Optometrists doing eye surgery? Not a good idea

An ophthamologist looks through a surgical microscope. (Photo: Dragon Images, via Shutterstock)

Summer travel is back in full force. But would you get on an airplane if you knew the pilot’s only training was practicing in a simulator for a week or so and then completing a few test flights with an instructor? That is essentially what AB 2236 would require with regard to an optometrist doing eye surgery in California if the bill became law.

The bill would permit optometrists to perform scalpel and laser eye surgeries and medication injections after taking a 32-hour course offering lectures and practice on models – in essence an extended weekend — passing a national test, also on models,  and completing a small number of training cases on patients. 

This is a far cry from the rigor that exists for the training of eye surgeons in California today.

The level of skill and safety for eye surgery simply cannot be attained through the training plan of the equivalent of a weekend course and limited supervised practice.

As former chair of the Department of Ophthalmology at the University of California San Francisco, I have overseen the training of scores of eye surgeons over my career. Surgical residency training has evolved over decades to today’s standards that demand a carefully staged and closely supervised introduction to procedures performed on patients. Surgery training extends over at least four years after medical school with national standards for content and quality, and rigorous external oversight.

A cardinal principle is that even within the training environment, patient safety must always be the first priority. For all graduating residents and fellows, surgical competence must be achieved and demonstrated under supervised circumstances before independent practice is allowed.

This is a level of skill and safety for eye surgery that simply cannot be attained through the training plan of the equivalent of a weekend course and limited supervised practice as outlined in the current bill. It might be argued that the many years of eye surgery residency training are necessary to learn the full range of all the complex and delicate procedures that eye surgeons do, while these courses are just targeting a few specific, simple procedures that require much less training and supervision.

However, there are two important counterarguments.

First, the stakes are extremely high in eye surgery. Even for seemingly simple procedures, the tissues involved are extremely delicate, the margins of safety are narrow, and surgical mishaps can be difficult or impossible to reverse.

Second, merely being competent with the technical aspects of a given surgery is actually not enough. Determining whether the patient truly needs surgery, choosing the right technique for his or her circumstances, assessing the risk for complications, and managing any complications that occur must also be mastered.

It is also concerning that this bill would place responsibility for regulating these surgeries not with the Medical Board of California, but solely with the California State Board of Optometry whose members would currently have no experience doing the surgical procedures they would be regulating.

The public is often perplexed to learn that the rules for establishing who can do surgical procedures on us and how much training they need can be changed with the stroke of a pen by legislators.

Californians deserve far better than the substandard training and potentially dangerous care that would be allowed under AB 2236; we can only hope that our legislators won’t allow this plane to take off.

Editor’s Note: Dr. Stephen McLeod is Chief Executive Officer of the American Academy of Ophthalmology.

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