Ophthalmologists are urging provincial governments not to move ahead with plans that would allow optometrists to perform some surgeries and laser eye treatments, which are currently outside their scope of practice.
Dr. Nina Ahuja, president-elect of the Canadian Ophthalmological Society, says surgery must remain in the hands of physicians and handing over even seemingly minor procedures to optometrists is “200 per cent unsafe” for patients.
Ahuja is responding to news that the Ontario and Alberta governments are working with optometrists to implement proposed changes to their practice, which they say would improve access to eye care.
Both professions specialize in the eye, but optometrists are primary eye care providers, with a four-year professional degree after an undergraduate education, and ophthalmologists are surgeons and eye disease doctors, with at least nine years of medical training, also after an undergrad program.
Based on her more than 20 years as an ophthalmologist, Ahuja said surgery is not just about technical training, but understanding how the entire body works, and the relevance of a patient’s medical history.
She compares the role of an optometrist to an air traffic controller and an ophthalmologist to a pilot.
“The air traffic controller knows a lot about aviation. They’ve done a lot of things in that realm. Your pilot has a completely different skill set. If you’ve got a family and you’re travelling home for a vacation or you’re travelling home for the holidays, who do you want to be flying the plane? I know I would want the pilot,” she said.
A spokesperson for Ontario’s health minister says the changes could allow optometrists to perform minor in-office surgical procedures under local anesthesia, use laser therapy to manage cataracts and glaucoma, order diagnostic tests and independently treat open-angle glaucoma.
According to a study that looked at ophthalmological surgeries in Ontario between 2010 to 2020, the number of patients waiting grew by 74 per cent, with the longest wait-lists for cataract, vitreoretinal and strabismus surgeries.
While none of those would be included in the proposed changes, allowing optometrists to take on additional tasks is meant to reduce pressure on doctors and hospitals that provide such care.
The Alberta College of Optometrists proposed broadening their scope of practice in 2020 to include minor laser treatments, injections and superficial skin surgical procedures, such as the removal of skin tags and warts.
Alberta’s Ministry of Primary and Preventative Health Services announced its support of an expansion last month, and now says it is working with the optometrists’ college to finalize proposed changes.
Optometrists would be required to pass laser and minor surgical examinations and complete supervised clinical practice before being authorized to perform the procedures.
The ministry says the college has been willing to “refine its proposals to address patient-safety considerations,” although it has not expanded further on what that entails.
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Dr. Allison Scott, president of the Canadian Association of Optometrists, said the changes would not include procedures that take place in an operating room, such as retinal surgeries.
Scott says data from jurisdictions in the United Kingdom and United States, where optometrists can perform laser procedures, shows it’s safe and effective.
A review published last year of more than 146,000 optometrists performing laser procedures in the U.S. showed two negative outcomes.
Scott says optometry students are trained in the procedures proposed, the complications that may arise and how to manage them, and that their expertise should be optimized.
“There are rigorous courses to make sure that we know the risks, know the safety profile and know that we can manage these cases safely.”
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