Ophthalmologists are cautioning provincial authorities against proceeding with initiatives that would permit optometrists to conduct certain surgeries and laser eye treatments, tasks that currently fall beyond their authorized duties.
Dr. Nina Ahuja, the incoming president of the Canadian Ophthalmological Society, emphasizes the importance of maintaining surgery within the realm of trained physicians. She asserts that delegating even seemingly minor procedures to optometrists poses a significant safety risk, estimating it to be “200 per cent unsafe” for patients.
The issue has been sparked by reports that the governments of Ontario and Alberta are collaborating with optometrists to introduce changes in their practice, aimed at enhancing 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. In contrast, ophthalmologists are specialists in surgical and eye disease management, requiring a minimum of nine years of medical training following their undergraduate education.
Drawing on over two decades of experience in ophthalmology, Ahuja highlights that surgical expertise transcends technical skills, encompassing a deep understanding of the body’s functioning and the significance of a patient’s medical background.
She draws an analogy between optometrists and air traffic controllers, likening ophthalmologists to pilots. Ahuja emphasizes the unique skill set of each profession by comparing the roles to those of an air traffic controller managing aviation activities and a pilot navigating the aircraft during a flight.
Ontario’s health minister’s spokesperson has indicated that the proposed changes could empower optometrists to perform minor in-office surgical procedures under local anesthesia, administer laser therapy for cataracts and glaucoma, order diagnostic tests, and manage open-angle glaucoma independently.
A recent study analyzing ophthalmological surgeries in Ontario from 2010 to 2020 revealed a 74% increase in patient waitlists, with cataract, vitreoretinal, and strabismus surgeries having the lengthiest wait times. Although the proposed changes do not encompass these specific surgeries, expanding optometrists’ responsibilities aims to alleviate the strain on healthcare providers and facilities offering such services.
In 2020, the Alberta College of Optometrists proposed broadening its scope of practice to include minor laser treatments, injections, and superficial skin surgical procedures like skin tag and wart removal. The Ministry of Primary and Preventative Health Services in Alberta has expressed support for this expansion and is actively collaborating with the optometrists’ college to finalize the proposed alterations.
Optometrists seeking to undertake these additional tasks would need to pass examinations on laser procedures and minor surgeries and complete supervised clinical practice before being authorized to execute the procedures.
The ministry has disclosed that the college is open to refining its proposals to address patient safety concerns, although specific details on these refinements have not been provided.
Dr. Allison Scott, head of the Canadian Association of Optometrists, clarified that the envisioned changes exclude operations conducted in operating rooms, such as retinal surgeries. She referenced data from the United Kingdom and the United States, where optometrists perform laser procedures, indicating that these practices have been deemed safe and effective.
International research evaluating over 146,000 optometrists performing laser procedures in the U.S., published last year, reported two adverse outcomes. Scott emphasized that optometry students receive comprehensive training on the proposed procedures, potential complications, and how to manage them, asserting the need to maximize their expertise in these areas.
She highlighted the stringent coursework aimed at ensuring optometrists are well-versed in the risks, safety protocols, and proper management of cases to guarantee safe practice.
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