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Patients' safety at risk as HB36 enables Non-MDs ability to perform surgical procedues

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If HB 36 passes, it will enable optometrists (non-medical doctors) to perform medical and surgical procedures to treat eye diseases and conditions. These procedures include lesion excisions for aggressive forms of cancer, laser treatments that can cause serious blinding illnesses/ injury if not performed correctly and injections around the eye. 

What's the difference between an optometrist and ophthalmologist?

Optometrists, while trained in medical diseases and improving vision through glasses and contact lenses, are not experienced surgeons and complete just four years of post-graduate training. Ophthalmologists are medical doctors with specialized training that requires four years of post-graduate study, four years of medical school and an additional one to two years of fellowship. 

Per HB 36, optometrists will be able to perform delicate procedures, such as lasers and injections, after attending a weekend or online course. According to Connie Calvert, executive director of the Kentucky Board of Optometry Examiners, only 32 hours of classwork courses are required to be certified to use lasers in humans. And according to Earl Smith, president of the Association of Schools and Colleges of Optometry, most optometry students gain laser experience practicing on animals, mostly rabbits. Relatively few students have hands-on training on human eyes. Students have even less training in scalpel surgery. Per Smith, students only operate on people AFTER they graduate. 

However, ophthalmologists are trained surgeons. The American Academy of Ophthalmology and the Accredited Council for Graduate Medical Education internship/residency training requires four years. Residents perform more than 100 lasers and 100 eye injections on average with supervision, prior to graduation. 

Passing HB 36 puts patients at risk and increases costs 

Expanding the scope of practice of optometrists in North Carolina endangers public health and increases costs. 

In Oklahoma and Kentucky, where similar laws have been passed, wrongful surgeries have been performed leading to life-threatening situations and blindness. Examples include:

  • incomplete removal of squamous cell carcinoma, which leaves patients at risk for additional surgeries and spread of cancer
  • blindness caused by scarring of the cornea after a glaucoma laser surgery
  • removal of a bleb, a bubble above the eye created by a surgeon to lower intraocular pressure in the treatment of glaucoma. In this case, the patient's bleb was misdiagnosed as a conjunctival cyst

A recent study* in Oklahoma found that among the 1,384 eyes receiving laser trabeculoplasty, the proportion of eyes treated by optometrists requiring additional laser treatment in the same eye (35.9%) was more than double the proportion of those treated by ophthalmologists (15.1%). Eyes treated by optometrists had a 189% increased risk of requiring more laser trabeculoplasty. Excess treatment increases costs to the patient. 

People prefer to see ophthalmologists for management of serious diseases, as well as laser and scalpel procedures

  • Only 8% of people would go to an optometrist for glaucoma management, after learning that an optometrist does not attend medical school. (Angie's List)
  • Only 2-4% would trust an optometrist with eye injections and laser surgery after understanding the difference in training of optometrists and ophthalmologists
  • 95% of 600 Americans surveyed wanted a medical doctor performing laser or scalpel procedure on their eyes (National Consumer's League)

Ophthalmologists ARE accessible in all counties of North Carolina

None of North Carolina's 100 counties have less than nine ophthalmologists within 50 miles of the center of the county seat. 

Approximately 97.7% of North Carolina's population has access to at least 31 ophthalmologists within 50 miles of the county seat. 

Passing HB 36 will not improve care to patients or lower costs and is not needed in North Carolina  

The information provided above definitively illustrates why the passing of HB 36, not only threatens public safety, but will increase costs to patients. Most importantly, people do not want the procedures outlined in HB 36 performed by a non-medical doctor. These procedures have serious risks, including blindness, and should not be lightly expanded into the scope of non-medically trained optometrists. This bill does not serve the people of North Carolina and, if passed, could seriously threaten the quality of eye care they receive.

* JAMA Ophthalmol. 2016;;134 (10): 1095-1101. doi:10.1001/jamaophthalmol.2016.2495)

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