Ophthalmologists cast wary eye on Oklahoma regulation

January 1, 2005

A single state has the attention of ophthalmologists and their advocates throughout the United States-and the state in question is not even a swing state.

In wake of a year when perhaps a dozen states received the bulk of the attention in a closely contested presidential election, Oklahoma holds center stage in a drama being played out not only in Oklahoma City, but in Washington, DC, as well as other state capitals and ophthalmology offices across the United States.

At issue, which is well known by now to those in the ophthalmic community, is the Sooner State's regulation that allows non-physicians-specifically optometrists-to perform not only surgery with a scalpel, but also laser procedures.

Optometrists can receive approval and licenses only in Oklahoma to do laser eye surgery, but there have been several instances of where Oklahoma-certified optometrists performed laser surgery in other states at Department of Veterans Affairs (VA) hospitals. Regional directors for the VA have authority to permit optometrists to do laser surgery, which means there is concern that such a practice could spread.

The VA now has a policy that requires laser surgery be performed only under the supervision of an ophthalmologist; the agency has fallen short of a requirement that would exclude all but ophthalmologists from actually doing the surgery.

The American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS) each have been heard loud and clear on the issues surrounding non-surgeons doing surgery, and representatives from both organizations say they will not be deterred in their efforts to change what takes place in Oklahoma.

Nancey McCann, director of government relations at the ASCRS, said the effort requires cooperation among all organizations that oversee medical practices and patient safety.

"We're working with the [AAO] on this on the federal level and the state level and we will continue to do that on the behalf of our members and their patients," McCann explained. "We are working on strategies at the federal level, but recognize that much needs to be accomplished at the state level, and obviously, specifically in Oklahoma. We are pushing the VA aspect. The VA has been made fully aware of our concerns and we continue to act on that level."

H. Dunbar Hoskins Jr., MD, executive vice president of AAO, said patient-safety concern is the single most important issue in this battle. He added that what is taking place in Oklahoma is representative of a much bigger concern in the field of medicine.

"The legislative process is breaking down," Dr. Hoskins said. "Legislators are gradually, piecemeal, handing off medical and surgical privileges. They are dismantling the whole certification process.

"Optometry has led this battle and they are very effective in the legislative process. While they are very good at this, they just do not have the skill to perform surgery," Dr. Hoskins said. "It is far more than just the technical skill to fire a laser or use a scalpel, and both are very important, but there is also the ability to manage complications, to lead a surgical team, to understand all that is required from everyone when surgery is performed."

Dr. Hoskins said optometrists have worked hard at developing friendships and relationships with lawmakers.

"Physicians are not good advocates in the legislative system," Dr. Hoskins continued. "They might see a reality and believe that no amount of cajoling or financial influence could or should change that reality. That is the fundamental difference between doctors and lawyers. The latter are always determined to change things to the way they want them by arguing, cajoling, convincing."