Optometrists, ophthalmologists battle over eye care bill

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There’s a nonsensical disconnect in California’s efforts to provide universal health care. There aren’t enough doctors willing to accept the state’s small fees for treating low-income patients.

So it’s universal healthcare in name only — despite Gov. Gavin Newsom’s repeated boasting about it — because millions of people are denied access to preventive medicine or treatment of their ailments.

There’s a little-picture partial solution to the access dilemma on the governor’s desk — one of 680 legislative bills as of Wednesday that Newsom must sign or veto by Sept. 30. This measure, AB 2236, concerns only vision care — but would affect millions of patients.

It pits two quarreling families against each other: primary care eye doctors and eye surgeons. The former are optometrists, the doctors you go to for an annual exam. The latter are ophthalmologists, the surgeons who remove cataracts, for example.

This is a battle over turf. The docs want part of the surgeons’ market share.

The optometrists argue the fight is about providing convenient care in the office and expanding patient access.

The surgeons, represented by the powerful California Medical Assn., argue it’s about safety — doctors performing procedures for which they’re not adequately trained.

“Kristine Shultz, executive director of the California Optometric Association, says of the primary care eye docs and surgeons: “They work together in the real world. It’s just in the state Capitol where they start fighting.”

These are called “scope of practice” battles.

The bill, by Assemblyman Evan Low, D-Campbell, would expand the optometrists’ role in vision care. The measure passed the Assembly with no votes to spare, 41 to 11 — with 28 legislators abstaining — after a passionate debate just 10 minutes before the deadline on the final night of the legislative session. There was bipartisan support, but also skittishness.

Under the bill, optometrists could not perform initial cataract surgery. But if the need for follow-up laser surgery developed later — perhaps years — they would be able to perform it.

They could also do laser surgery for glaucoma. Now they can only treat with eye drops. They could surgically remove skin tags off eyelids. And they could make an incision to squeeze out a stye.

Supervised training on people would be required for state certification.

But not enough training, opponents contend.

“This is eye surgery. It’s easy to say it’s easy. But complications are real. You can, if things go wrong, blind someone,” says Dr. Craig H. Kliger, executive vice president of the California Academy of Eye Physicians and Surgeons and a UCLA assistant professor.

“The amount of training in this bill is not adequate to make someone competent to practice by themselves. It’s not safe for the public.”

That’s disputed by John G. Flanagan, dean of the UC Berkeley School of Optometry and Vision Science.

He says 10 other states allow similar procedures for optometrists “and there have been virtually no complaints or problems.”

In California, optometrists are required to earn a four-year college degree, then attend a four-year optometrist school. The surgeons need a four-year degree, four years of medical school and four years of residency.

The access problem stems primarily from most surgeons refusing to treat Medi-Cal patients, bill supporters say. But most optometrists do.

Also, there’s an acute shortage of surgeons in many rural regions, including the Central Valley. Thirteen counties have no surgeon at all, Flanagan says. Six counties have only one.

Look, I’m just a newspaper hack. This kind of medical stuff is way out of my bailiwick. But Newsom must have experts on his staff who can advise him wisely.

I’m hoping they tell him it’s safe and sensible to allow optometrists to expand their practice and provide more patient access — so the state can start to do what it claims to be doing about universal health care.

George Skelton is a Los Angeles Times columnist.

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