Many of you may have questioned in the past what the difference is between an optometrist, commonly found next to optical stores and in malls and shopping centers, and ophthalmologists, found in the medical setting in clinics and hospitals. Well, an optometrist goes to optometry school for 4 years and learns mostly about performing general eye exams and fitting people with glasses or contacts. On the other hand, ophthalmologists are medical doctors (MD's) who are trained in diseases of the eye and eye surgery.
In the past the MD's have questioned whether or not optometrists should be allowed to perform laser eye correction and other laser surgical procedures. The state has allowed them access to many of these procedures.

I personally don't feel that optometrists have the full training to be performing some of these more complicated surgeries. I think these should be reserved for the better trained ophthalmologist. My eyes are important and I'd never let an optometrist operate on my eyes.

What do you think?

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"Eye-care providers battle over procedure


By Kirsten McIntyre
NEWS 9

The following is a script from a NEWS 9 broadcast

A battle is brewing at the State Capitol tonight. The issue? The health of your eyes, and whether a state law puts you at risk.

Throughout the years, the fight between optometrists and ophthalmolgists has become a political one.

It's involved lawmakers, the attorney general's office, and now the governor's office.

The battle all centers around one issue: Who's allowed to perform surgeries in Oklahoma, and who's not?

Dr. Larry Henry has been practicing as an optometrist for more than a decade.

He says he's performed hundreds of laser procedures with no problems.

But Dr. Cindy Bradford and other ophthalmologists are concerned about two state laws that allow optometrists to perform certain laser surgeries.

And, Dr. Bradford says, the new rules being considered at tonight's board of optometry meeting open the door to more than a 100 new eye procedures that she says optometrists aren't trained to perform.

She's not alone in her concerns. The Oklahoma State Medical Association has joined the fight.

I spoke with Gov. Henry's office this afternoon. A spokesperson tells me the governor has been working with both sides, trying to reach a compromise.

When that didn't happen, the optometrists decided to move forward with the new rules.

If they approve them tonight, they'll be sent to the governor. He will then have 45 days to approve or reject them."

"Medical groups oppose eye surgery proposal
by Ray Carter
The Journal Record
10/6/2004

A coalition of medical organizations urged Gov. Brad Henry on Tuesday to reject proposed rules they said would allow optometrists to perform eye surgeries without first receiving training.
"We come together today because of a great injustice being done to patients in Oklahoma and to ask Gov. Brad Henry to stand up for patient safety, quality of care, and to reject the rules promulgated by the Oklahoma Board of Examiners in Optometry just last night," said William Hazel Jr., trustee of the American Medical Association. "These rules would allow non-physicians, non-surgeons to do eye surgery. Out of 50 states in our nation, only Oklahoma puts its citizens' health and safety at risk in this way."

The new rules, which must still be approved by Henry before taking effect, would implement the provisions of House Bill 2321, which was approved by the Legislature this year. The bill, which allowed optometrists to perform certain surgeries, passed the Oklahoma House of Representatives 85-9 and cleared the state Senate 40-6.

The bill was filed in response to an opinion issued by the Office of the Attorney General that said optometrists could not legally perform certain procedures officials said had been provided by optometrists for years.

Supporters of the legislation said the procedures were minor and major surgeries that would still be handled by ophthalmologists.

Supporters of the legislation also said optometrists must complete eight years of education that includes 8,000 clinical hours of training before an individual can be licensed, and that the industry's medical malpractice insurance rates indicate there are few occurrences of serious damage to patients.

But several medical groups said the regulatory rules approved this week by the State Board of Examiners in Optometry go far beyond the original scope of the law.

Hazel said by changing the law to allow optometrists to perform certain eye surgeries, the Legislature "opened the door to a poorer quality of care for patients" that optometrists are now trying to "throw wide open" through "self-policing regulations."

He said the proposed regulation would allow optometrists to "cut with scalpels on patient's eyes."

"This is outrageous," Hazel said. "Imagine going to a physical therapist and having hip surgery or a nurse midwife for a cesarean section. Unthinkable."

