Optometrists are primarily trained to examine a patient's eyes for screening functions and vision prescriptions, including corrective lenses, glasses and contact lenses. Had a proposed California bill not been vetoed by Gov. Gavin Newsom, those responsibilities would have suddenly included complex surgical procedures using scalpels and lasers.
Minimal additional training would have been required for optometrists as part of California Assembly Bill (AB) 2236, had it passed.
"Surgery on or around the human eye is not something to be taken lightly," said David H. Aizuss, MD, an ophthalmologist in Calabasas, California, and a member of the AMA Board of Trustees. "It is one of the most intensive things that a patient can undergo because one false movement inside the eye can result in loss of vision or even total blindness."
Dr. Aizuss discussed the opposition to AB 2236, the distinct differences in training between optometrists and ophthalmologists, and how the AMA worked with other physicia006E organizations to oppose the bill in a recent episode of “AMA Update.”
Distinctions between optometrists, ophthalmologists
The training called for "in AB 2236 was a far cry from the rigor that exists for training eye physicians and eye surgeons," Dr. Aizuss said. "And the reduction in surgical licensing requirements that would have occurred would have been tremendously detrimental to patient safety."
Fighting scope creep is a critical component of the AMA Recovery Plan for America’s Physicians.
Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety.
Optometrists have limited medical therapeutic training and would only be required to take a 32-hour training course, Dr. Aizuss said, compared with ophthalmologists who complete at least four years of residency training after medical school. Three of those years are in a surgical residency program following a one-year internship.
During that time, ophthalmologists learn about safe and effective surgical and pharmacological treatments, as well as other interventions that may be appropriate depending on the individual medical needs of the patient.
"Ophthalmology training has to include not only the technical skills to perform a procedure but also the medical knowledge that's needed to analyze when surgery is clinically indicated," Dr. Aizuss said.
AB 2336 was amended to create a certification program with extra training requirements for optometrists wanting to perform these advanced surgical procedures, but the change was not enough, he said. The proposed amendment also did not account for the medical needs of certain populations, specifically geriatric and pediatric populations.
"The delicate nature of these procedures can result in damage to the eye if done incorrectly, which is irreversible for the patient," Dr. Aizuss said. "Had this bill passed, it would have exposed patients to really serious risks, loss of vision or even life-threatening consequences."
Optometrists doing eye surgery? Learn more about why the radical California bill was vetoed on safety grounds.
Standing together made the difference
The AMA continues to fight similar legislative initiatives across the country that could negatively affect patient care. That is why the AMA founded the Scope of Practice Partnership, a collection of 105 national, state and specialty medical associations to ensure patient care is led by highly trained physicians.
The partnership provides resources needed to battle pieces of legislation that would create inappropriate scope of practice expansion, Dr. Aizuss said.
"The AMA immediately, on the request of the California Medical Association, pointed out the differences in education and training of ophthalmologists and optometrists through letters to the legislature and directly to Gov. Newsom," Dr. Aizuss said. "This was an episode where medicine's unified opposition clearly made a difference."
Read more about why stopping scope creep is about protecting patients.
“AMA Update” covers health care topics affecting the lives of physicians and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more—because who’s doing the talking matters. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.