N.C. considering a surgery bill that Kentucky regrets passing

Optometrists would be allowed to perform eye surgery under bills being considered in the N.C. legislature.
Optometrists would be allowed to perform eye surgery under bills being considered in the N.C. legislature. File photo

As a professor of ophthalmology and a teacher of eye surgeons, I implore North Carolina not to make the mistake my Kentucky made six years ago, blindly rushing into law a bill that let non-surgeons operate on people’s eyes – a move legislators later regretted, and which Kentucky’s citizens opposed four-to-one.

The N.C. General Assembly is considering two misguided proposals, House Bill 36 and Senate Bill 342, that would let optometrists who are not medical doctors and have little or no surgical training – perform hundreds of kinds of eye surgery with scalpels and lasers. Such a move would threaten patient safety across North Carolina while raising the cost of health care for everyone.

HB 36 and SB 342 remove the current law’s requirement of a medical license to perform eye surgery and would prevent the North Carolina Medical Board from determining the standards of medical education and surgical training. These bills cast aside vital safety protections for patients across North Carolina.

In 2011, I witnessed firsthand how a very similar “access to care” bill was rushed through Kentucky’s General Assembly in one week with scant discussion or debate. Independent observers objected to lowering the standard of medical care and putting the eyes of Kentucky citizens at risk, but our law passed at the legislative equivalent of light speed.

Since our law passed, we have seen unnecessary surgery, inappropriate surgery and misdiagnoses. Using the kind of lasers allowed in HB 36 and SB 342, optometrists in Kentucky have performed YAG laser capsulotomies on patients who did not need it. We have seen complications after the procedure, such as a worsening of macular degeneration.

These optometric surgical complications are in addition to numerous misdiagnoses, inappropriate therapies and overlooked problems that I have treated. Patients have suffered missed corneal infections, inappropriately treated corneal ulcers, and missed glaucoma that were never reported because there is no medical board oversight of optometrists in Kentucky.

In Kentucky, as in North Carolina, optometrists cite “access to care” as a justification to let them go beyond their proper scope of practice. But access claims have been vastly overstated in both states. An optometrist in Kernersville, N.C., recently claimed that her patients must travel to neighboring Winston-Salem (10 miles) or Greensboro (17 miles) to see an ophthalmologist, as if that were untenable. Meanwhile, there’s an ophthalmology office only a mile and a half away.

Since our legislature in Kentucky hastily enacted our law, several lawmakers conceded that they regret having passed the bill so quickly, without allowing for adequate discussion and consideration of the harmful consequences.

There is a proper, established pathway for people who want to perform delicate eye surgery to learn how to do it right: go to medical school and complete an ophthalmology residency.

Would you let a shoe salesman operate on your feet?

Please, for the sake of North Carolina’s 10 million people, don’t make Kentucky’s mistake. Don’t put North Carolina patients at undue risk. Leave eye surgery to trained eye surgeons.

Woodford S. Van Meter, MD, FACS, is a professor of Ophthalmology at the University of Kentucky. Email: