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Eye exam

A free eye exam is performed on a patient at the Remote Area Medical clinic inside the Los Angeles Sports Arena in April 2010 in Los Angeles.

The Wyoming Legislature is halfway toward approving a bill that would allow optometrists to begin performing certain noninvasive procedures, though more specialized eye surgeons oppose the effort.

At issue is Senate File 55, a measure that passed the Senate last week and is waiting for movement in the House. The bill would expand the scope of practice for Wyoming optometrists, allowing specialists with “training from a(n accredited) college of optometry” to perform certain noninvasive procedures, according to the bill, such as treating infected eyelid glands. Optometrists would also be able to perform three types of “noninvasive” laser procedures, according to the bill; LASIK surgeries and cataract surgery would be prohibited.

Optometrists spend four years after college to become doctors of optometry. Ophthalmologists, meanwhile, are medical doctors who go through similar education as other physicians and are capable of providing more specialized treatment, like surgeries.

“Optometry is a regulated profession and scope of practice should not be a political issue but an issue of patient access to quality eye health and vision care,” Kari Cline, the director of the Wyoming Optometric Association, wrote to the Star-Tribune in a statement. “ ... The Wyoming Optometric Association fully supports updating the scope of practice to allow Wyoming doctors of Optometry to practice to the full extent of their training and education.”

“This bill is a radical departure from our current high standard of patient care in Wyoming,” said Anne Miller, the president of the Wyoming Ophthalmological Society, which opposes the effort. “Vision is precious, and we’re truly concerned about patient safety in Wyoming.”

Other states have taken similar steps in recent years, and more are currently considering the move. The Wyoming Legislature is considering a somewhat similar bill that would allow patients to receive physical therapy with or without a prescription (that bill passed the House and was sent to the Senate this week).

To bolster its case, the ophthalmologist society polled 501 registered voters here and says the results demonstrate that Wyomingites don’t support the legislation.

“After respondents were informed about the differences in medical training that an ophthalmologist must complete to be certified in comparison to an optometrist, 71% oppose the legislative proposal,” Magellan Strategies, which conducted the poll, wrote in its report. “Among Wyoming voters who have used the services of an ophthalmologist, an optometrist, or both, only 25% of respondents support the proposal.”

“73% of Wyoming voters were less likely to support the legislative proposal after being informed that patients that had laser surgery for glaucoma performed by optometrists were three times more likely to need repeat surgery,” the poll continued.

In October, the Journal of the American Medical Association published a study of 1,384 eyes that underwent laser trabeculoplasty — a procedure to treat glaucoma that the Wyoming bill would authorize optometrists to perform. Nearly 36 percent of the eyes who underwent the procedure conducted by an optometrist needed additional laser surgery. In comparison, just over 15 percent of eyes who were treated by an ophthalmologist needed the treatment repeated.

In the study, a vast majority of the 1,384 eyes were treated by ophthalmologists. Just 234 of them were treated by optometrists.

“Considerable differences exist among the proportions of patients requiring additional (treatment) comparing those who were initially treated by ophthalmologists with those initially treated by optometrists,” the study’s authors, led by ophthalmologist Dr. Joshua D. Stein, concluded. “Health policy makers should be cautious about approving laser privileges for optometrists practicing in other states until the reasons for these differences are better understood.”

When asked about the polling data, Rep. Eric Barlow — a Gillette Republican and the chairman of the committee that sponsored the legislation — was unmoved.

“On the Optometrist bill... who the heck polls on practice act stuff.... really? enough said,” he said in an email to the Star-Tribune.

The Wyoming optometrist group said the procedures the act would allow them to perform were safe and that the opposition by the other eye doctors was common.

“In those states that have passed this type of expanded optometric care, some as long as twenty years ago, there have been no reported adverse outcomes from the expansion, zero lawsuits and no rising malpractice insurance,” Cline wrote in a statement response to questions from the Star-Tribune.

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She added that optometry students “are currently receiving the education and passing exams” to perform the procedures the bill would allow. The bill would require more education for current optometrists and would expand the scope only for optometrists who’ve received training.

But Miller, who heads the ophthalmologist group, said the difference of training between her physicians and optometrists is significant. She stressed that “this is not a turf battle” and said that “optometrists are an essential part of the eye care team.”

“The education that ophthalmologists get through their residency, that’s where we learn to become surgeons,” she said. “We see patients day in and day out. ... And it is not possible for optometrists to get that same degree of training but also the experience you get in the pre-operative evaluation as well as learning how to treat the complications that will arise when you perform procedures.”

Miller said she couldn’t understand why optometrists and state lawmakers — who voted overwhelmingly in the Senate to advance the bill to the House — were pushing for expanded scope. She said none of the procedures that would be authorized by the bill are urgent, and patients can be referred to an ophthalmologist for them.

“The good news is there truly is not an access problem in Wyoming,” she said. “Optometrists and ophthalmologists work together. We’re all part of the same team. (Optometrists) provide an invaluable service.”

Cline, the executive director the optometrists group, said optometrists provide care for 98 percent of Wyoming and they are the only eye care for most of the state’s counties.

“Despite broad access to optometric care, residents of Wyoming are restricted from getting a full range of optometric care and services,” she wrote in her statement. “This bill will help patients in Wyoming gain access to care that is readily available but restricted due to outdated regulations. With these changes Wyoming can once again provide up to date, best possible patient care.”

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Follow education reporter Seth Klamann on Twitter @SethKlamann

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Education and Health Reporter

Seth Klamann joined the Star-Tribune in 2016 and covers education and health. A 2015 graduate of the University of Missouri and proud Kansas City native, Seth worked for newspapers in Milwaukee and Omaha before coming to Casper.

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