In October 1980, an otherwise run-of-the-mill presidential debate between Jimmy Carter and Ronald Reagan yielded an exchange that helped define Reagan’s message and, if you believe the pundits, win him the election. After Carter painted Reagan as being opposed to Medicare—which by then had become untouchable, lest a politician risk losing the senior vote—Reagan smiled, shook his head and said, “There you go again.” With those four words, he painted Carter as a hysterical Chicken Little and himself as a level-headed pragmatist.
That long-ago exchange came to mind while reading the latest anti-optometry screed making the rounds. As we report in our news section, Virginia, Utah and several other states are advancing scope expansion laws at the moment, some including laser procedures. This prompted an ophthalmologist in Virginia to trot out all the usual arguments in a local newspaper: optometrists aren’t surgeons, they don’t even go to medical school (good heavens!) and their job is just to take care of vision problems while referring any patients with eye disease to an MD.
When I see arguments like this, I just want to shake my head and say, “There they go again.”
These arguments never work, even with a glossy coat of sophistry layered on top like in this particular case. In his op-ed, the MD noted that ophthalmologists undergo “at least 12 years of higher education” whereas optometrists “can practice eight or nine years after graduating high school.” Notice how he frames that distinction: MDs get higher education while you do some unspecified… stuff… after high school. That’s shameful, and shows how bankrupt the anti-optometry arguments are.
Obviously, no one should downplay risks or the need for qualifications. But they also shouldn’t be inflated either. This MD has no problem being grandiose in his description of laser procedures in an attempt to raise the stakes: “In essence, we create microscopic explosions in the eye. And like any explosion, both good and bad impacts occur within the blast radius.” Really, the blast radius? Come on, dude—it’s a YAG laser, not a stealth bomber.
He also likes to drift away from the specific procedures in question and wax philosophical about surgery as a concept, arguing that, “Providing safe surgical care to patients requires rigorous instruction and years of supervised residency training.” For an ILM peel? Absolutely. Same goes for a tube shunt, a DMEK or dozens of other complex eye surgeries that optometrists have no interest in. But SLT and capsulotomy are performed in an office setting, not an OR, without general anesthesia and without exposing patients to risk of intraocular infection. These are a qualitative differences that he conveniently ignores. Because he has to—the fact is that complication rates and malpractice rates are not higher among optometrists who perform such procedures.
When the facts aren’t on the ophthalmology lobby’s side, they resort to emotional ploys. But the results are always the same in the long run: legislatures look at the data, are reassured of public safety and support scope expansion. Hyperbole and hand-wringing may rile up the base, but they don’t win against calm confidence. Just ask Jimmy Carter.