Optometrists and ophthalmologists see eye to eye

Groups representing optometrists and ophthalmologists have finally reached a compromise on a scope of practice bill governing the two eye-care professions, according to the bill's author.

The new language in SB 1406 by Sen. Lou Correa, D-Santa Ana, has been approved by Legislative Counsel and should be in print by Thursday morning, Correa said. If it passes and is signed by the governor in its new form, the bill will allow optometrists 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 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, and both sides hired expensive contract lobbyists in the closing weeks of the legislative session

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, joining 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 for eight years after college, twice the length of time needed to become an optometrist. But optometrists outnumber ophthalmologists by about 5,900 to 2,100 in California, according to data from the Optometric Association, and are better represented in low-income rural areas, said Tim Hart, legislative advocate for the Optometric Association

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 "needles 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."

The Legislature last looked at the scope of practice mix between the two professions in 2000. SB 929 by Senator Richard Polanco allowed to prescribe some drugs, Hart said, but for did not account for new drugs. The compromise bill, he said, allows them to prescribe certain classes of drugs, which should keep optometrists far more up to date.

But much of the fight centered around glaucoma treatment. New optometrists coming out of school these days are well-trained in glaucoma treatment. Under the compromise bill, a six-member panel made up of three ophthalmologists and three optometrists will come up with a curriculum for optometrists who graduated before 2008. Under SB 929, the education for optometrists to treat glaucoma had several provisions that made it difficult to complete, Hart said, such as the direct supervision of an ophthalmologist. Over eight years, only 130 optometrists in the state completed the requirements.

With modern retinal scanning techniques, Hart said, it is possible to diagnose early-stage diabetes by just looking at a picture. With such rates of diabetes and glaucoma running three times higher among rural Latinos than among the general population, Hart said, it is important for optometrists to be able to treat glaucoma.

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