The New Hampshire Senate is considering Senate Bill 440, which poses a serious threat to quality eye care for patients in need of advanced eye surgery. This hazardous legislation would grant optometrists, who are not medical doctors or trained surgeons, the authority to perform delicate surgery on and around the eye with lasers and scalpels.
As an ophthalmologist, I underwent an extensive educational journey spanning a minimum of eight years, which included medical school, hospital residency, and surgical training. Training and education prepared me to be a medical doctor first before receiving the rigorous training that equipped me with the necessary skills and knowledge to be a surgeon acquired through hundreds of surgical procedures. Conversely, optometrists attend optometry school only, and their surgical training in an optometry educational curriculum consists of a 32-hour course that could be completed over a long weekend.
Optometrists play a crucial role as respected members of the eye care team. Their significance lies in conducting comprehensive eye examinations and vision assessments, as well as prescribing corrective lenses and identifying specific eye irregularities. In collaboration with an ophthalmologist, they also possess the authority to prescribe a restricted range of oral medications for eye care, including antibiotics and glaucoma medications. However, one thing is clear: they do not have the necessary level of education and training to safely perform ophthalmic surgery. While SB 440 contains a short list of “prohibited” surgeries, optometrists would be authorized to perform any other eye-related surgery not listed—potentially hundreds of surgical procedures.
When the sight of Granite State patients requires medical attention or intricate, advanced surgical procedures, they rely on the expertise, knowledge, and extensive training of the healthcare provider. As ophthalmologists—medical doctors specializing in eye surgery—patients place a significant amount of trust in our ability to perform surgery on one of their most essential organs. They also depend on our expertise to determine whether surgery is the appropriate course of action.
All surgical procedures involving the eye and its surrounding regions demand meticulous attention and expertise, as any mistakes can have severe consequences. Prior to confirming whether an eyelid lesion is cancerous, it is imperative to send a sample for a biopsy, as there is no certainty without this diagnostic procedure. I also need to know when a patient really needs surgery. Underlying medical conditions unrelated to the eye can pose as eye diseases. Misdiagnosis or unnecessary treatment could have serious consequences for a patient. My foundational understanding of the human body and medicine has prepared me to identify the unexpected.
Advocates for SB 440 will mistakenly argue that by permitting optometrists to perform surgeries, we can reduce costs for patients and enhance healthcare accessibility. Undoubtedly, numerous rural communities face challenges in terms of affordable and easily accessible healthcare options, and it is imperative that we address this issue.
However, granting optometrists the authority to conduct surgeries with negligible training utilizing surgical tools, such as scalpels, to remove potentially cancerous skin lesions and lasers to perform glaucoma and post-cataract surgery is not the solution New Hampshire citizens need or deserve. This would only create a two-tier system of surgical eye care for patients. According to a survey conducted by the American Medical Association, there is much public confusion about the difference between ophthalmologists and optometrists. Nearly 47 percent of respondents thought an optometrist was a medical doctor.
What is the real cost of increasing access by letting underqualified and undertrained practitioners do surgery on the eye or eyelid? A minor surgical mistake measuring only a few millimeters can lead to a punctured eyeball and irreversible vision impairment. No matter how benign a skin lesion appears, no one can be sure whether it is malignant without removing a sample for a biopsy. But improperly cutting off a cancerous eyelid lesion could cause deformity or, worse—it could cause the cancer to spread.
It is imperative that we do not compromise the safety of patients in New Hampshire by diluting surgical safety standards. Enabling optometrists to perform surgery without the extensive clinical training and education provided by medical school, hospital internship, and surgical residency programs is a perilous decision that jeopardizes the level of care Granite Staters rightfully anticipate and deserve. We kindly urge the executive departments and the Administration Committee to reject SB440.
