VA puts laser back in MD hands only

February 15, 2005

Optometrists are no longer permitted to perform laser eye surgery at facilities run by the Department of Veterans Affairs (VA). That directive came about Dec. 17 following a campaign undertaken by various associations and individual physicians who saw such surgeries as threats to patient safety.

Optometrists are no longer permitted to perform laser eye surgery at facilities run by the Department of Veterans Affairs (VA). That directive came about Dec. 17 following a campaign undertaken by various associations and individual physicians who saw such surgeries as threats to patient safety.

Then, in mid-summer, the VA changed its policy and required laser surgery be performed only under supervision of an ophthalmologist. However, a plan was not developed for implementing rules governing the supervision of optometrists by ophthalmologists. So, the new directive allows only qualified ophthalmologists to perform laser eye surgery in VA health facilities.

However, a member of the U.S. House of Representatives from Oklahoma, who was one of the lawmakers prodding the VA to change its policy on laser eye surgery, said taking the scalpel out of the collective hands of optometry is next on the agenda.

Targeting scalpel surgery "We are now targeting scalpel surgery," said U.S. Rep. John Sullivan (R-OK). "We are going to come out with a strategy and a plan. This will be a bipartisan effort among (lawmakers) who clearly understand the importance of this issue."

It is Congressman Sullivan's home state that has allowed optometrists to be licensed to do surgery, but he has no qualms about where he stands on the issue. When he was in the Oklahoma state legislature, he was one of only 17 representatives out of more than 100 who voted against allowing optometrists to expand their practices into areas that he said should be reserved for medical doctors.

"You don't have to have a medical background to know that the practice of allowing optometrists to do surgeries is just not right," Congressman Sullivan said. "This whole scope of practice issue has been heavily influenced by strong lobbying that influenced lawmakers who didn't (take the time) to understand the dangers."

Congressman Sullivan said that only optometrists and their lobbyists could possibly think that licensing optometrists to do surgery is a smart policy.

"I feel strongly that veterans deserve quality health care, and surgery by non-physicians is just not acceptable," Congressman Sullivan said. "It jeopardizes veterans' safety."

Jonathan Perlin, MD, an undersecretary in the Veterans Health Administration, rescinded the policy that was allowing optometrists to perform surgery if they were able to find an ophthalmologist to supervise such procedures.

"The VA took an important step toward ensuring that veterans receive only the highest quality eye care," said H. Dunbar Hoskins Jr., MD, executive vice president of the AAO. "Ophthalmologists have the medical education and surgical training necessary for the safe performance of invasive surgical eye procedures.

"Patient safety triumphed because medical and veterans' organizations took action," Dr. Hoskins said. "They contacted the VA and involved their congressional representatives in order to help protect our veterans."

Still, it was not so much the specific aspect of the problems associated with optometrists performing surgery that changed VA policy. Rather it was an inability to specify the ways ophthalmologists would watch over the optometrists.