Who can do eye surgery? We need a visionary answer

Published March 31, 2017

Editorial by Fayetteville Observer, March 29, 2017.

North Carolina's optometrists and ophthalmologists are poking each other in the political eye this year, sparring over legislation that would allow optometrists to perform several kinds of laser surgeries. The debate so far has been as much about politics and money as it's been about the eye health of North Carolina residents. That needs to change.

The surgeries in question are two laser procedures for glaucoma, one laser surgery for cataracts, and the removal of "skin tags" or benign lesions around the eyes.

The optometrists argue that allowing them to perform these relatively common and simple procedures would improve eye care in parts of the state where there are few or no ophthalmologists.

The ophthalmologists argue that optometrists don't have the medical and surgical training to safely perform those surgeries, especially when the case turns complex. Nor, they say, do they have the training to help them recognize when lesions may actually be cancerous.

Optometrists get four years of post-college training in dealing with eye diseases and correcting vision problems. Ophthalmologists must complete medical school in addition to their specialized training in eye treatments and surgery.

An underlying issue here is money. Allowing optometrists to perform those procedures would add to their income, perhaps at the expense of ophthalmologists.

Both groups are practicing aggressive politics, hiring high-powered lobbyists and making substantial political contributions to lawmakers. Optometrists have long been politically active in North Carolina. Former House Speaker Jim Black is an optometrist.

The real bottom line should be patient outcomes and safety. Several states already allow optometrists to perform these laser surgeries and schools of optometry are beginning to teach it. But critics say optometrists aren't as skilled at surgery as ophthalmologists.

There may be a compromise here, although neither side may want to pursue it. It's possible that optometrists could reliably perform these surgeries under the supervision of an ophthalmologist, much as physician assistants perform medical procedures under a medical doctor's oversight.

There may also be other compromises that are reasonable, but we won't learn about them from dueling doctors making their case in the General Assembly. This idea needs more research. Fortunately, this state has the resources at hand. Lawmakers have on their doorsteps some of the best medical schools in the South and some of the nation's top experts in health-care policy as well. We suggest that the General Assembly form a commission to research the issue and deliver a report with recommendations for action.

Our eyes are a delicate organ, and sight is one of our most precious gifts. This is the wrong place to be playing politics. We hope our lawmakers have vision enough to see that.

http://www.fayobserver.com/opinion/20170329/our-view-who-can-do-eye-surgery-we-need-visionary-answer