Ophthalmologists are cautioning provincial governments against proceeding with proposals that would permit optometrists to conduct certain surgeries and laser eye treatments, procedures that are currently beyond their authorized practice. Dr. Nina Ahuja, the incoming president of the Canadian Ophthalmological Society, asserts that surgical interventions should remain under the purview of physicians, emphasizing that delegating even seemingly minor procedures to optometrists poses a significant safety risk to patients.
The concerns voiced by Ahuja follow reports that the governments of Ontario and Alberta are collaborating with optometrists to introduce changes to their practice, aiming to enhance access to eye care services. While both professions focus on eye health, optometrists serve as primary eye care providers, having completed a four-year professional program post-undergraduate studies, whereas ophthalmologists are trained as surgeons and specialists in eye diseases, undergoing a minimum of nine years of medical training after their undergraduate education.
Drawing on her extensive experience of over two decades in ophthalmology, Ahuja underscores that surgery entails more than technical expertise; it necessitates a comprehensive understanding of the body’s functioning and the significance of a patient’s medical background. To illustrate this point, she likens the roles of an optometrist and an ophthalmologist to those of an air traffic controller and a pilot, respectively, emphasizing the distinct skill sets and responsibilities each role entails.
In Ontario, a spokesperson for the health minister reveals that the proposed changes might enable optometrists to carry out minor surgical procedures in-office under local anesthesia, utilize laser therapy for managing conditions like cataracts and glaucoma, order diagnostic tests, and independently address open-angle glaucoma cases. These adjustments aim to alleviate the strain on healthcare providers and facilities, as highlighted by a recent study on ophthalmological surgeries in Ontario, which reported a 74% increase in patient wait times between 2010 and 2020, with cataract, vitreoretinal, and strabismus surgeries facing the lengthiest backlogs.
Meanwhile, the Alberta College of Optometrists put forth a proposal in 2020 to expand their scope of practice to encompass minor laser treatments, injections, and superficial skin procedures such as skin tag and wart removal. The Alberta Ministry of Primary and Preventative Health Services recently announced its endorsement of this expansion and is collaborating with the college to finalize the proposed changes. Optometrists seeking to undertake these additional tasks would be required to pass examinations on laser procedures and minor surgeries and complete supervised clinical training before being authorized to perform these interventions.
Acknowledging the importance of patient safety, the ministry notes that the college has been receptive to refining its proposals to address safety considerations, although specific details on these refinements have not been disclosed. Dr. Allison Scott, president of the Canadian Association of Optometrists, reassures that the proposed changes exclude procedures conducted in operating rooms, such as retinal surgeries. Citing data from international jurisdictions like the United Kingdom and the United States, where optometrists are authorized to perform laser procedures, Scott emphasizes the safety and efficacy of such practices, underlining the rigorous training optometry students undergo to manage potential complications effectively.
A study published last year examining over 146,000 optometrists carrying out laser procedures in the U.S. reported only two adverse outcomes, indicating the overall safety and success of these practices. Scott stresses that optometry students are thoroughly trained in the proposed procedures, potential complications, and their management, asserting that their expertise should be maximized to enhance patient care and access to eye health services.