It goes without saying that patients want the most qualified and experienced person operating on their eyes, especially for complicated procedures or conditions that could result in things like vision loss.
Professionals operating on our eyes must be qualified and have significant training in the procedures they're doing. However, that may not be the case much longer, if a pending bill makes its way through the California Legislature.
SB492 is legislation that would further blur the lines between what an ophthalmologist and an optometrist can do. The training distinction between these professionals is significant. An ophthalmologist has undergone years of training -- about twice as much as an optometrist -- and has performed hundreds of training procedures on live human patients. This ensures they are supremely equipped to perform delicate procedures on the eyes.
Yet, SB492 turns a blind eye to this very important aspect of being able to safely deliver eye care.
Essentially, the bill would allow optometrists to perform some of the same eye surgeries and procedures as ophthalmologists, but with only a tiny fraction of the training currently needed.
How different is the training between the two professions? Vastly different. An ophthalmologist attends four years of medical school, serves another year as an intern, then spends an additional three years as a resident during which time hundreds of surgeries are performed.
At the end of these eight years, an ophthalmologist has achieved the competence necessary to perform the most intricate operations on the eye.
In contrast, SB492 does not require surgical training be performed on live patients in all, or even most cases, and only requires a minimal numbers of procedures. Plus, it doesn't even require trainees to perform entire surgeries. That means lesser-trained professionals would be performing procedures that would risk the sight of many patients across California.
If passed, SB492 would allow optometrists to remove eyelid lesions (that could be cancer), do laser surgery to treat glaucoma and other conditions, and administer injections into the eyelids and even into the eye.
The unfortunate part is we've already seen tragic cases of what happens when optometrists practice beyond their capabilities, which is what makes SB492 even scarier.
Just a few years ago, right here in Northern California, the Department of Veterans Affairs Palo Alto Health Care System conducted a three-month internal review after a patient was found to have lost vision and discovered that 23 patients experienced "progressive visual loss" while receiving treatment for glaucoma from the hospital's optometry service. And what did the VA review conclude? It decided that the fundamental problem was that the optometrists involved were practicing beyond their scope.
So why are the proponents of SB492 trying to pass a law that will likely endanger the safety of patients? They claim that under the new federal health care law, many new Californians will be insured but unable to find access to ophthalmologists.
Luckily though, the profession of ophthalmology is seeing an increase in the number of medical students entering the field of ophthalmology, so the proponents' argument is moot. Besides, you don't increase quality by lowering standards.
Eye surgery is too difficult, too technical and too important to be handed off to anyone other than someone with appropriate and substantial training.
That's why SB492 is bad policy for the state and bad medicine for the people. I urge the California Legislature to stand up for quality health care and for patient safety and reject this legislation.
Patricia Austin, MD, is the past president of the Alameda Contra Costa Medical Association and Trustee, California Medical Association. She is a resident of Walnut Creek.