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Deal on scope of practice between Optometrists, ophthalmologists

Senator Lou Correa, D-Santa Ana, said Tuesday that groups representing optometrists and ophthalmologists have finally reached a compromise on a scope of practice bill governing the two eye care professions.

The new language in Correa's SB 1406 has been approved by Legislative Counsel and is scheduled to go into print this morning. If it passes and is signed by the governor in its new form, the bill will allow optometrist to perform several procedures they were previously barred from. Meanwhile, ophthalmologists were able to protect some of the procedures they say they alone are qualified to perform-notably, anything involving cutting into the eye.

The Capitol Weekly first reported on SB 1406 in May, some involved said a deal was close, though Bryce Docherty, legislative advocate for the California Academy of Eye Physicians and Surgeons, said this wasn't the case. Instead, the bill became one of the most heavily-lobbied of the session. The California Optometric Association spent $170,000 on lobbying through the first six months of the year. The Eye Physicians and Surgeons spent $125,000. Both groups saw their spending rise sharply from the previous year, particularly the Eye Physicians, who reported only $78,000 in lobbying for all of 2007.

As negotiations heated up this month, both side brought in big-gun lobbying help. The Eye Physicians tapped Lang Hansen O'Malley and Miller Governmental Relations on August 7. Five days later, the California Optometric Association hired Sloat Higgins Jensen & Associates.

"This bill was literally a full employment act for lobbyists in Sacramento," Correa joked. "Every time I turned around I heard someone say ‘Hey Lou, we're join you in the fight,' or it was ‘Hey Lou, nothing personal.'"

Correa said that he carried the bill largely to provide more healthcare options for people in rural areas. Ophthalmologists generally attend school longer than optometrists. But optometrists outnumber ophthalmologists 5,800 to 2,300 in California, according to data from the Optometric Association, and are better represented in low-income rural areas.

Because so many people in these areas have access to an optometrist but not an ophthalmologist, the optometrists argued they should be allowed to widen the scope of treatment they can provide. Of particular interest was glaucoma, a common eyesight problem that is also often a precursor to a diabetes diagnosis. Correa said that optometrists can now treat "90 percent" of glaucoma cases. This will help not only with eye care, but earlier diagnosis of diabetes, he said.

Meanwhile, the ophthalmologists were able to maintain control over many of the most complex procedures-especially, as Docherty put it, the treatments involving "syringes and scalpels." Optometrists, he added, did not get "carte blanche authority to diagnose and treat all forms of glaucoma."

"If we can do it, anybody can do it," Docherty said of the deal. "It's a deal that I don't think any of the parties really like. But it's not necessarily a deal any of the parties hate, either."

 
Many of the final specifics of what optometrists can and cannot do will be determined by a six-member panel made up of three ophthalmologists and three optometrists. Once finalized, their recommendations would be handed of the California Board of Optometry to implement.

In what might be a rare admission from a legislator, Correa credited the lobbyists involved with helping to bring a complicated deal to fruition.

"This is a fight that has been going on for a long time," Correa said. "I hope the deal sticks."

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