To better argue their stance on scope expansion, ODs must understand that of their opposers.

To better argue their stance on scope expansion, ODs must understand that of their opposers. Photo: Nate Lighthizer, OD. Click image to enlarge. 

Ophthalmologists and their advocates have cited various arguments over the years as to why their profession—and not optometry—should be the sole provider of all forms of eye surgery. Ocular surgery is increasing in demand due to the rising prevalence of vision-threatening conditions such as glaucoma. As optometrists fight to demonstrate the necessity and safety of laws that allow them to perform these procedures, it is essential for ODs to understand the nature of these oppositional claims from ophthalmology to more effectively advocate for themselves.

The American Glaucoma Society recently published a paper explaining its position on the matter, called “Glaucoma Surgery and Lasers Should be Performed by Surgeons.” Their arguments lean on rationale such as the lack of research to prove that there’s a legitimate need to expand scope of practice for optometrists based on geographic location.

“Lack of access to ophthalmic lasers or ophthalmologists has been cited by some as a reason to expand the scope of practice of optometrists,” the authors noted in the paper. “Peer-reviewed publications, however, have demonstrated adequate patient access to an ophthalmologist. Furthermore, geographic access may not improve in states that have allowed optometrists to perform ophthalmic lasers.” The authors go on to cite a study from 2016 which reported that 90% of Medicare beneficiaries in the country live within 30 minutes of an ophthalmologist.

Additionally, the authors presented data from three states with an expanded scope of practice in optometry—Oklahoma, Kentucky and New Mexico—claiming that these laws have not improved geographic access. In these states, they noted that “75% of residents have an estimated travel time of 30 minutes or less to an ophthalmologist, and greater than 94% of residents have a travel time of 60 minutes or less.” They also added that, in Oklahoma, travel distances and times for patients on Medicare who received YAG capsulotomy were similar whether the procedure was done by an OD or an MD (50 minutes vs. 47 minutes).

Another main argument cited in the paper involves the differences in training between ODs and MDs. The authors name various glaucoma procedures—primarily SLT, LPI and YAG capsulotomy—and explain the possible complications of surgery, harping on the importance of extensive ophthalmic training, which is received to a lesser extent by ODs than MDs. However, they didn’t present any evidence that these complications occur more often in patients treated by an optometrist vs. an ophthalmologist.

Being aware of the viewpoints of those who oppose optometric scope expansion will help ODs and their advocates form more convincing factual arguments to combat the concerns of patients and lawmakers.

Kolomeyer NN, Gupta D, Rhodes LA, et al. American glaucoma society position statement: glaucoma surgery and lasers should be performed by surgeons. Ophthalmol Glaucoma. October 3, 2022. [Epub ahead of print].