Expanding optometric scope of practice will improve health care delivery

By Dr. Lisa Gontarek

In his Feb. 4 opinion piece, “Eye surgery should be left to the experts,” Dr. Michael Keverline blurred the lines of reality regarding critical legislation that will help Virginians see more clearly.

During this year’s General Assembly, legislators are considering optometry legislation to allow Virginia’s optometrists to perform three in-office laser procedures to treat glaucoma and provide after-cataract surgery care. These procedures can already be performed by optometrists in eight other states — but in Virginia, can only be completed by an ophthalmologist. Contrary to what Dr. Keverline suggests, these procedures are low-risk and effective treatments that allow patients to quickly resume living, working and driving with better vision – and will become more in-demand as Virginia’s population ages.

Consider these statistics from the National Eye Institute. There are currently more than 24 million Americans with cataracts, a number that is expected to double over the next 30 years. Glaucoma affects more than 3 million Americans over age 40, a number that is expected to reach 4.2 million by 2030. This means the need for the procedures included in our legislation also will increase in the coming decades.

Optometrists earn doctorate degrees upon completion of four years of optometry school and specialize in the diagnosis and treatment of eye and vision problems. Optometric education includes more than 10,000 hours of didactic and clinical post-graduate training focused on the eye, its components, medical treatments and the more than 270 systemic diseases that manifest themselves in the eye including diabetes, hypertension and cancer. While a component of our job includes fitting patients for glasses and contact lenses, Virginia’s optometrists have also been treating glaucoma for 25 years and managing after-cataract conditions for almost 40 years. All U.S. optometry schools train students to perform these laser procedures, and although many optometrists are currently trained and certified to perform them, Virginia law doesn’t permit us to do so.

Dr. Keverline suggests allowing optometrists to perform these procedures would “lower the professional standards of care without improving access to it, and harm Virginians along the way.” Doctors of optometry have the training and are just as capable as ophthalmologists of providing these treatments. To suggest otherwise is just not the case. These exact procedures have been performed by doctors of optometry in other states over 100,000 times without any patient harm. Expanding optometric scope of practice would increase access to care and reduce potential complications for patients who would otherwise have to wait for treatment by an ophthalmologist. According to the American Optometric Association, doctors of optometry provide more than two thirds of primary eye health care in America, and more than 99 percent of the U.S. population lives in counties with an optometrist. More than half of Virginia’s counties do not have a practicing ophthalmologist.

As a practicing optometrist for more than 24 years, I am committed to a code of ethics, optometric oath and standards of professional conduct as outlined by the American Optometric Association. Included in my commitment is my promise that the health of my patient will be my first consideration and that I will practice the art and science of optometry to the fullest scope of my competence. I consult and collaborate with my health care colleagues and refer my patients to other specialists as needed. If Virginia’s legislators approve these bills, Virginia’s optometrists will be required to obtain certification by a college of optometry, complete hands-on training and pass an examination in order to perform these procedures.

Dr. Keverline inaccurately states, “the Department of Veterans Affairs prohibits optometrists from doing these procedures.” In fact, an August 2020 update to the Veterans Health Administration’s Eye and Vision Care Policy issued a directive emphasizing the use of interdisciplinary care allowing doctors of optometry to perform these laser procedures for our nation’s heroes. In effect, the directive proved that veterans are best served when doctors of optometry deliver care with full practice authority.

Finally, Dr. Keverline states, “only 10 percent of Virginia voters would be comfortable with an optometrist performing a laser-eye treatment.” What he failed to mention is that the poll was commissioned by the Virginia Society of Eye Physicians & Surgeons, the same organization of which Dr. Keverline serves as president. Data was collected from 625 registered voters — or less than one percent of the more than 5.95 million registered voters in Virginia.

For nearly 40 years, Virginia’s optometric scope of practice has evolved with our education and training and has never been repealed. HB 213 and SB 375 are about continuity of care and reducing potential complications for patients who would otherwise have to wait for treatment.

Ask your legislators to support HB 213 and SB 375 today to help Virginians stay healthy and see more clearly.

Dr. Lisa Gontarek is president of the Virginia Optometric Association. She practices in Chesapeake, Va.