A Slice of the EYE

The eyes are often referred to as the windows to the soul. A new piece of legislation makes them seem more like a money pie to be carved up and served to the highest bidder.

In yet another example of bumbledom, courtesy of the 2017 legislative session, Florida may soon allow non-surgeons to perform eye surgery. Really. HB 1037/SB 1168, which passed the state House Health Quality Subcommittee 8-7 two weeks ago, would allow optometrists to perform eye surgery after taking a 30-hour course. Optometrists, unlike ophthalmologists, are not medical doctors; contrast their maybe four years of doctor schooling with that of an ophthalmologist who’s spent at least about a decade learning the skills and trade, including hundreds and hundreds of hours practicing surgery under the supervision of other physicians, and tell me who you’d want holding a laser up to your retina.

No one is saying that optometrists aren’t qualified to perform certain, less-invasive medical procedures. Optometrists can provide excellent, basic eye care up to and not including surgery. Think of it this way: Your dental hygienist may be awesome—but when it comes time to get the gas, there better be a doctor holding the mask.

Right now just three states allow optometrists to perform surgery: Oklahoma, Kentucky and Louisiana, places that aren’t exactly on the leading edge of much, except maybe teen pregnancy and KKK membership. And there have been problems. A 2016 review of more than 1,300 cases found that patients receiving laser trabeculoplasty from optometrists in Oklahoma were more than twice as likely to require an additional laser trabeculoplasty than those who had the same procedure done by an ophthalmologist.

But medical school is hard, amiright? Why should people have to spend 10 years or so learning about the eyes and the rest of the body before they cut open eyeballs?

Well, for one, ’cause a bad outcome in eye surgery can cause blindness, which is a major bummer. And for two, ’cause the committee was fed a bunch of hogwash to convince its members to narrowly pass this bill.

“They got up in the house hearing and just absolutely lied,” said Christopher R. Seymour, executive director of Florida Society of Ophthalmology (FSO).

For example, an optometrist testified that there was a shortage of ophthalmologists who accept Medicaid, both around the state and in Manatee County. FSO reports that Florida has the sixth-highest concentration of ophthalmologists in the nation. And according to Doctor.com, there are 57 ophthalmologists within 25 miles of the Manatee County seat, Bradenton, who accept Medicaid, and 142 within 50 miles. I don’t know about you, but I’d rather travel 50 miles (though given the numbers, I wouldn’t have to) to have an actual doctor operate on my eyes than go down the street to the weekend doc.

Nevertheless, this legislation is being billed as a way to increase Floridians’ access to medical care because that’s an easy argument to get behind.

Seymour also pointed out that the assertion that people who can’t find an actual doctor to accept Medicare or Medicaid insurance should go to some glorified tech with a bachelor’s degree and a piece of paper essentially justifies establishing tiers of care for people based on income. But you won’t find that in the marketing materials that groups like the Florida Optometric Association (FOA) are pitching to legislators, to whose campaigns they’ve also doled out at least a cool $2.1 million, according to Miami New Times, which also reports that House Speaker Richard Corcoran’s brother Michael is one of a dozen lobbyists hired to advocate for this bill.

The law wouldn’t just let every Tom, Dick and Harry who went to optometry school and sacrificed a weekend learning how to be a “surgeon” whip out a scalpel or laser and get to surgery-ing—it will also allow them to prescribe Schedule 2 drugs, including everyone’s favorite: opioids. Definitely don’t have enough opioids in Florida.

A ’script pad is a great way to get patients in the door, though, which many believe is the real motivation for this bill.

A few weeks ago, Optometry Times’ chief optometric editor Ernie Bowling whined that when optometrists try to get a bigger share of the eye pie, “it seems that every special interest group comes out of the woodwork against us,” groups like “[o]phthalmology, the general medical lobby, you name ’em.” God forbid that licensed physicians advocate for allowing only real doctors to operate on eyeballs.

Also of note is the FOA’s 4th Quarter 2016 Legislative Report, which gives a big fist bump to all its members who “valued our profession enough to step up your level of engagement,” (that means money) without which “we would be unable to support our friends in the Florida Legislature and in turn, our collective voice and message could go unheard.”

It’s a good thing the legislature can hear them, because pretty soon, some unlucky patients might not be able to see them.