VA ends optometrist eye surgery option

The supervision requirement proves to be a sticking point.

By Myrle Croasdale — Posted Jan. 17, 2005

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Only ophthalmologists will be doing eye surgery at the Dept. of Veterans Affairs medical centers now that the VA has ended a controversial policy letting optometrists do certain laser procedures under the supervision of an ophthalmologist.

"Our nation's veterans deserve the best care possible, and now they can be assured that surgical eye care in VA hospitals meets the rest of the nation's high standard of care," said American Medical Association President John C. Nelson, MD, MPH.

H. Dunbar Hoskins Jr., MD, executive vice president of the American Academy of Ophthalmology, agreed. "Ophthalmologists have the medical education and surgical training necessary for the safe performance of invasive surgical eye procedures," he said. "Patient safety triumphed because medical and veterans' organizations took action -- they contacted the VA and involved their congressional representatives in order to help protect our veterans."

The issue arose after Oklahoma authorized optometrists to perform certain laser procedures. Under VA policy, health care professionals can function within the full scope of their state license anywhere in the VA system. When a Kansas facility gave an Oklahoma-licensed optometrist the OK to do laser surgeries, organized medicine responded and the VA added the requirement that optometrists performing these procedures must be supervised by an ophthalmologist. No laser surgeries were ever actually performed by VA optometrists.

Michael Kussman, MD, acting deputy undersecretary for health for the Dept. of Veterans Affairs, said a panel of VA optometrists and ophthalmologists was formed to hash out what the supervision requirement would look like, but failed to agree. The optometrists responded to the stalemate by opting to give up the surgery issue, he said.

"The optometrists came to us and said, 'We are independent practitioners, and we don't want any part of our work to be under others, so we'd rather not do this in the VA,' " Dr. Kussman said.

The AMA, AAO, American Society of Cataract and Refractive Surgery, American Legion and other veteran and medical groups joined the lobbying effort against optometrists doing VA eye surgery.

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