YAG laser

A YAG laser, a tool used to perform minor in-office procedures.

Leaders of an organization representing Idaho ophthalmologists fear a bill pending in the state Legislature would jeopardize the safety of many patients who get eye surgery using therapeutic lasers.

Supporters of House Bill 317, however, say the legislation would pose no additional risk and would lower patients’ medical costs while improving their access to care.

The bill, known as the Optometric Physician Licensing Act, would allow the state’s optometrists to conduct three in-office laser procedures that only ophthalmologists, who are medical doctors, can conduct under current regulations.

The bill was introduced Jan. 13 by the Idaho Bureau of Occupational Licenses to meet a directive by Gov. Brad Little that state boards seek to make regulations more consistent and streamlined. Having already delayed a vote on the bill to allow lawmakers time to review a study about a similar proposal in Vermont, HB 317 is now scheduled for a Thursday vote in the House Health and Welfare Committee.

In general, optometrists examine, diagnose and treat eyes, while ophthalmologists are medical doctors who can perform surgery on unhealthy eyes.

“Although both are referred to as ‘eye doctors,’ ophthalmologists are medical doctors with more education and clinical training than optometrists,” the Idaho Society of Ophthalmology wrote in its literature against HB 317. “This prepares ophthalmologists to safely identify who needs eye surgery, and then, perform that surgery.”

Nonetheless, Idaho optometrists have been allowed to conduct certain surgical procedures for the past 23 years, and reportedly without incident; HB 317 would expand that list.

Julie Eavenson, a spokeswoman for the bureau, explained that the bill was drafted following meetings involving leaders representing both the optometrists and ophthalmologists. She said the bureau concluded optometrists meet the minimum training standards to safely provide the laser procedures to the public.

“We’re not putting barriers in for people that don’t have any basis in fact,” Eavenson said, adding that the bureau thoroughly vetted the issue prior to introducing the bill.

Twin Falls Doctor Nathan Welch, president of the Idaho Society of Ophthalmologists, believes the bureau’s bill would improperly expand the scope of practice for optometrists. Welch argues ophthalmologist schools provide “uniform, standardized training,” while standards of optometry programs can vary. Furthermore, he said ophthalmologists receive more clinical training and undergo a three-year surgical residency and a year-long hospital internship.

“(Optometrists) don’t get to practice with a laser day in and day out on humans under the supervision of trained doctors who are watching them for months and months,” Welch said.

Kris Ellis, policy adviser for Idaho Optometric Physicians, emphasized that not all optometrists would qualify to perform the laser surgeries under the pending bill. She noted the bill includes language requiring optometrists to have performed at least five supervised laser procedures on patients to be eligible.

Ellis said many optometrists in rural areas have already met that requirement and would be eligible immediately. Others may opt to obtain extra training, she said.

Idaho has more than 600 optometrists but fewer than 90 ophthalmologists. Nonetheless, Welch disagrees with the basic assertion that the change would improve access to care. He points out that there’s no backlog for laser treatments in Twin Falls.

Ellis, however, said a survey done by optometrists in the Boise area found the average waiting time for a laser is now about a month.

“Optometrists are Idaho’s most accessible eye care providers,” Idaho Optometric Physicians wrote in literature supporting the bill. “In many counties, they are the only eye doctors. Allowing certified optometrists to use laser treatment greatly expands the access and affordability of medical care to Idahoans.”

Oklahoma, Louisiana and Kentucky currently allow optometrists to perform eye laser surgery. Ellis said optometrists in those states have conducted 100,000 laser procedures without any complaints to their boards.

Be that as it may, Welch said ophthalmologists from those states have shared several anecdotes about patients who have come to them to repair damage following surgery with an optometrist.

Ellis takes such reports with a grain of salt, in the absence of specific data.

In Vermont, the state’s Office of Professional Regulation recently recommended against expanding the optometric scope of practice to include nine advanced procedures.

Ellis believes Vermont is far different from Idaho. For example, Idaho optometrists can already perform five of the nine procedures that would be approved for them under Vermont’s bill. Furthermore, one of the procedures on Vermont’s list would be specifically excluded in Idaho under HB 317.