No. 10: Oklahoma authorizes lasers for ODs in 1998December 11, 2012
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Oklahoma has become the first state to specifically authorize optometrists to use lasers to correct vision and provide eye care.
Legislation authorizing properly certified optometrists to provide certain types of eye care and vision correction using lasers was signed into law by Oklahoma Gov. Frank Keating (R), March 16. The new law goes into effect Nov. 1.
“We are pleased that the governor has taken into consideration the careful investigation of this issue by both the Oklahoma Senate and House of Representatives and has signed the bill giving Oklahoma doctors of optometry the right to practice optometry utilizing the full extent of our medical and clinical education and training,” said Wes Hall, O.D., president of the Oklahoma Association of Optometric Physicians.
“Gov. Keating and the Oklahoma Legislature are to be commended for seeing through the unwarranted, alarmist rhetoric from ophthalmology and acknowledging the excellent track record of Oklahoma optometrists who have been capably performing laser surgical procedures for many years,” said AOA President Michael D. Jones, O.D.
“This landmark legislation is a further recognition of the advances in optometric education, training and practice. The members of the Oklahoma Association of Optometric Physicians are to be congratulated for their pioneering efforts,” Dr. Jones said.
The Oklahoma optometry law already defined the practice of optometry to include “the correcting and relief of ocular abnormalities by means including but not limited to” contact lenses, eyeglasses and prisms.
The new legislation specifically notes that “laser surgery procedures” are among those authorized means.
However, the new law specifically excludes procedures on the retina, laser in-situ keratomileusis (LASIK) and cosmetic eyelid surgery.
The bill also clarifies that low vision rehabilitation is within the scope of optometric practice and specifically clarifies that optometrists can dispense pharmaceutical samples to patients.
The bill also stipulates that optometrists must be certified by the Oklahoma Board of Examiners in Optometry in order to perform “laser surgery procedures” or to prescribe or administer drugs.
In a technical note, the legislation substitutes the more generally used term “vision therapy” for “visual training.”
“Nothing in this title (of legislation) shall be construed as allowing any agency, board or other entity of this state other than the Board of Examiners in Optometry to determine what constitutes the practice of optometry,” the legislation also stipulates.
The provision is designed to end a lengthy and hard-fought dispute between medicine and optometric groups over laser use in the state.
The Oklahoma Association of Optometric Physicians (OAOP) sought the legislation following a court case last year in which an Oklahoma County district court judge issued a judgment ordering all optometrists in the state to refrain from performing laser procedures on the human eye.
The ruling was the result of a challenge to a 1993 declaratory judgment by the Oklahoma Board of Examiners in Optometry that affirmed Sooner State optometrists could use lasers.
The suit against the state optometry board was filed in 1994 by the Oklahoma State Board of Medical Licensure and Supervision.
The state medical board contended laser use represents the unauthorized practice of medicine.
The suit contended that laser use constitutes surgery and optometrists were not qualified to perform such procedures.
In his ruling, Judge Eugene Mathews last July also declared that optometrists are not adequately trained to perform laser surgery. Doctors of medicine or osteopathy are qualified, the court ruled.
Judge Mathews ruled that the state optometric practice act did not provide optometrists with authority to perform either surgery or laser procedures on the eye.
The Oklahoma optometry board protocol was the first ever to specifically authorize optometrists to use lasers.
Oklahoma optometrists have been performing laser procedures safely since 1988, according to the optometry board. Most of those procedures have been YAG posterior capsulotomies, according to OAOP.
The Oklahoma optometry board said the court ruling made access to eye care more difficult for many Oklahomans who live in rural areas.
“These are the patients who have been helped by optometrists for years, with no evidence of harm by their optometrists. The result of this ruling will be to limit Oklahomans’ access to one medical domain,” the optometry board said in a press statement following last year’s ruling.
Oklahoma optometrists have taken on responsibility for laser procedures because the state has a high percentage of rural residents, some living in very remote areas, who would not otherwise have adequate access to laser treatment, according to OAOP.
