Louisiana’s Ophthalmologists and Optometrists Don’t See Eye to Eye


Bob Mannby Bob Mann

You may recall those entertaining commercials a few years ago for Holiday Inn Express, part of that company’s “Stay Smart” campaign. The humorous notion was that a good night’s sleep made you smarter and qualified you for demanding tasks for which you had no training.

My favorite spot featured an operating room filled with a bevy of nurses and a surgeon, standing around a patient on an operating table. As the operation is ending, the surgeon removes his surgical mask. “You’re not Dr. Stewart,” a startled nurse says. “No,” the man calmly admits, as he takes his leave, “but I did stay at a Holiday Inn Express last night.”

The spot’s tagline is, “It won’t make you smarter. But you’ll feel smarter.”

I can see!
I can see!

From all appearances, Louisiana’s optometrists have been resting well at their local Holiday Inn Express – so much so, they now feel smart enough to perform various surgical procedures on the eye that have always been reserved for ophthalmologists.

Ophthalmologists are physicians who attended four years of medical school, finished an internship and underwent a three-year residency in eye surgery. All of that training adds up to about 17,000 hours over eight years or more.

Optometrists, on the other hand, are people to see for glasses, contacts and routine eye care. They get four years of training, but not in surgery and they are not medical doctors.

Nonetheless, these well-rested optometrists have persuaded legislators that, after a few days of training, they’ll be qualified to perform all kinds of surgical procedures. Currently, only medical doctors licensed by the Louisiana State Board of Medical Examiners can perform invasive procedures on the eye.

As passed by the House and Senate, however, HB 1065 would allow optometrists to perform various ophthalmic surgery using scalpels, cryoprobes, lasers, electric cautery or ionizing radiation. Among the specific procedures the bill would permit is YAG laser capsulotomy, an outpatient treatment for cataracts, and laser peripheral iridotomy, a surgical treatment for glaucoma. The bill would wisely prohibit them from performing the sight-correcting LASEK or LASIK procedures, but I suspect that will be next. Optometrists in Oklahoma already can perform LASIK.

It’s all part of a movement by optometrists to expand their practices to include lucrative eye surgeries. So far, only Kentucky and Oklahoma have opened the surgical suite to optometrists.

Barber Training-40 hours!
Barber Training-40 hours!

In Louisiana, the state requires you to train for 1,500 hours to get a barber’s license. However, if you examine peoples’ eyes for glasses and contact lenses and wish to perform certain types of eye surgery, legislators believe that about 40 hours of training should suffice.

How did such an absurd piece of legislation make it this far, you ask? The bill’s author is ostensibly Rep. Rogers Pope, R-Denham Springs, but everyone around the Capitol understands the real force behind it is New Orleans Sen. David Heitmeier, chairman of the Senate Health and Welfare Committee, which overwhelmingly approved the bill.

It is no coincidence that Heitmeier is also an optometrist with a strong financial interest in expanding his scope of practice. Although Heitmeier surrendered his committee gavel and recused himself from the committee vote, his intense lobbying for the bill is well known around the Capitol.

Pope claims the bill is about expanding access to medical care “to people who have no opportunity to get eye care.” That suggests that Louisiana faces a shortage of ophthalmologists when, in fact, one estimate puts us at 15th in the nation, per capita, for the number of eye surgeons.

Ethis? Moral? DUH!
Ethics? Moral? DUH!

Pope and his colleagues are actually trying to expand access to the millions of dollars that patients and their insurance companies now pay to highly trained eye surgeons, more of which would soon be going into the optometrists’ pockets.

If you’re not sure whether you support this radical change, ask yourself: Would you allow a chiropractor to inject epidural steroid injections into your spine for your back pain? Would you let a dental hygienist drill your teeth to fill a cavity? Would you want a pharmacist to prescribe a narcotic for your migraines? Would you ask an audiologist to put tubes in your child’s ears?

My guess is your answer to all these questions would be an emphatic no — even if each of those health care professionals slept for a solid month at a Holiday Inn Express.

Sixty-six House members and 25 senators voted for this reckless bill. Perhaps Gov. Bobby Jindal will be just as heedless of common sense as legislators, but it’s clear to anyone with eyes to see that he should veto this legislation.

If Jindal cares about our eyes, the ayes should not prevail.