Protect Eye Surgery in South Dakota
By Dr. Ryan Geraets and Barbara Smith
Tomorrow, the South Dakota Health and Human Services Committee will consider a bill (SB 87) that seeks to expand the scope of practice for the profession of optometry to include surgery on and around the eye with instruments such as scalpels and lasers. As leaders in the South Dakota medical community, we adamantly oppose this legislation. Expanding the scope of practice to allow non-surgically trained optometrists to perform surgical procedures puts South Dakota patients at risk.
The average patient may not know the difference between optometrists and ophthalmologists—but there is a big difference. Ophthalmologists are medical doctors and trained eye surgeons—optometrists are not. Optometrists are valued members of the eye care team and undertake a four-year training program focusing on eye examination and disease identification. But they do not properly train in performing surgery. They learn about specific, minor procedures but do not undergo the necessary education and training to perform the surgeries included in the proposed bill.
Ophthalmologists, on the other hand, are medical doctors and trained eye surgeons. They undergo at least 10,000 more hours of training than optometrists and attend four additional years of residency, where they must complete hundreds of hands-on, supervised surgical procedures.
As South Dakota doctors who perform eyelid surgery and laser surgery inside the eye, we can attest that these are not minor surgeries. Among surgeons, eye surgery ranks as one of the most risky, invasive surgeries for a patient. We cannot forget the patient as we debate who should be able to perform these surgeries. Our first priority should be our patients and their vision.
Today, South Dakota is rightfully in line with an overwhelming majority of states that exclusively allow ophthalmologists to perform laser eye surgeries on patients, but SB 87 seeks to dilute our quality of care. This bill is part of a larger national agenda by the optometry profession stemming from an aggressive and well-funded optometry lobby. Advocates incorrectly claim that allowing optometrists to perform eye surgery would improve availability and access to eye care. Medical research, however, shows there is no significant increase in accessibility to eye care in states that allow optometrists to perform eye surgery.
In states that have enacted similar legislation, patients have been hurt. A few years after the Louisiana legislature mistakenly expanded optometrists’ scope of practice to allow them to perform surgery, a Texas resident named Charlotte was told by a local optometrist that she required laser surgery. The state of Texas rightfully prohibits optometrists from performing surgery, but instead of referring her to one of many ophthalmologists near her home who would have been happy to treat her, Charlotte’s optometrist convinced her to drive six hours to have laser eye surgery performed by one of his optometry colleagues in Louisiana.
Surgery that would have taken an ophthalmologist less than 10 minutes lasted more than two hours, and Charlotte woke up to swollen eyes, extreme pain, and discomfort. As a result of the optometrist’s laser surgery, Charlotte suffered irreversible eye damage to both of her lenses.
We cannot let this happen in South Dakota. The surgical expansions in SB 87 are dangerous and would dramatically reduce the quality of eye care in our state, potentially hurting people and causing irreversible damage. As leaders in our state’s medical community, we urge the members of the House Health and Human Services Committee to vote no on SB 87. There are no shortcuts to safe surgery.
Ryan Geraets, MD, is an ophthalmologist in Sioux Falls and serves as President of the South Dakota Academy of Ophthalmology. Barb Smith is CEO of the South Dakota State Medical Association.