What Should be the Line between Optometry and Ophthalmology?

on May 10th, 2011 | Filed under Optoblog

Kentucky now joins Oklahoma as the only states that explicitly allow optometrists to perform laser surgery on/around the eyes and even lumps and bumps removal.  (Read the article here.  H/T to kevinmd.  Also see a news article here.)

When people ask me what’s the difference between an ophthalmologist and an optometrist, I always like to say, “Optometrists do everything an ophthalmologist does except surgeries.”  (By the way, I don’t consider foreign body removal a surgery. Chalazion removal- yes, definitely a surgery.)  Even one of the ophthalmologists in the feature story seems to agree with that statement:

“We draw the philosophical line in the sand with surgery,” says Dr. David Parke, chief executive officer of the American Academy of Ophthalmology.

Of course, proponents of the bill think that allowing ODs to perform laser surgeries is good for people because, as Governor Beshear explains:

“I signed Senate Bill 110 to give Kentuckians greater access to necessary eye care.”

Now, I would probably refute that it gives people, particularly rural people, greater access to eye care. For a doctor to buy all the necessary equipment to perform a YAG capsulotomy, he would need to invest in a pretty expensive piece of equipment. To keep up payments, he would have to do a lot of procedures. How many YAGs does a rural optometrist usually see a month? Probably not a lot. How far away is the surgeon who did the patient’s cataract surgery in the first place? Probably not that far.

subtenon injection

subtenon injection


subtenon injection materials

subtenon injection materials

Optometrists are already trained in school to do periocular injections, but can an optometrist be trained to do YAGs? Absolutely. It’s an easily learned skill that is widely studied for potential complications and side effects. This stuff is not magic- it just needs training. But it’s also a skill that, if not done regularly, can get lost. If I had a patient tomorrow that needed a subtenon’s injection, I would have to refer them out because I haven’t had to do one since leaving optometry school. No way would I feel comfortable. I also think that it’s in the patient’s best interest to have a procedure done by someone who does that particular procedure regularly.

Anyway, I kind of like my definition of optometrist. What do you all think?

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