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Commentary: Optometrists properly trained for new roles

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During this year’s General Assembly, legislators will consider optometry legislation to allow Virginia’s optometrists to perform three in-office procedures to treat glaucoma and provide after-cataract surgery care. Opponents of these bills are questioning our ability to perform these procedures by claiming that we, doctors of optometry, also known as optometrists, do not have the training to perform these procedures. Additionally, they claim the legislation isn’t needed because there are enough ophthalmologists to treat patients needing this care in the commonwealth.

In reality, optometrists earn doctorate degrees upon completion of four years of optometry school. Optometric education includes more than 10,000 hours of didactic and clinical post-graduate training focused on the eye, its components, medical treatments and the more than 270 systemic diseases that manifest themselves in the eye including diabetes, hypertension and cancer. While part of our job involves fitting patients for glasses and contact lenses, Virginia’s optometrists have also been treating glaucoma for 25 years and managing after-cataract conditions for almost 40 years. 

House Bill 213 and Senate Bill 375 seek to allow doctors of optometry to perform three in-office laser procedures to treat glaucoma and provide after-cataract surgery care. Contrary to what our opponents would like you to believe, these bills aren’t seeking the right to perform cataract surgery, LASIK, injections into the eye or other laser treatments. These procedures do not involve scalpels, needles or other surgical instruments. Instead the bills seek privileges for optometrists to perform three specific laser procedures that will become more in-demand as Virginia’s population ages. These procedures are low-risk, effective and can provide immediate results for patients. 

Optometrists already manage and treat complications that can arise from patients having glaucoma or needing after-cataract care. Under current Virginia law, if an optometrist determines that a patient needs one of these laser procedures, the optometrist must refer the patient to an ophthalmologist for treatment. This extends the time that the patient must wait for care and can result in additional co-pays and health care costs, time off work and living with blurry vision.

One of our colleagues has a patient who needs one of these laser procedures, but because our colleague is not able to provide this treatment, her patient must wait until April for an appointment with an ophthalmologist. That means her patient will have to live with blurry vision for an additional two months – something that would be unnecessary if Virginia law allowed optometrists to perform these procedures. Another colleague in Southwest Virginia used to perform these procedures when she lived in another state, but now that she’s in Virginia, her patients must travel two to three hours for treatment by an ophthalmologist.

According to a 2018 work force study by the Virginia Department of Health Professions, there are more than twice as many optometrists as ophthalmologists in Virginia. The American Optometric Association says doctors of optometry provide more than 2/3 of primary eye health care in America, and more than 99% of the U.S. population lives in counties with an optometrist. Expanding optometric scope of practice would increase access to care and reduce potential complications for patients who would otherwise have to wait for treatment.

Optometrists have performed these procedures more than 100,000 times in eight other states since the 1990s without complications. All optometry schools in the United States train students to perform these procedures. And if Virginia’s legislators approve these bills, Virginia’s optometrists will be required to obtain certification by a college of optometry, complete hands-on training and pass an examination in order to perform these procedures.

Some opponents of the legislation claim that the cost of the laser would inhibit optometrists from doing these procedures. In reality, doctors of optometry often purchase equipment that is not reimbursed because it assists in providing exceptional patient care—something optometrists have done in Virginia for over 100 years.

For nearly 40 years, Virginia’s optometric scope of practice has evolved with our education and training and has never been repealed. To learn more, visit trustedeyecare.com. Please ask your legislators for their support of HB 213 and SB 375 to help all Virginians see clearly.

Dr. Anthony Zarella is a trustee of the Virginia Optometric Association and an optometrist in Charlottesville. Dr. Jerry Neidigh is a past president and legislative chair of the Virginia Optometric Association and an optometrist in Richmond.

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