Johanna Jensen: Eye surgery requires extensive, supervised training

This week, the Idaho House of Representatives passed House Bill 317, which would allow optometrists in our state to perform certain surgeries now performed only by trained medical doctors.

These lasers cut tissue and are therefore scalpels. When I learned how to do surgeries and laser procedures on eyes during my surgical residency, I had several years of supervised training by experienced ophthalmologists. We learned how to deal with complex patients and innumerable variations in human anatomy. Most importantly, as an eye surgeon, I learned when NOT to operate.

I use lasers to treat the inside of the eye almost every day, but only after performing hundreds of procedures during my residency. These lasers make cuts inside the eye to treat glaucoma, scar tissue that can form after cataract surgery, and retinal tears.

I believe anyone who is adequately trained to do a procedure can do so. Today, there are no national surgery training programs for optometrists. Currently only two optometry schools are in states where optometrists are permitted to perform laser or scalpel surgery. Optometrists do not currently have the training and supervision required to perform safe surgery on your eyes.

Idaho’s statute currently prohibits optometrists from performing laser surgery. Lasers can cut as deeply and as permanently as any scalpel. Laser surgery done incorrectly can result in permanent blindness. The 32-hour optometric training course referred to in House Bill 317 uses artificial eyes and tissue, and does not involve supervised procedures on humans.

For an optometrist to be certified in Idaho, under House Bill 317, only five laser procedures on patients would need to be observed by a certified optometrist or ophthalmologist, and scalpel surgeries are not required to have any supervision whatsoever. This is unacceptable. An error of less than 1 millimeter with a scalpel could result in permanent blindness. There are no shortcuts when it comes to acquiring the medical knowledge and surgical skills to perform delicate eye surgery.

This bill is not a turf war. Ophthalmologists work with optometrists every day, both in my own office and around the state, to ensure Idahoans have the best treatment for their eyes. This bill isn’t required to improve access to eye care in rural areas. Ninety-five percent of Idahoans are just as close to a Walmart as an ophthalmologist. This bill isn’t necessary to provide better emergency eye care for our population. If you have a tear in your retina, or uncontrolled pressure in your eye, I or my colleagues can treat you that day.

Only three states in our country are currently allowing optometrists to use lasers. Just last year, 11 states looked at this exact same issue and determined it is not safe for their population. I am asking you to contact your senator and ask him or her to vote against this dangerous bill. Legislation should not replace education. Please tell your senator that House Bill 317 poses an unnecessary threat to patient safety and the quality of surgical care Idahoans enjoy.

Johanna Jensen, MD, is immediate past president of the Idaho Society of Ophthalmology.