"Oklahoma has the unfortunate distinction of being the only state in the United States to permit optometrists to perform surgical procedures," said David Russell, vice president of the Oklahoma State Medical Association. "No other state has compromised the health of its citizens by permitting optometrists to perform any type of surgery."

Russell said the proposed rules go beyond the intent of the legislation approved this year, saying the law was meant to "clarify" the practice of optometry and not expand it. But Russell said the proposed regulatory rules implementing the law are "ambiguous and overly broad," allowing a dramatic expansion of the scope of optometry.

"Medicine must be learned through education and experience," said Ann Warn, president of the Oklahoma Academy of Ophthalmology. "It cannot be granted or bestowed by any act of government."

Warn said the proposed regulations should provide only a list of specific procedures that optometrists can perform instead of the broad language now involved.

Hazel noted that ophthalmologists must complete four years of medical school in addition to several years of additional training.

"The M.D. makes a difference," he said.

In comparison, Hazel said optometrists "are not required to finish college" and are licensed to do eye exams and order glasses.

"They do not have surgical training," Hazel said.

While ophthalmologists possess doctorates and can diagnose and treat eye diseases, optometrists primarily provide glasses and other visions aids.

Steve Hinshaw, a spokesman for the Oklahoma Osteopathic Association, said the proposed rules would not affect the prices Oklahomans pay for eye procedures even though a larger pool of providers will now handle those services.

"It will not lower the costs," Hinshaw said. "It will lower the quality of care."

He said most Oklahomans have little problem finding an ophthalmologist even though there are far more optometrists than ophthalmologists in Oklahoma.

"Access is not a problem," Hinshaw said. "You can get to an ophthalmologist, a surgeon who's trained, within 30 minutes anywhere in Oklahoma."

During legislative debate on House Bill 2321, officials said ophthalmologists can be found in only 18 of Oklahoma's 77 counties while optometrists are in 72 counties. One legislator said there were 101 ophthalmologists to serve the state's 3.5 million citizens, compared to 600 optometrists.

Paul Sund, communications director for Henry, said the governor will review the proposed rules before making a decision. He has 45 days to approve or reject the rule.

"Gov. Henry has not had an opportunity to review the new rule in detail yet," Sund said. "Before making a final determination, the governor and his staff will thoroughly review the proposal, considering all available information."

But David Cockrell, president of the State Board of Examiners in Optometry, said the proposed rules were drafted with the input and support of the governor's office.

"The governor's office signed off or agreed to them two weeks ago, which is why the board meeting was last night and why those rules were promulgated and then passed," Cockrell said.

He said the governor's office was involved in drafting the rules so they did not authorize any procedure that was not done by optometrists prior to the issuance of the opinion by the Office of the Attorney General.

"We didn't expand anything we've done and we could document what we have done," Cockrell said.

Cockrell noted that Henry sent a letter to all members of the Legislature saying he would sign House Bill 2321 into law so long as it did not expand or restrict the scope of optometry.

"That's what these board rules do," Cockrell said.

He said ophthalmologists also had input during the drafting of the proposed regulatory rules.

"They and we spent the summer working with the governor's office on these board rules, so this isn't any surprise to them on what the board rules passed last night were," Cockrell said. "They've had the opportunity to comment on them three or four times over the summer through the governor's office."

I agree. If the optometrist has not had the education he/she needs to do minor surgery, then they need to stick with eye exams. Leave the surgeries, whether minor or major, up to the opthomologists. I can't "see" where they would have it any other way.

Optometrists are already performing LASIK eye surgery. I remember that was a pretty large controversy awhile back when they were given permission to perform these surgeries. I personally wouldn't have an optometrist perform any surgery on my eyes. They just don't have the training. Sure, they're fine for eye exams and checking for diseases of the eye, but I think for more complicated surgeries for which they really aren't qualified, they need to refer out to an eye physician, namely, an ophthalmologist.

