Shield Our Eyes: Lawmakers Across the Country Must Ensure Eye Surgery Can Only Be Performed by Medical Eye Surgeons 

COMMENTARY

Training and experience matter, especially when health is on the line. Just as one would rightly be concerned to discover a flight attendant, rather than a pilot, flying their airplane, so too would most people be alarmed to find the person performing surgery on and around their eyes is not a medical doctor or trained surgeon. 

Unfortunately, this is not a hypothetical scenario. It is very real for the 10% of Americans who live in states that have permitted optometrists to perform invasive eye surgery on patients after they complete a 32-hour weekend instruction course versus the more than 16,000 hours of medical education and surgical training that ophthalmologists undergo before they can perform these delicate procedures. Most consumers are not aware of these distinctions, but if they knew the real story, the choice of who performs their eye surgery would be crystal clear.

In the above example, flight attendants and pilots both play very important roles, but undergo very different types of training. The same is true of medically licensed ophthalmologists and other eye care professionals like optometrists. Ophthalmologists are medical doctors and trained surgeons who must graduate from an accredited medical school and train for thousands of hours under supervised internships and clinical opportunities before they are allowed to safely perform laser eye surgeries on their own. Optometrists are vital for providing routine eye care and optical aids such as glasses and contacts but are not medical doctors and don’t undergo anywhere near the same level and extent of clinical training. 

Research shows a significant risk of complications when laser eye surgeries are not performed by a trained medical doctor, which is why the majority of states don’t allow optometrists to perform laser eye surgery. However, that may soon change as more states are expected to consider legislation that removes patient safeguards and dramatically loosens the scope of practice for these delicate surgeries on and near the eyes.

In 2024 numerous state legislatures will be faced with proposals that, if passed, would undermine the standards of safe surgical eye care. In most of these states, the bills will be reintroduced after lawmakers already quashed them previously dozens of times. Meanwhile, some lawmakers in Missouri and New Hampshire have filed similar bills — the first time such unsound legislation that could compromise quality eye care is being considered in these two states.

There is no reasonable justification for passing these harmful laws. Proponents argue that it will improve access and convenience for patients. But data suggests there is no access issue, as 90% of Medicare beneficiaries nationwide live within a 30-minute drive of an ophthalmologist. We must prioritize patient safety over an expansion of medical practice for individuals who simply are not qualified to perform eye surgery. 

This has become a national issue. Not just because so many states are considering this unnecessary legislation, but because the Department of Veterans Affairs is weighing policies that could expose America’s veterans to substandard surgical care. Since the Veterans Health Administration removed guardrails two years ago in its community care guidelines that specified only ophthalmologists can perform invasive eye surgery, it is considering going even further by loosening the scope of practice nationwide in its forthcoming National Practice Standards.

Understandably, some members of Congress and veterans groups are extremely upset about lowering the standard of eye care and potentially exposing veterans to unnecessary risks when undergoing eye surgery that impacts their vision. 

With lawmakers across the United States focusing on a wide range of important issues this year, it’s important for them not to lose sight of the high standards that keep patients safe every day — and heed the call of the 79% of Americans who oppose optometrists performing invasive eye surgeries.

Given the many flaws inherent in loosening the scope of practice for advanced eye procedures, we expect lawmakers to see through these attempts to increase patient volume at the expense of quality care, and work to shield Americans’ eyes from dangerous and unnecessary scope of practice expansion for unqualified providers. 

David H. Aizuss, M.D., is a board-certified ophthalmologist and American Medical Association Board of Trustees secretary. He can be found on X.