When it comes to health care, there’s no substitute for education. Seeing a health professional who doesn't have adequate training for the type of care required can result in poor quality care, risks to patient safety and adverse outcomes such as hospitalization, blindness or even death. Lawmakers should therefore tread very lightly when considering proposed scope of practice changes that would allow optometrists to perform scalpel or laser surgery.
Patients understand what’s at stake too. Fully 89% want only ophthalmologists to be allowed to perform eye surgery.
Not all doctors are created equal
All optometrists have completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (OD) degree. Some also complete an optional residency in a specific area of practice, but there is no mandatory postgraduate training in optometry.
By contrast, ophthalmologists are physicians—either medical doctors, MDs, or doctors of osteopathic medicine, DOs—whose education and training consists of pre-professional undergraduate education in a college or university, four years of medical school, four years of residency training, and about 40% of ophthalmology residents go on to do an additional one- or two-year fellowship in a subspecialty. All of that is preceded by the four years it typically takes to earn a bachelor’s degree.
In addition, whereas optometrists receive about one-year in clinical rotations, ophthalmologists get more than 12,000–16,000 hours during their training.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety.
Leave surgery to ophthalmologists
But it’s not just the length of education that sets ophthalmologists apart from optometrists; it’s also the nature of their training.
Optometrists’ education and training is focused almost entirely on examining the eye for vision prescription, dispensing corrective lenses, and performing some eye screening functions.They may provide low-vision rehabilitation, vision therapy, spectacle lenses and contact lenses, but they are never trained to perform surgery, whether it be with a laser or a scalpel.
Ophthalmologists, on the other hand, are trained specifically to safely perform surgery, to anticipate and address unexpected medical events or complications both during and following surgery, and to effectively manage a patient’s medical care. This includes training in the preoperative ophthalmic and general medical evaluation and assessment of indications for surgery, from surgical risks and benefits to local and general anesthetic considerations. They are also trained in management of systemic and ocular complications from surgery and anesthesia.
The upshot: Optometrists are great for eyeglasses and contacts, but not for surgery.
Learn more with the AMA about what sets apart physicians and nonphysicians. Also, visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
The threats are real
Arkansas, Colorado, Kentucky, Louisiana, New Mexico, Oklahoma, Tennessee, Virginia and Washington have all passed laws allowing optometrists to perform surgery and other procedures that had previously been prohibited within their defined scope of practice. In addition, California passed a bill in 2022 that would have allowed optometrists to perform advanced eye procedures—including surgery—after completing just an additional 32-hour weekend training, had it not been vetoed by Gov. Gavin Newsom.
Stay up to date on fight against scope creep
See how the AMA defends against scope of practice expansions that threaten patient safety.
And in 2023, more than a dozen state legislatures considered optometry scope of practice bills. Only one state passed a bill allowing optometrists to perform advanced procedures—and it did not include laser surgery. Each year brings new challenges, yet to date the overwhelming majority of states do not allow optometrists to perform surgery.
“It's important to really make clear that 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,” said David H. Aizuss, MD, an ophthalmologist in Calabasas, California, and a member of the AMA Board of Trustees, on an episode of “AMA Update.”
“Surgery on or around the human eye is not something to be taken lightly,” added Dr. Aizuss, who appreciates that there is a special place for optometrists on an eye care team—he has six of them working in his practice. But, he noted, students of optometry are not exposed to standard surgical treatment, standard surgical procedure training, aseptic surgical technique or the medical response to adverse surgical events.
“This legislation crystallizes how scope creep can result in threats to patient safety,” he said. “Surgery in the eye is neither risk free, nor uncomplicated. 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.”
Learn more with the AMA about great resources that set the record straight for policymakers on scope of practice. The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to use when fighting scope creep.
