March 16, 2005

Optometry Board’s Decision to Set Own Surgery Parameters Jeopardizes Oklahoma Patients.  Medical Community Calls on Elected Officials to Reject Rule.

Oklahoma City – The Oklahoma Board of Examiners in Optometry recently adopted a permanent rule that allows optometrists to perform more than 100 scalpel surgical procedures (44K) . Despite objections from the medical community, and contrary to a commitment made by Gov. Brad Henry to allow for input by the medical and osteopathic communities, the optometry board took it upon itself to draft and approve a rule March 10 that significantly expands the scope of practice for optometrists. 

“The real losers in this battle are Oklahoma patients, who, under this rule, will be subjected to a standard of care that is below that of the rest of the nation,” said Ann Warn, MD, president of the Oklahoma Academy of Ophthalmology. “We are disappointed by the board’s action and vow to fight to ensure that this rule is rejected by the Governor and the legislature.”

The procedures allowed under this rule include the use of scalpels and insertion of needles directly into the eye. If the governor and the legislature do not act to reject this regulation, the quality and safety of surgical eye care for Oklahoma’s patients will be at risk. Oklahoma’s governor and legislature have 45 days to take action. They will have three choices: do nothing ( and it will become law), accept it or reject it. Oklahoma is the only state in the nation that allows non-physicians to perform eye surgery. Prior to this newest regulation, they were limited to certain laser procedures.
 
Optometrists originally approached the legislature in August 2004 alleging they were experiencing reimbursement problems with three procedures: epilation of eyelashes, insertion of punctal plugs and surgical removal of superficial foreign bodies. This situation prompted lawmakers to pass enabling legislation and subsequently approve an emergency legislative rule that essentially expanded optometry’s scope of practice.

If Oklahoma lawmakers agree, this emergency ruling could become permanent. The rule includes a random and incomplete list of 14 surgical procedures that optometrists may NOT perform and does not clearly state the original three procedures optometrists sought help on in the first place.

“Oklahoma patients must beware. Just because your optometrist wears a white coat and calls him or herself a doctor, doesn’t mean that they are trained to do surgery,” added Mukesh Parekh, MD, president of the Oklahoma State Medical Association. “We, as medical and osteopathic physicians, rely on many years of schooling and training, including long internships and residencies, to learn how to treat the whole patient. To suggest that someone might attend a weekend course at a hotel on how to do scalpel surgery on your eye, and then legally be able to perform that procedure on patients, is frightening. This is a crisis in the making. We hope Gov. Henry and the legislature will intervene and reject this rule.”

“This is the single most significant threat to quality of health care and patient safety that exists anywhere in America today,” said William Hazel, MD, member, Board of Trustees, American Medical Association at an earlier pre-hearing press conference.

If the ruling is limited to those three procedures, which the American Academy of Ophthalmology believes are within optometry’s scope of practice, that action in itself is not problematic to ophthalmology.

“But this rule is so broadly worded it could allow optometry to perform surgery with a scalpel that includes a myriad of 100 specific surgical procedures,” said Cynthia Bradford, MD, the Academy’s secretary for state affairs. “An easier, better and safer solution would be a rule that clearly states the three procedures in question, no more, no less,”
 
“This is not about business,” Dr. Hazel said. “It’s about an urgent need to protect patient safety and quality of care. Optometry wants to perform these procedures and seeks clarification on scope of practice for billing purposes. We seek to guard patient safety, uphold quality of care, and protect outcomes. Only in Oklahoma are non-surgeons/physicians allowed to perform surgery on unsuspecting patients. It is the responsibility of Oklahoma lawmakers to protect Oklahomans.”

The American Medical Association, American Academy of Ophthalmology, American Osteopathic Association, American College of Surgeons and the American Society of Cataract and Refractive Surgeons are focused on preserving patient safety and quality of care for all of Oklahoma’s surgical eye care patients and urge Gov. Henry and the legislature to reject this rule.

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The American Academy of Ophthalmology is the voice for ophthalmologists and their patients in Washington, D.C., and is the world's largest organization of eye physicians and surgeons, with more than 27,000 members.

Reporter Contact: Governmental Affairs, 202.737.6662, or media@aao.org