rule-making process should produce a result that neither expanded nor contracted the scope of practice that existed prior to the attorney general's opinion."

Henry said he intends to hold everyone to that "non-expansion of scope of practice" agreement.

"The rule approved by the optometry board meets the scope of practice criteria and is consistent with the agreement struck by representatives of the ophthalmologists and the optometrists in April," Henry said.