A misleading proposal under consideration in Augusta, LD 1803, is being marketed as a mere “modernization of eye care.” In reality, the proposal would endanger patient safety standards by allowing optometrists — who are not medical doctors or trained surgeons — to perform various types of surgery on and around the eye using lasers, scalpels and needles.

This proposal is part of a national wave, and follows in the footsteps of similar bills rejected in neighboring New Hampshire and Vermont. As was proposed in those states, optometrists would be able to perform a wide range of surgeries simply by completing a mere 32-hour course on plastic models.

Optometrists are a key part of the eye care team, performing important services when it comes to primary eye care: diabetic exams, monitoring for cataracts and performing lens prescriptions, for example. However, they don’t attend medical school or surgical residency and are not adequately trained to perform the surgeries allowed in the proposal.

Ophthalmologists are medical doctors specially trained in eye surgery, and their training is critical for managing complex ocular conditions and surgical complications. Ophthalmologists graduate with over 144 weeks of surgical training on live tissue and meet national standardized surgical metrics before becoming independent practitioners.

The significant gap in education is reason alone to reject the proposal. However, proponents are peddling misleading claims about what their bill would do and downplaying its risks to Mainers’ vision.

For example, the proponents say their plan would let optometrists provide “non-invasive, minor laser procedures” that “do not require general anesthesia, cutting or injections into the eye.” Such an argument is a smokescreen, as all surgery is inherently invasive. As defined by the American Medical Association, surgery is an invasive procedure.

Laser surgeries achieve results by disrupting normal tissue inside the eye and the proposal would also allow injecting anesthesia and cutting into the delicate tissues surrounding the eye. It’s false to claim that razor-sharp scalpels to remove lesions from a patient’s eyelid or surgical lasers altering tissue on the eye are “non-invasive.”

Also misleading is the claim that optometrists are allowed to perform these procedures within the U.S. Department of Veterans Affairs.  Veterans Health Administration (VHA) Directive 1121(2) Appendix G clearly affirms that laser eye procedures are, in fact, not approved to be performed by optometrists, but rather ophthalmologists. This directive applies to all VHA facilities anywhere in the U.S., including Togus.

When it comes to surgery on or around the eye, there is little room for error. These surgeries, if done wrong — or performed on patients who might be better treated through non-surgical options — carry disastrous ramifications. In fact, there are examples in the handful of states where similar bills were enacted.

A patient from Texas who had laser eye procedures by an optometrist suffered permanent vision loss that significantly affected her quality of life. A patient in Oklahoma suffered complications from a laser surgery by an optometrist that left her with a permanent black spot in the center of her vision and legally blind. Both of these surgeries would be authorized for optometrists to perform in the so-called “modernization of eye care” proposal being considered in Maine.

Some mistakenly claim that Maine has an access issue, but reality paints a different picture, as 83% of Mainers live within 30 minutes of an ophthalmologist. In the few states where similar proposals have been enacted, optometrists who actually perform these surgeries are few and far between, and those who do are mostly in the major population centers, so there’s little evidence this proposal would improve access here.

Ophthalmologists support allowing Maine residents to receive care when and where they need it, but from a qualified provider.  For the sake of patient safety, we must urge our leaders in Augusta to reject legislation that would make Maine the first state in New England to eliminate medical school and residency as requirements for performing eye surgery.