The issue of whether optometrists should be permitted to perform
surgical procedures is one that has generated a great deal of controversy,
legislative debate and contention within the eye care profession.
Currently, two states Oklahoma and Kentucky permit some
degree of laser surgical privileges for optometrists. In 1998, Oklahoma became
the first state to allow optometrists to perform some minor surgical
procedures, including some procedures using a scalpel and lasers. In early
2011, Kentucky optometrists gained the authority to perform certain types of
injections, laser procedures and lump and bump procedures around
While many arguments have been articulated both for and against
optometric surgical privileges, perhaps the most powerful case for such
legislation can be conveyed simply through numbers.
There are 550 doctors of optometry in 106 of Kentuckys 120
counties. In contrast, two-thirds of the states counties do not have an
ophthalmologist, I. Ben Gaddie, OD, president of the Kentucky Optometric
Association and a Primary Care Optometry News Editorial Board
member, said in an interview. And at the same time, patient need is
David A. Cockrell
According to David A. Cockrell, OD, FAAO, vice president of the Oklahoma
Board of Examiners in Optometry and secretary-treasurer of the American
Optometric Association, some of the minor procedures categorized legislatively
as surgery would not fall into most peoples definitions of surgery.
We dont get to define which procedures are listed as
surgical procedures, Dr. Cockrell told PCON. Many of the procedures
optometrists perform from the simple removal of an eyelash to something
much more broad arent considered by the general public to be
Bobby J. Christensen, OD, FAAO, a private practitioner in Oklahoma, said
most procedures performed by optometrists are minor, such as foreign body
removal, draining a stye or epilating lashes.
It has been my experience over the last 30 years that optometrists
will not attempt a procedure they do not feel qualified to perform, even if the
law will allow it, he said in an interview. If the foreign body is
embedded on the visual axis or has penetrated into the posterior stroma, the
optometrist is going to refer that patient to the corneal specialist, just like
most general ophthalmologists would do.
Bobby J. Christensen
Dr. Cockrell pointed out that some newly developed technologies and
procedures might be classified as surgeries, which would automatically exclude
optometrists from performing them.
If optometrists dont have surgical privileges and something
new comes out even if its something weve already done, but
just a new technique we have to go back each time and legislate for that
specific technique, he said. No other health care profession has to
In states such as Kentucky and Oklahoma, which encompass many remote
areas, the issue of access to care has been a key consideration in seeking
optometric surgical privileges. Dr. Gaddie said the legislation is expected to
make care more available to Kentuckians.
This law will enable patients to visit their local eye doctor to
undergo these procedures, instead of having to travel to an ophthalmologist
often in another city or county for the same level of care,
he said. Patients benefit by having greater and easier access to a wide
range of eye care performed by the eye doctor they know and trust.
Dr. Cockrell added that the issue of access to care is not strictly
geographical. He discussed two underemphasized access problems, the first of
which is wait times for appointments.
In many busy surgical practices, it literally could be 1 to 2
months wait time for a surgical intervention, even for simple
procedures, he said, as opposed to a quick appointment within a day
or two. So its a timeliness issue.
The second issue Dr. Cockrell cited was access to insurance panels,
another potential source of confusion.
Someone I refer to might not be on that patients panel,
although I might be, he said. It then becomes a panel/provider
issue, which can become complicated and expensive for the patient.
For patients with limited access to eye care, the option of seeing a
nearby optometrist for minor surgery could decrease time away from work, thus
reducing financial burdens.
In some areas, a patient might have to make a 3-hour trip to get a
procedure that literally takes 10 to 15 minutes to perform, Dr. Cockrell
said. They have to take a full day off from work to do this, which
significantly increases the cost. If they can see a practitioner in their own
community for the same procedure, their time away from work is considerably
Dr. Gaddie said optometric surgical privileges also help streamline the
Medicaid process and cut costs.
Medicaid costs will be reduced, because eye care patients will
need fewer referrals and fewer multiple office visits, and will incur lower
transportation costs, he said. This is a much-needed savings for a
program running a deficit in the hundreds of millions of dollars.
For practitioners, surgical privileges might decrease frustrations over
billing codes, Dr. Christensen added.
Many of the minor procedures fall under the surgery codes,
he said. The optometrist might not get paid for a simple epilation
because of the billing code.
Impact on optometric education
As optometrists in some states expand their practice scopes into
surgical procedures, this expansion is likely to broaden the parameters of
optometric education. According to Dr. Gaddie, most optometry students are
already exposed to some extent of surgical training.
Most of the schools and colleges of optometry teach and train
laser and minor surgical procedures already, he said. Any
substantive scope-of-practice change in the profession of optometry has
implications for optometric education.
Providing the latest and best
Dr. Cockrell said he believes optometry and health care overall
is likely to benefit from the profession gaining surgical
I think this will have a positive effect on health care, he
said. Health care is continually changing, and optometry still
encompasses a broad range of services, from routine eye examinations to
specialized vision therapy, to traumatic brain injury therapy. This enables our
profession to spread out and do more.
Dr. Gaddie said the acquisition of surgical privileges is also likely to
improve the eye care experience for patients.
We already comanage and treat a variety of complex conditions, as
well as provide pre- and postoperative care for glaucoma, cataracts,
complications from diabetes and other issues, he said. Now, doctors
of optometry will be able to provide the latest and best technology to treat
their patients in their office, rather than forcing them to make a second
appointment to travel to another doctor.
He added that in light of health care reform, the need for such
efficiency is likely to become greater than ever in his state.
Health care reform is expected to create an additional 600,000
newly insured Kentuckians who will need convenient access to quality eye
care, he said. by Jennifer Byrne
Editors Note: Primary Care Optometry News attempted to
interview several representatives from optometry schools regarding the
curriculum as it relates to surgical privileges, but we were unable to obtain
any comments. We welcome your feedback on the optometric education aspect of
- Bobby J. Christensen, OD, FAAO, is senior vice president of strategic
planning for Vision Source, a network of private practice optometrists. He can
be reached at 6912 East Reno #1, Midwest City, OK 73110; (405) 732-2277; fax
(405) 737-4776; email@example.com.
- David A. Cockrell, OD, can be reached at 1711 W. Sixth St.,
Stillwater, OK 74076; (405) 372-1715; fax: (405) 372-3350;
- I. Ben Gaddie, OD, is a Primary Care Optometry News
Editorial Board member. He can be reached at Gaddie Eye Centers, 7635
Shelbyville Rd., Ste. 101, Louisville, KY 40222; (502) 423-8500; fax: (502)