http://www.tucsoncitizen.com/index.p...004b5_guestopt

Guest Opinion: VA's laser surgery ruling puts veterans at risk

JEFF MALTZMAN
letters@tucsoncitizen.com

As an ophthalmologist specializing in glaucoma, a potentially blinding disease, I am very concerned about ongoing attempts by optometrists across the country to perform surgery, despite a lack of appropriate education and training.
Most worrisome is the potential danger to our nation's veterans, as the Veterans Administration recently loosened its standards for their eye care.

Optometry and ophthalmology are very different, and the distinction now is more important than ever.

Ophthalmologists undergo four years of medical school and a year as an intern, providing full-time, supervised patient care in a hospital. Then they enter residency, where they receive a minimum of three years of intensive, highly supervised medical and surgical training in diseases and disorders of the eye and visual system.

Countless hours are spent in the operating room, honing skills necessary to perform very delicate, precise ocular surgical procedures. Many go on to complete one to two more years of sub-specialization training to gain more expertise and surgical proficiency in a particular aspect of eye care.

Ophthalmologists must pass a three-stage national examination required of all physicians, and most go on to become certified by the American Board of Ophthalmology via a rigorous examination procedure.

This long, arduous course of study is vital. Without it, eye surgery cannot be mastered.

Optometrists do not attend medical school and are not physicians. They complete four years of optometry school where, like ophthalmologists, they are trained to diagnose and manage ocular disease. Their experience with optics and refraction, the science of prescribing glasses and contact lenses, is typically strong.

Unlike ophthalmologists, however, they undergo no training in surgery, nor do they have the appropriate background in medicine to do so.

Optometrists are valued members of the health care community, providing outstanding primary eye care to many patients. Many ophthalmologists work with optometrists, with great benefit to their patients. Unfortunately, some optometrists undertake surgery, a potentially dangerous proposition.

At one time, optometrists were licensed only to perform eye examinations and prescribe corrective lenses. Through extensive lobbying over 20 years, optometry has expanded such privileges in most states to include treatment of many ocular diseases with medications.

In 49 of 50 states, optometrists are prohibited from performing any eye surgery. Minor procedures, such as removal of ingrown eyelashes and ocular foreign bodies, are and should be allowed.

Oklahoma, in 1998, became the only state to let optometrists perform certain types of laser eye surgery after only a brief training course - a dangerous precedent. And Oklahoma recently passed legislation allowing optometrists to perform surgery with a scalpel.

Unprepared optometrists may one day remove cataracts and perform glaucoma surgery without undergoing the rigorous training of true surgeons. Is this truly in the interest of their patients?

The greatest danger to patient safety now threatens our veterans. Despite a longstanding rule that optometrists not be permitted to perform surgical procedures, the Veterans Administration recently decided to allow laser surgery by optometrists. While all but one state recognize that surgery requires properly trained physicians and surgeons, our nations' veterans are being treated beneath this standard of care.

The optometric lobby has argued that they should be permitted to conduct "routine" laser procedures. Laser surgery is surgery, with potentially serious complications, including the risk of blindness. And surgery is never routine. Every procedure carries the same risks, the respect for which comes from the proper education and training.

The American Academy of Ophthalmology, together with the support of many other physician organizations, is actively fighting this attack on patient safety for our veterans. In response, legislation introduced in the U.S. House and Senate would permanently end veterans' eye surgery performed by non-physicians.

At a time when we are asking so much of our men and women in the armed forces, we all need to stand up for their right to the same quality of medical care we expect for ourselves.

Demand surgery by surgeons. Contact your members of Congress and ask them to support the important legislation before them. Be sure your family and friends understand what is at stake and ask them to do the same.

This is an issue not of politics but of patient safety, an issue that soon may affect us all. We need to act now, before we lose yet more ground in our fight for safe, quality health care.

Dr. Jeff S. Maltzman is a Tucson ophthalmologist specializing in glaucoma and cataract surgery.

__________________
Moderator - State Licensing Forum

Still skeptical after all these years.
This is it. There are no hidden meanings.WYSIWYG

http://www.internetmedicalschool.homestead.com

http://www.chiropractormds.homestead.com/index.html

I agree with the opinion in this article.

Yet I still wonder if the motivation for it is equal parts protecting the public and also protecting the earning potential of opthamologists.

Sometimes I think that states that present greater difficulties to IMGs who seek licensure are also motivated 50% of the time by the need to protect the public, and 50% of the time motivated by a desire to limit competition.

What do you think?

__________________
Saba Forum Moderator
Saba University School of Medicine, MSIV
Interests: Pediatrics, Psychiatry

I don't think that limiting competition is the name of the game....because the balancing act are NP, PA's, naturopaths,chiropractors,who all compete for the same clients. There is still enough shortage of docs in rural America that docs are needed but most don't want to go and live in the country.

I think that Boards believe their job is to protect the consumers..they see perverts,drunks,druggies, idiots, that must be stopped from practicing and they must make judgement calls on schools..it isn't an easy balancing act. az skeptic

__________________
Moderator - State Licensing Forum

Still skeptical after all these years.
This is it. There are no hidden meanings.WYSIWYG

http://www.internetmedicalschool.homestead.com

http://www.chiropractormds.homestead.com/index.html

Okay, maybe I'm just paranoid because I'm on the outside looking in right now.

__________________
Saba Forum Moderator
Saba University School of Medicine, MSIV
Interests: Pediatrics, Psychiatry