April 15, 2005
5 min read

Oklahoma optometry board passes surgical rule

The AAO says the rule allows optometrists to perform a number of surgical procedures. Optometry says it does not expand their scope of practice.

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Optometrists in Oklahoma may be allowed to perform numerous surgical procedures if a rule adopted by the Oklahoma Board of Examiners in Optometry is passed by the state legislature and signed by the governor, according to the American Academy of Ophthalmology.

The AAO, along with the American Society of Cataract and Refractive Surgery and other medical organizations, are urging the legislature and Oklahoma’s governor, Brad Henry, to reject the rule, according to an AAO press release.

If the state legislature does nothing within 45 days of the ruling, which was adopted on March 10, the rule will become law, the AAO said. The legislature can also choose to accept or reject the rule.

According to the AAO, the ruling was prompted when Oklahoma optometrists were having problems with reimbursement for three procedures. The procedures, epilation of eyelashes, insertion of punctal plugs and the removal of superficial foreign bodies, were defined as surgical, and there was a question whether optometrists could be reimbursed for surgical procedures.

To remedy the situation, Oklahoma lawmakers adopted an emergency legislative rule. The AAO and others note that the way the rule is worded, in the negative, opens the door for optometrists to perform “more than 100” procedures using a scalpel. Rather than specifying the three procedures in question to be non-surgical, the ruling instead “includes a random and incomplete list of 14 surgical procedures that optometrists may NOT perform.” This makes it conceivably possible for optometrists to perform other scalpel-based procedures that are not on the list, according to the AAO.

The American Academy of Optometry declined to comment on the issue for this article, and the American Optometric Association could not be reached for comment at press time.

Surgical procedures excluded

A bill passed in Oklahoma in 1998 allowed optometrists to perform certain anterior segment laser procedures. Some optometrists began performing procedures outside the list delineated, and an insurance company queried the viability of reimbursement claims for those procedures. The attorney general of Oklahoma promulgated an official opinion on what laser procedures optometrists could perform, said Ann A. Warn, MD, president of the Oklahoma Academy of Ophthalmology.

“The question was taken to the attorney general: Given the laser bill of 1998, does it allow them to do those surgeries or any other surgeries?” Dr. Warn told OSN. “He came back with the opinion that no, the bill said they could only do anterior segment [laser] surgery, but [the rule] said nothing of lid surgeries and cosmetic blepharoplasty that had been done.”

After the opinion, the board of optometry examiners crafted the current ruling, which if it becomes law may allow optometrists to perform at least 100 scalpel procedures, with the exception of the 14 procedures specified, she told OSN.

In response to the rule, the AAO and others persuaded the governor to write a letter expressing his disapproval for the expansion of the scope of practice. The solution mandated was to have the AAO and the optometry board work together to promulgate a rule that delineated what procedures optometrists could perform, Dr. Warn said.

Response to ophthalmology

David A. Cockrell, OD, FAAO, president of the Board of Examiners in Optometry in Oklahoma, said the permanent rule had nothing to do with clarification on specific procedures. He said the AAO sought an opinion from Oklahoma Attorney General Drew Edmondson in January 2004 regarding optometrists’ ability to perform surgery in general.

“The request was whether or not optometrists could specifically do surgery by statute, and whether or not the Board of Examiners in Optometry could authorize surgery. … Did our law specifically say we could do surgery, and did our law specifically say the Board of Examiners in Optometry could authorize surgery?” Dr. Cockrell told OSN.

The attorney general’s opinion said that the law did not specifically allow optometrists to perform surgery, according to Dr. Cockrell. The opinion said the board could not authorize surgery by law. The attorney general also said that there was no definition of surgery in Oklahoma, so he could not say what optometrists could or could not do, Dr. Cockrell said.

He said a temporary rule was passed in October to respond to the AAO’s concerns. He said optometrists believe that the rule does not expand the scope of practice, nor does it restrict anything that optometrists have been doing. He noted that Gov. Henry sent a letter to all legislators in Oklahoma last spring saying he would sign a ruling that did not expand or restrict optometry’s scope of practice.

“Ophthalmology went back to the legislature after that [temporary] ruling came out and said that optometrists want to do cataract [removal], retinal procedures and corneal transplants. Those were the three procedures that they talked about, which optometrists in Oklahoma have never done. The board decided to address those concerns for them by specifically excluding areas of surgery that optometry just does not do,” he said.

Rule adopted by the Oklahoma Board of
Examiners in Optometry on March 10

Chapter 10. Licensure and regulation of optometrists
Title 505:10-5-17. Proper scope of practice of Non-Laser Surgical Procedures

(a) The practice of optometry is defined to be the science and art of examining the human eye and measurement of the powers of vision by the employment of any means, including the use or furnishing of any self-testing device, the use of any computerized or automatic refracting device, the use of pharmaceutical agents, the diagnosis of conditions of the human eye, and the correcting and relief of ocular abnormalities by means including but not limited to prescribing and adaptation of lenses, contact lenses, spectacles, eyeglasses, prisms and the employment of vision therapy or orthoptics for the aid thereof, low vision rehabilitation, laser surgery procedures, excluding the retina, laser in-situ keratomileusis (LASIK), and cosmetic lid surgery. (59 O.S. 581) In addition, the practice of optometry shall include the correction and relief of ocular abnormalities by Non-Laser Surgical procedures not excluded in paragraph (b) of this rule.

(b) Except for the postoperative care of these procedures, the following Non-Laser Surgeries are excluded from the scope of practice of optometry:

(1) Non-Laser Surgery related to removal of the eye on a living human being;
(2) Non-Laser Surgery requiring full thickness incision or excision of the cornea or sclera other than Paracentesis in an emergency situation requiring immediate reduction of the pressure inside the eye;
(3) Penetrating Keratoplasty (Corneal Transplant), or Lamellar Keratoplasty;
(4) Non-Laser Surgery requiring incision of the Iris and the Ciliary body, also includes Iris diathermy or cryotherapy;
(5) Non-Laser Surgery requiring incision of the Vitreous;
(6) Non-Laser Surgery requiring incision of the Retina;
(7) Non-Laser Surgery Extraction of the Crystalline Lens;
(8) Non-Laser Surgery Intraocular Implants;
(9) Incisional or excisional Non-Laser Surgery of the Extraocular Muscles;
(10) Non-Laser Surgery of the eyelid for incisional Cosmetic or Mechanical repair of Blepharochalasis, ptosis, and tarsorrhaphy or eyelid malignancies.
(11) Non-Laser Surgery of the boney Orbit, including Orbital Implants;
(12) Incisional or excisional Non-Laser Surgery of the Lacrimal System other than Lacrimal probing or related procedures;
(13) Non-Laser Surgery requiring full thickness Conjunctivoplasty with graft or flap; and
(14) Any Non-Laser Surgical procedures that does not provide for the correction and relief of ocular abnormalities.

Source: Board of Examiners in Optometry, Oklahoma

For Your Information:
  • Ann A. Warn, MD, can be reached at 3201 West Gorge Blvd., Lawton, OK 73505; 580-250-5855; fax: 580-250-5808.
  • David Cockrell, OD, FAAO, can be reached at 1711 West Sixth St., Stillwater, OK 74074; 405-372-1715; fax: 405-372-3350.
  • Jeanne Michelle Gonzalez is an OSN Staff Writer who covers all aspects of ophthalmology, specializing in practice management, regulatory and legislative issues. She focuses geographically on Latin America.