The Ophthalmologist or the Optometrist as Surgeon

It was fascinating to read the editorial by Dr Hazel¹ in the April 2005 issue of the ARCHIVES regarding optometrists in their desire to be surgeons. It would seem blindingly obvious (excuse the pun) that the only possible objection ophthalmologists could have to optometrists performing surgery is if the optometrists did not obtain the extensive medical training it takes to become a full-fledged surgeon.

In Australia, optometrists undergo only 4 years of education and training whereas it takes about 15 years or more for ophthalmologists to convince their teachers, peers, and the public that they are adequately trained. Entry into medical school is highly competitive, as is entry into ophthalmology training. This training consists of at least 5 to 7 years of university study to graduate as a doctor, 3 years of general medical and surgical training, typically at least 2 years of further study to complete a higher degree (master's degree or PhD), and then 5 years in specialty ophthalmology training. In the specialty training period, the budding ophthalmologist may complete general training to become a comprehensive ophthalmologist or may commence subspecialty training. Thus, ophthalmology trainees must demonstrate that they have a respectable background of general medical and surgical knowledge and skills, and then they remain in supervised ophthalmology training for longer than the entire optometry course. Our society values and expects continuous improvement in the standards of patient care. In this environment, it should be blatantly obvious that governments must protect patients by restricting surgical rights to those who are adequately trained. Patients surely deserve and demand this most basic protection. What sensible reason could governments have for weakening standards required for surgical practice?

We are alarmed that ophthalmologists—the professionals who would treat the complications of surgery by optometrists—were not given appropriate oversight of the practice of optometry in the Oklahoma bill. We also have significant concerns that the expansion of practice rights by nonphysicians—with its consequent reduction in the standard of care—is not limited to the United States. Many governments may perceive a financial incentive in allowing this to occur. However, we feel that the longer-term costs to patients and to the community would be completely unacceptable, and importantly, this potential for harm is avoidable. We hope that the ophthalmologists in Oklahoma will share the lessons learned with their international colleagues.

Correspondence: Dr Francis, Chatswood Grove Eye Clinic, Suite 12, 12-14 Malvern Ave, Chatswood, New South Wales 2067, Australia (if@student.unsw.edu.au).

Financial Disclosure: None.