Ophthalmologists raise safety concerns as provinces consider allowing optometrists to perform minor surgeries
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Ophthalmologists are urging provincial governments not to move forward with plans that would allow optometrists to perform certain surgeries and laser eye treatments, which are currently outside their scope of practice.
Dr. Neena Ahuja, president-elect of the Canadian Ophthalmological Society, says surgery should remain in the hands of physicians and that turning even minor procedures over to optometrists is “200 per cent unsafe” for patients.
Ahuja is reacting to the news that the Ontario and Alberta governments are working with optometrists to implement proposed changes to their practice, which he says will improve access to eye care.
Both professions specialize in the eyes, but optometrists are the primary eye care providers, with a professional degree following four years of undergraduate education, and ophthalmologists are surgeons and ophthalmology doctors, with at least nine years of medical training, also following a graduate program.
Based on his over 20 years of experience 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 that of an air traffic controller and the role of an ophthalmologist to that of a pilot.
“The air traffic controller knows a lot about aviation. They’ve done a lot of things in that field. Your pilot has a completely different skill set. If you have a family and you’re going home for the holidays or you’re going home for the holidays, who do you want flying the plane? I know I would want a pilot,” she said.
A spokesperson for Ontario’s health minister says the changes could allow optometrists to perform minor surgical procedures in the office under local anesthesia, use laser therapy to manage cataracts and glaucoma, order diagnostic tests and treat open-angle glaucoma independently.
According to one study observed ophthalmic surgery In Ontario between 2010 and 2020, the number of patients waiting increased by 74 per cent, with the longest waiting lists for cataract, vitreoretinal and strabismus surgery.
Although none of them would be included in the proposed changes, allowing optometrists to perform additional tasks is meant to reduce pressure on doctors and hospitals that provide such care.
The Alberta College of Optometrists proposed broadening its scope of practice in 2020 to include small laser treatments, injections and superficial skin surgical procedures such as the removal of skin tags and moles.
Alberta’s Ministry of Primary and Preventive Health Services announced its support for the expansion last month, and now says it is working with the College of Optometrists to finalize the proposed changes.
Optometrists must undergo laser and minor surgical examinations and complete supervised clinical practice before being authorized to perform procedures.
The ministry says the college is prepared to “refine its proposals to address patient-safety considerations”, although it has not elaborated further on what this involves.
In the legislature Tuesday, the Alberta government and opposition debated the possibility of a hybrid health-care model, which could allow people to see doctors through the public system or by paying out of pocket in a private system. Travis McEwan takes a look at the debate and how the model could affect health care issues like waiting times.
Dr. Allison Scott, president of the Canadian Association of Optometrists, said the changes will not include operating room procedures such as retina surgery.
Scott says data from jurisdictions in the United Kingdom and the United States, where optometrists can perform laser procedures, shows it is safe and effective.
a review A published report of more than 146,000 optometrists who performed laser procedures in the US last year revealed two negative results.
Scott says optometry students are trained in the procedures offered, the complications that may arise and how to manage them, and their expertise must be tailored.
“There are rigorous courses in place to make sure we know the risks, know the safety profile and know that we can manage these cases safely.”
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