Michael D. DePaolis |
“It’s just a matter of semantics.” It is
a term we all hear uttered with some regularity. In a broad sense, semantics is
the study of meaning – and linguistically it often refers to the meaning
or interpretation of a word or phrase. As such, the phrase “it’s just
a matter of semantics” is frequently used to explain a trivial distinction
– resulting from misinterpretation of mere words – rather than
significant substance. So, given this interpretation, is it logical to say that
optometric surgery is just a matter of semantics?
To a great degree, stating that optometric surgery is a
matter of semantics depends on just how one defines surgery. And the definition
of surgery is a bit ambiguous in its own right. Merriam-Webster’s online
dictionary (www.merriam-webster.com) defines surgery as “the branch
of medicine concerned with diseases and conditions requiring or amenable to
operative or manual procedures.”
Given the broad nature of such a definition, it is
justifiable to say surgery includes epilating a rogue eyelash or removing the
most superficial of corneal foreign bodies. While they are “operative or
manual procedures” well within the existing scope of optometric practice,
they are not generally viewed as surgery by practitioner or patient alike. Most
importantly, they are vastly different than more invasive procedures, such as
cataract extraction and IOL implantation in a patient with zonular dehiscence
or vitrectomy with epiretinal membrane peel in a diabetic patient. While
clearly on opposite ends of the spectrum, they all are, nonetheless, considered
surgery. In this respect, the topic of optometric surgery appears to be
anything but a matter of semantics.
As I see it, however, the problem is very much one of
semantics. We simply define surgery in too broad of a sense. We see it in the
verbiage of legislative initiatives as well as in insurance provider contracts.
The term surgery covers too many things. How else could one possibly consider a
relatively minor procedure such as an eyelash epilation in the same vein as a
much more invasive and technically challenging intraocular manipulation? Herein
resides the problem.
On one hand, optometry covets the right to perform minor
surgical procedures – within the legal scope of licensure and in
compliance with proper insurance procedural coding practices – to provide
much-needed patient services in a timely, efficient, safe and cost-effective
manner. On the other hand, ophthalmology views optometric surgery as a rogue
attempt to secure the privilege of performing invasive surgical procedures for
which they are not properly trained.
To a certain degree each stance is defensible.
Defensible, that is, until we start better defining and differentiating
surgery. Again, it is a matter of semantics.
While I do not foresee a resolution to this contentious
topic any time soon, I firmly believe the solution ultimately requires three
actions.
First, and foremost, we need better definition –
and differentiation – of just what constitutes surgery.
Second, ophthalmology must accept that optometrists are
only going to perform those procedures for which they are adequately trained
and in their patients’ best interest. Additionally, in those geographies
in which an ophthalmology manpower shortage exists and patient needs dictate,
optometrists are more likely to perform these procedures.
Finally, optometry must continue to respect its own limitations,
performing only those procedures for which we are properly trained, then
legally legislated. Whether this is all a matter of semantics or not, one thing
remains certain: Above all, we must agree to do what is in the patient’s
best interest.