Should nonmedical doctors perform laser eye surgery? Bill would expand scope of optometrists

Rep. Jim Dunnigan, R-Taylorsville, speaks at the Capitol in Salt Lake City on Feb. 21, 2019. Dunnigan is proposing a bill that would expand the scope of optometrists to perform three procedures with lasers.

Rep. Jim Dunnigan, R-Taylorsville, speaks at the Capitol in Salt Lake City on Feb. 21, 2019. Dunnigan is proposing a bill that would expand the scope of optometrists to perform three procedures with lasers. (Kristin Murphy, Deseret News)

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SALT LAKE CITY — While some might not know the difference between an optometrist and ophthalmologist, the question of whether the one with less training should be able to perform laser procedures sparked a heated debate in the Utah Legislature on Monday.

HB224 would allow optometrists to perform three specific treatments using lasers. They would not be able to perform surgeries considered more complex like Lasik.

An optometrist is a doctor of optometry, but not a medical doctor. They receive four years of optometry school but do not need to complete a residency. An ophthalmologist, meanwhile, is a medical doctor who receives four years of specialty training after their medical degree.

Bill sponsor Rep. Jim Dunnigan, R-Taylorsville, said optometrists reached out to him last summer to tell him they want their scope of practice expanded to what they're trained to do.

"We're not the first one to do this. This has been done in nine other states," he said during a House Business and Labor Committee meeting on Monday.

The bill would allow optometrists to perform laser capsulotomy, which helps a patient see more clearly after cataract surgery; a laser trabeculoplasty, which reduces pressure in the eyes of patients with glaucoma; and laser peripheral iridotomy, which relieves pupillary blocks that can cause glaucoma.

Many of those procedures have been done by optometrists without issues, according to Dunnigan.

Weston Barney, president of Utah Optometrics Association, said optometrists provide vision care to more patients in Utah than other specialists.

Optometrists' training and education include minor, in-office surgical procedures using lasers, he said, but Utah's law hasn't been changed in decades to address changes in training.

Over 100,000 patients have received those treatments by optometrists, but those numbers are no longer tracked by the government because they are now considered "routine treatment," Barney said.

"Our goal is not to enter operating rooms that provide major surgical care for patients, but to provide these minor, in-office treatments that can save patients time and money," he said, adding that the bill would help rural Utahns access greater care.

Sometimes, Barney said he sees patients who need one of those procedures — but he needs to refer them to ophthalmologists in his practice. That means the patients need to reschedule, sometimes with inconvenience.

"This could be avoided all for a five-minute procedure," he said.

He contended that physician assistants and others who aren't medical doctors can perform minor procedures without going through medical residencies.

But when the meeting opened for public comment, Dr. Jared Parker, an ophthalmologist, expressed safety concerns about those with less training undertaking laser surgeries.

He noted that his practice benefits from working in a "unified team" of optometrists and ophthalmologists. When optometrists encounter issues beyond their expertise, they refer a patient to an opthamologist.

No training optometrists have received "comes close" that of ophthalmologists, he said.

Parker pointed to two referrals he received who ended up not needing the procedures recommended by optometrists. He said if they hadn't been referred to a more qualified surgeon, they would have received the treatments.

"There is no such thing as routine eye surgery. Eye lasers cut tissue and carry significant risk," including retinal detachment and other issues, Parker contended.

"These complications can cause permanent vision loss," he said.

He added that the procedures are "not as simple as being proposed today."

Rep. Ashlee Matthews, D-West Jordan, said she appreciates "from the perspective that this could potentially move some barriers for lower-income, underinsured people, to access this care."

She questioned what the price difference for patients would be if an optometrist performs a procedure versus an ophthalmologist.

Dr. Mark Taylor, an optometrist, said procedures are covered through insurance, which dictates the reimbursement. The cost would be similar for an optometrist and an ophthalmologist, but costs are lower when procedures take place in an office instead of in a surgical facility.

"I believe all involved do important work. And I'm concerned that we have not been able to show that optometrists cannot do these procedures," Rep. Cory Maloy, R-Lehi, said of the arguments against the bill, calling the cases on both sides "compelling."

Rep. Brian King, D-Salt Lake City, however, called the bill a "patient safety issue" and that he would not feel comfortable supporting it.

The bill received a 9-3 favorable recommendation from the committee, meaning it will move to the full House for a vote.

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Ashley Imlay is an evening news manager for A lifelong Utahn, Ashley has also worked as a reporter for the Deseret News and is a graduate of Dixie State University.


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