Washington state patients would benefit from updated eye care laws | Opinion
This year, optometrists from across the state are asking the Legislature to update Washington’s scope of practice law that currently prevents them from caring for their patients to the full extent of their training.
The law in question hasn’t been significantly updated in two decades. When the last update occurred, the iPhone was still on Steve Jobs’ drawing board at Apple. Just as personal communication technology has evolved dramatically since then, so too have optometric procedures, technologies, medications, and training.
Collectively, these advances have significantly improved how optometrists can care for their patients. Our peers in other states currently perform a range of straight-forward in-office procedures, deliver injections around the eye, and prescribe certain oral medications — all elements of patient care that we are fully trained to provide, but prohibited from doing here in Washington.
What does this mean to you as a patient? More cost and more hassle.
When we have to refer a patient to an ophthalmologist for a procedure we are trained to perform, it means at least one additional doctor appointment. Patients often incur more time away from work, more travel time and expense, and childcare costs. A recent study identified low-income and minority patients to be among those most likely to be affected.
In addition to the expenses involved, prohibiting optometrists from fully using their education and training also can mean significant delays to treatment because referral times can be three months or longer in most areas of the state. Some patients will look at the time, money and inconvenience involved and opt to delay or, worse yet, forego treatment they need.
Ophthalmologists opposing this much-needed update to the state’s optometric scope of practice laws argue that optometrists aren’t sufficiently trained to perform the procedures being proposed.
That argument ignores the fact that optometrists in other states are already safely providing this care. The state Department of Health’s review of the proposed bill found that other states report no evidence of increased adverse outcomes when trained optometrists perform the procedures versus when they are done by ophthalmologists.
In Oklahoma, for instance, where 50,000 in-office laser procedures have been completed since first authorized in 1998, there have been no complaints registered with the Oklahoma Board of Examiners in Optometry.
It also ignores another fact confirmed by the DOH analysis: All 25 optometry schools across the country provide classroom and clinical instruction on oral steroid prescriptions, therapeutic injections, eyelid lesion removal, and the proposed in-office procedures.
Finally, it ignores ophthalmology’s history of waving red flags whenever advances in optometric scope of practice are proposed, concerns that simply haven’t materialized. Ophthalmologists warned of dire consequences if optometrists’ were given authority to administer dilating drops, as well as other oral and topical medication prescribing privileges. None of these predicted disasters occurred, and optometrists use these treatment tools safely and without complication daily.
Optometrists complete four years — thousands of hours — of intensive classroom and clinical post-graduate training focused on the anatomy, diseases and treatment of the eye. After that, we must pass rigorous board exams to obtain a license and comply with strict continuing education requirements to maintain that license.
Taking all this into consideration, the DOH concluded, “these procedures are safe … when performed by a trained and qualified optometrist.”
This is not to say that an optometrist is trained or qualified to do everything that an ophthalmologist can do. We aren’t. That’s why our proposed legislation specifically exempts dozens of procedures from our authority, including LASIK, cataract removal, and any procedure requiring general anesthesia.
Access to health care is a serious problem, and as our population ages, eye care is an area of growing concern. There are three times as many practicing optometrists in the state as there are ophthalmologists. Allowing these trained professionals, who serve as the primary eye care provider to most patients, to practice to the full extent of their training will reduce costs for everyone, improve patient convenience, and increase access to timely, high-quality eye care.
It’s time for lawmakers to modernize optometry’s scope of practice in Washington state.
Dale Tosland, O.D., is an optometrist practicing in Olympia. He is Diplomate of the American Board of Optometry and President-Elect of the Optometric Physicians of Washington.