Surgeon qualifications in the eye of the beholder?

The gift of sight is something that we often take for granted. The ability to see the smile on a loved one’s face or even read this article is all powered by our eyes. If you need a surgical intervention to remedy a problem with this vital organ, you may also take for granted that the professional performing that procedure is adequately equipped to do so. Unfortunately, trusting that professionals performing eye procedures are qualified may no longer be a fact New Jerseyans can take for granted.

A-5445/S-3841 seeks to expand the scope of practice for optometrists, allowing them to perform laser and scalpel eye surgeries without earning the privilege to do so through proper education and training.

Although both are referred to as “doctor,” optometrists differ from ophthalmologists in their levels of education, clinical training, and in what they can properly and safely diagnose and treat.   Optometrists are NOT medical doctors and are NOT trained surgeons.  Optometrists complete a four-year optometry school program focusing on basic eye care services such as eye exams/refractions and contact lens fitting, followed by voluntary one-year post-graduation program, completing a total of approximately 2,500 hours of clinical training.

Ophthalmologists ARE medical doctors, trained in surgery on and around the eye.  They complete four years of medical school, a one-year hospital internship and a mandatory three-year surgical residency in ophthalmology.  Additionally, in many cases, ophthalmologists complete a one- to-two-year subspecialty fellowship.  Ophthalmologists complete at least 17,000 to 22,000 hours of clinical training before they are authorized to treat patients on their own, including any treatment requiring surgery.

Despite these vast differences in training and experience, proponents of the bill claim there’s nothing to worry about regarding scope expansion because optometrists would only be performing “simple” or “minor” eye procedures. Unfortunately, there is nothing “minor” or “simple” about using a high-powered laser to treat glaucoma and cataracts or using injectable anesthesia and scalpels around the eyelid. The consequences of incorrectly performing these “minor” procedures on one of our most delicate organs can be life altering.

The data on surgical complications is incomplete, as only a few states allow optometrists to perform an advanced scope, and many complications are resolved by ophthalmologists and go unreported.  What we do know, however, that despite this under-reporting, there is still a 189% increased hazard when the procedure is performed by an optometrist according to a study published in the Journal of the American Medical Association following the enactment of a scope expansion in Oklahoma.

Our state legislature has an obligation to protect public health and safety. There is no other scenario where lawmakers would willingly give the green light to an 189% increase in health hazards for their constituents. Eye surgery should not be a political issue, it should be determined by proper education and experience – and the facts here are undeniable.

As if performing laser and scalpel surgeries without a medical degree isn’t outlandish enough, A-5445/S-3841 would further allow the New Jersey State Board of Optometry to grant optometrists the ability to perform other types of surgeries following a simple petition to their board. Allowing the optometry board (not the Board of Medical Examiners which includes actual medical doctors) to determine what other procedures optometrists can perform is the equivalent of leaving the fox in charge of the hen house.

Lastly, let’s address “access to care”, a term being inappropriately abused by the proponents of the bill, to somehow convince lawmakers that there exists a shortage of ophthalmologists to handle the demands of patients in NJ.  The facts are, New Jersey is fortunate to have one of the nation’s highest concentration of ophthalmologists – whereby no resident in NJ needs to travel beyond a 30 min commute to see an ophthalmologist.  Further, optometry’s use of scare tactics to somehow claim that Medicaid patients are challenged in receiving timely and convenient care are flat out lies.  With the current levels of access to licensed and trained ophthalmologists in NJ, there is no need to expand the scope of practice for optometrists, and by no means should we weaken standards of care at the expense of NJ patients. Bottom line, removing safeguards for eye surgical care in NJ is wholly unnecessary and exposes patients to unnecessary risks.

Beauty is in the eye of the beholder – qualifications for performing surgery certainly are not. Lawmakers who want appropriately trained medical doctors performing surgery on their own eyes should want no less for you.

Dr. Cecily Lesko is an ophthalmologist in Clifton, New Jersey and is affiliated with multiple hospitals in the area, including Mount Sinai Hospital and St. Mary’s General Hospital. She received her medical degree from Icahn School of Medicine at Mount Sinai and has been in practice for more than 20 years.