September 25, 2019
By Dr. Murray Feldstein
For many of our nation’s aging seniors, eye health can be among the most important health issues they face. It often means being able to see a grandchild’s face or being able to retain one’s independence though continuing to drive. It means not living a cloistered life.
While many eye conditions are treatable, too many Americans live in medically underserved areas and lack access to competent eye care. The Centers for Disease Control and Prevention (CDC) estimates that only two-thirds of the diabetics who are susceptible to retinopathy—which is simple to treat but often leads to blindness when left untreated—obtain preventive eye exams.
Fortunately, there is something that state lawmakers can already do to help alleviate this problem. A recent report by Avalon Health Economics, commissioned by the American Optometric Association, highlights the particular problems the elderly experience with eye disease. By allowing optometrists who are educated and trained in retinopathy to treat these patients, patients can have better access to the care they need.
Optometrists are like general practitioners for the eyes and already treat most Americans for their primary eye problems. They work in a variety of settings, including their own practices or in large outlets such as Walmart or Costco. Optometrists go through a lengthy training program: Most optometrists finish college before entering optometry school, which takes four years to complete.
By comparison, ophthalmologists, who are medical doctors (MDs) specializing in eye disease, go through four additional years of training. This is because they don’t receive their specialty eye training until after medical school. Thus, optometrists’ training is more focused than MDs and concentrated solely on eye disease.
While optometrists are not trained to perform the complicated eye procedures that only ophthalmologists can perform—such as cataract extractions or retinal surgery—they are very well trained to do the refractions, eye exams, and basic treatments that can diagnose or prevent the most common causes of blindness, such as macular degeneration, diabetic retinopathy, and glaucoma.
Current licensing regulations prevent optometrists in most states from practicing what they have been trained to do. Organized medical special interest groups advocate policies that suppress competition. While these groups cite patient safety as their only concern, all of the published data prove this objection is unfounded. As a physician with over 50 years of experience in both rural and urban-academic settings, I think the objection of organized medicine is biased by its self-interest.
Optometrists often practice in areas where there are no ophthalmologists. There has been growing recognition that not taking advantage of optometrists’ skills is foolhardy, and a number of states have subsequently liberalized their regulations. Over a period of two decades, optometrists in Oklahoma, Louisiana, and Kentucky have been permitted to prescribe eye medication, remove small growths from the eyelids, and use lasers to treat narrow angle glaucoma and other conditions.
There have been no reported adverse outcomes in those states for the tens of thousands of laser procedures performed by optometrists. Patients in communities without ophthalmologists were able to get safe and timely care from eye specialists without having to travel long distances.
This is a patient issue, not a political one. Both the Obama and Trump administrations have published White House reports urging reform of healthcare licensure. Healthcare providers, irrespective of the degrees behind their names, should be permitted to practice to the fullest extent of their training and competence—at the top of their license.
Dr. Murray Feldstein is a visiting fellow in healthcare policy at the Goldwater Institute.