This kind of reminds me of the Chiropractor vs. Medical Doctor debate that's been going on for years now. Chiropractors make a lot of claims that they can't live up to. Sure, Chiropractors help some disorders, mainly of the bones and joints, but there are some Chiropractors now claiming that a spinal adjustment will cure asthma, poor eye sight, the common cold, and other things like that. That's just nonsense. Chiropractors have gotten sued for refusing to refer patients with serious illnesses out ot medical doctors. I just can't accept that. Both Chiropractors and Optomoetrists need to accept their limitations and refer out when necessary.

Patrick, laser eye surgery consists of an anesthesiologist administering anesthetic and then a computer performing the procedure based on parameters entered by the doctor. In most cases, when an opthamologist performs the surgery, he's using figures entered by an optometrist.

If it were someone taking a knife to my eye, that'd be one thing. As it is, I don't really have a problem with it. Anything to keep the price down and make this affordable to as many folks as possible. If you want the opthamologist to do it, you should pay the extra $ yourself.

I don't really have a problem with optometrists performing LASIK as long as they have the proper training. I just don't think most optometrist have the training to do more complex procedures.

You know, if they disallow optometrists from performing this procedure, the price will probably rise dramatically.

It's almost criminal how much these guys make off of this simple procedure as it is!

Yeah, I have no problem with Optometrists performing LASIK. It seems to be a pretty easy procedure. I'm just not so sure how many other procedures they should allow optometrists to perform, since they're not really trained in surgical procedures.

Yeah, I have no problem with Optometrists performing LASIK. It seems to be a pretty easy procedure. I'm just not so sure how many other procedures they should allow optometrists to perform, since they're not really trained in surgical procedures.

If it's a machine that does all the work, and all the doc has to do is input the measurements she's taken, then I don't see the problem at all.

For other more complicated non-machine-driven procedures? We need a trained surgeon.

Besides -- what insurance company is going to insure a doc to do procedures she's not trained to do?

This is actually going to be an interesting ethical debate in medicine in upcoming years. As technology improves, the availability of robosurgeons which can do as good a job (or better) than real surgeons may become a real possibility and help to decrease the cost of health care.

Are we going to require real surgeons to operate those types of machines, or will it suffice to have technicians who can ensure that the machine gets the right measurments?

(is this too scifi?)

Optometrists have been fighting to get access to the scalpel for years now.

As technology improves, the availability of robosurgeons which can do as good a job (or better) than real surgeons may become a real possibility and help to decrease the cost of health care.
Come on, Mid, do you really think the cost of health care will go down for any reason? Too much profit being made; robosurgeons will just pad the profit margin more.

Come on, Mid, do you really think the cost of health care will go down for any reason? Too much profit being made; robosurgeons will just pad the profit margin more.

Doctors sure aren't making the big bucks. Salaries have decreased by a pretty large margin over the past several years. Seems like all of the big bucks are going to the hospitals, insurance companies, and pharmaceutical companies.

It's pretty sad when a Dr. goes to school for 12 + years, and makes 120K a year. 120K sounds like a lot, but when you think about the fact that they hold lives in their hands, I don't think it's a lot.

Doctors sure aren't making the big bucks. Salaries have decreased by a pretty large margin over the past several years. Seems like all of the big bucks are going to the hospitals, insurance companies, and pharmaceutical companies.

It's pretty sad when a Dr. goes to school for 12 + years, and makes 120K a year. 120K sounds like a lot, but when you think about the fact that they hold lives in their hands, I don't think it's a lot.
I wasn't talking about the doctors. I completely agree with you.

Doctors sure aren't making the big bucks. Salaries have decreased by a pretty large margin over the past several years. Seems like all of the big bucks are going to the hospitals, insurance companies, and pharmaceutical companies.

It's pretty sad when a Dr. goes to school for 12 + years, and makes 120K a year. 120K sounds like a lot, but when you think about the fact that they hold lives in their hands, I don't think it's a lot.

120K is for a staff 9-5 type job at a hospital if I'm not mistaken. Doctors who open their own businesses and employ other doctors are the ones who make the big bucks. The same is said to be true for the law field (although there are exceptions in the solo practitioner world).

I wouldn't worry too much though Patrick. As tough as it is to enter your field, I see less and less people going to med school. That's probably good news for those of you who have done so.

They go to law school instead these days :(