Which medical providers can perform certain types of eye surgery is a hotly debated issue in Arkansas.
Optometrists defend Act 579 passed by the Arkansas General Assembly in 2019 as simply updating laws similar to those in some neighboring states to allow optometrists to perform more minimally invasive eye surgeries that do not require general anesthesia. Ophthalmology supporters contend that optometrists do not have the training and experience necessary to perform these surgeries and that allowing them to do so would put patients at risk.
Currently, Act 579 has not gone into effect. Safe Surgery Arkansas, representing ophthalmologists, has presented signatures to put a referendum on the ballot that would allow voters to decide the issue. Arkansans for Healthy Eyes, representing optometrists, maintains that proper laws regarding voter referendums were not followed.
But the Arkansas Supreme Court ruled that the signatures must count, and a challenge from Arkansans for Healthy Eyes filed in Pulaski County Circuit Court was rejected.
David Wroten, executive vice president for the Arkansas Medical Association, said optometrists don’t go to medical school, have no residency requirements and don’t receive adequate training to perform eye surgeries under the supervision of residency directors.
“After graduating from a four-year medical school, ophthalmology residents spend three to five years in ‘supervised’ residency training programs becoming proficient in performing surgical procedures on the eyes,” Wroten told Arkansas Money & Politics. “We’re talking about surgical procedures that use lasers, scalpels and needles. Optometrists say they can do these kinds of surgeries after taking a weekend course.”
Vicki Farmer, executive director of the Arkansas Optometric Association and the chairwoman of Arkansans for Healthy Eyes committee, counters that doctors of optometry receive eight years of formal education, including four years of intensive, doctoral-level education in optometry school where they are trained to examine, diagnose, treat and manage disease, disorders and conditions of the eye.
“The in-office procedures allowed under Act 579 are being taught now, and have been for some time, in optometry schools across the nation,” Farmer said. “In fact, many optometrists were performing these procedures while in optometry school and then returned home to practice in Arkansas, where they weren’t allowed to use the same procedures to care for their patients.”
Act 579 is similar to laws in several neighboring states, said Susan DeBlack, an optometrist who earned a Doctor of Optometry degree and practices at Conway Family Eye Care.
“Doctors of optometry in Oklahoma have been safely and effectively performing these procedures for more than 20 years,” DeBlack said. “Louisiana, Kentucky and Tennessee all have similar optometrists’ scope-of-practice laws. The safety record for optometry in these nearby states has been excellent.”
DeBlack said patients, especially in rural Arkansas, benefit when they are able to see their local optometrist for these minor procedures done in-office, which reduces time off work and saves travel time as well as the added expense often incurred when their optometrist needs to refer the patient to a specialist.
“There are full-time doctors of optometry in 80 percent of Arkansas counties, compared to ophthalmology, which has full-time practices in about 30 percent of counties,” DeBlack said. “Optometrists have been treating eye diseases including glaucoma and performing various minor surgical procedures, such as removing foreign objects from the eye, for many years. Doctors of optometry routinely perform the post-operative care for these procedures and know how to manage complications. In addition, there is comprehensive coursework for current optometrists to achieve certification in these procedures, which is comparable to courses available to other physicians to learn new technology. “
DeBlack said it is important to note that the law does not include cataract surgery, LASIK or any other major eye surgery which would be done in an operating room or require general anesthesia.
Ophthalmologist Laurie Barber, M.D., chair of Safe Surgery Arkansas, was a professor of ophthalmology for 26 years before going into private practice at Little Rock Eye Clinic.
“There is a huge gap in training between ophthalmologists and optometrists,” Barber said. “My patients have been very concerned about the bill that was passed that would allow non-medical providers to perform eye surgery. I felt called under the Hippocratic Oath to keep the patients of Arkansas from being harmed by people not trained to do eye surgery. Our goal in this ballot referendum is to educate the people in the state that there are those who attend medical school and do residencies in eye surgery and those who do not. Ophthalmologists do; optometrists don’t.”
Barber recognizes that similarities of the names and professions are confusing for many. She suggests people look at the M.D. initials following their doctor’s name.
“You want to vote against the bill that would allow non-medical professionals to perform eye surgery,” Barber said. “Vote ‘no’ to prevent an act passed by legislators in Arkansas from going into effect that could harm our friends and families having eye surgery.”
A laser is a very intense cutting instrument; it is a scalpel of light that has the potential to be harmful, she said.
“You could damage crucial parts of the eye that could harm vision in that patient,” Barber said. “There is no minimally-invasive laser surgery of the eye. The eyeball itself is small and if you laser a secondary cataract, you can cause decreased vision.”
Barber said another issue with Act 579 is that it would allow optometrists to do surgery on lesions of the eyelid. “They have never done that in optometry school, and they are not trained to differentiate from different lesions that can occur on the eyelid including cancer, much less do they know how to do incisions, control bleeding and do sutures because they are not surgeons,” Barber stressed.
Farmer disputes that the legislation puts patients at risk.
“Act 579 from 2019 will benefit patients across the state by providing better access to quality eye care,” she said.
Before Act 579, the law governing the practice of optometry in Arkansas had not been updated in more than 20 years, she noted.
“After months of debate and hours and hours of testimony from both sides, the law passed the legislature overwhelmingly,” Farmer said. “The whole idea is to improve access to care so patients don’t have to drive farther and pay more for procedures an optometrist could do in the same visit.”
Farmer said her group is considering further legal options regarding the voter referendum.