Oklahoma has a total of 481 optometrists. There are optometry practices in some 72 of the state’s 77 counties, while there are ophthalmologists in only 23 counties, the association noted.
Availability of health care to rural residents in remote locations has consistently been a top priority issue for Oklahoma optometrists, the association notes.
State optometrists have been involved in other innovative rural care efforts, such as a rural health network for Native Americans, formed in cooperation with the Oklahoma chapter of the National Rural Health Association, OAOP notes.
Optometrists have become an important source of laser treatment for Oklahoma residents, according to OAOP.
Thousands of laser procedures have been performed by optometrists in the state, according to the OAOP.
Interest in lasers among Oklahoma optometrists also has been spurred by the strong laser program at Northeastern State University College of Optometry in Tahlequah, where many of those practitioners received their professional education, according to Dr. Hall.
Northeastern has been the site of extensive laser training. The optometry school was headed by medical doctor-optometrist Les Walls, O.D., M.D., from 1986 to 1992.
OAOP notes that Oklahoma ODs have compiled an impressive record concerning laser use.
There have been no significant safety problems and no malpractice cases related to the procedures, according to published reports.
No evidence concerning adverse reactions was introduced by the Oklahoma Medical Association during last year’s court case.
During debate on the new law, the Oklahoma Osteopathy Association sent faxes to its members asking for examples of harm caused to patients by optometrists using lasers, according to Russell Laverty, O.D., secretary-treasurer of the Oklahoma Board of Examiners in Optometry.
The new law was approved by an overwhelming 76-22 vote in the Oklahoma House of Representatives and an equally substantial 33-13 vote in the Oklahoma Senate.
OAOP members say state legislators have generally recognized optometry’s importance to Oklahoma health care in the past.
Three times the state legislature has rejected bills—backed by state medical associations—which would have specifically restricted optometric laser use, OAOP notes.
Some OAOP members say they believe legislators were put off by last year’s court ruling, which some saw as an attempt to circumvent the intent of the legislature.
Legislators also were impressed by the educational background of today’s optometrists, known officially in Oklahoma as “optometric physicians,” according to Saundra Gragg, OAOP executive director.
“They have finally come to realize optometrists are physicians with a doctorate-level education,” Gragg said.
Northeastern University optometry graduates have four years of rigorous postgraduate lecture, clinical, research and laboratory experience, as well as four-year undergraduate degrees, notes George Foster, O.D., dean of the Northeastern College of Optometry.
Northeastern students receive “more than 4,000 hours of classroom clinical and lab training in the doctoral program. Of that, more than 100 hours are dedicated specifically to laser education,” Dr. Foster noted.
Northeastern’s 110 optometry students and residents provide care to 40,000 Oklahomans each year in a supervised clinical setting. That means optometry graduates have considerable clinical experience before entering practice, Dr. Foster noted.
In addition, Oklahoma optometrists are required to complete 18 hours of continuing education each year—more than is presently required for medical doctors in the state, Gragg noted.
OAOP President Dr. Hall also credited stringent oversight of the profession by the state optometry board. However, “the major reason doctors of optometry have such an unblemished track record in laser procedures is their competency, conservatism, and concern for their patients,” Dr. Hall said.
Meanwhile, even “the (Oklahoma) Medical Board’s own witnesses characterized the (laser) procedures at issue as relatively straightforward” during last year’s trial, according to an optometry board statement.
Oklahoma is not the only state in which optometrists have been known to use lasers. Nor is it the only state in which legislation or regulations have been proposed to officially sanction optometric laser use.
A bill which would have specifically authorized the use of lasers by optometrists was passed by the New Mexico state legislature last year but was vetoed by Gov. Gary Johnson (R).
Idaho optometrists were briefly permitted to use lasers in 1995 under a state board of optometry rule.
However, that authority ended when a state court ruled that the procedure was not authorized by the state’s optometry law.
Enactment of the new law set off a storm of speculation about laser use by ODs across the nation.