Ask any American how they think our government should be treating the nation’s veterans, and almost everyone will say that those who served our country should be treated at least as well as the average person on the street.
Thankfully, the U.S. Department of Veterans Affairs (VA) is taking proactive steps to honor the debt that we, as a nation, owe to those that have “borne the battle” by ensuring veterans have the same freedom to seek out needed eye and vision care from the eye doctor type of their choice, which virtually every other American now enjoys.
Earlier this fall, the VA updated its guidelines governing eye care within its community care program. It removed language that said, “only ophthalmologists can perform invasive procedures, including injections, lasers and eye surgery,” therefore allowing veterans to seek out the full range of care both optometrists and ophthalmologists are able to provide in their states under their state-issued licenses. Such a move can boost veteran access to essential care, when and where it’s needed, and align the VA with every other federal program, including Medicare and Medicaid, as well as every major private health insurer. Makes sense, right?
That’s why it’s disheartening to see some groups working to persuade the VA to reverse this policy alignment. Why are they doing this? While they claim the new guidelines raise concern for patient safety, in our view it’s really about professional turf protection. Some ophthalmologists — a profession facing dwindling numbers despite an increasing supply of patients needing care — and their representative organizations and groups are afraid that if veterans are given the freedom to choose optometrists for more of the care they need, they might do exactly that.
A recently published op-ed by a South Carolina ophthalmologist discusses this concern for patient safety, claiming that optometrists are only trained to provide primary eye care and that the “first human subject an optometrist performs surgery on could be a veteran.” However, the reality is that generations of optometrists in certain states have been trained and licensed to provide a wide range of medical eye care, including laser and other surgery procedures, and have been safely and effectively providing this care for decades.
In our view, the author is attempting to paint the recent VA move as radical, but in reality, the VA is making changes so that it is no longer the outlier among other federal and private coverage providers. Medicare, Medicaid, the Indian Health Service, and major private health insurers cover and reimburse optometrists for surgical care when providing care within the bounds of their state scope of practice. Further, the author uses a contentious ophthalmology study as support for his safety concerns. While scope of practice varies by state, we — a veteran optometrist and an optometrist/ophthalmologist — feel the need to respond to emphasize the importance of the change to the VA guidelines.
Every state in the nation right now recognizes doctors of optometry to provide a broad range of primary and medical eye care. Optometrists nationwide are authorized to detect, treat, and manage an array of eye diseases, including glaucoma and macular degeneration. Right now, 10 states recognize the ability of doctors of optometry to perform laser and other eye surgeries, with more states approving optometrists to perform other office-based surgical procedures. These states estimate tens of thousands of successful surgical procedures with near-zero negative outcomes reported.
In several states, the allowance of optometrists to perform these procedures has led to an improvement in access to care, which patients desperately need, particularly in underserved and rural areas. Additionally, these procedures are competency-tested by the National Board of Examiners in Optometry.
America’s veterans deserve our gratitude for their service and sacrifice. They deserve to be treated at least as well as every other citizen, and they deserve nothing less than to be kept out of political fights aimed at protecting professional turf. That’s why it’s important that veterans have access to and the freedom to seek out needed eye and vision care from the eye doctor type of their choice. The VA is doing right by veterans, and we encourage the Department to hold strong to their updated guidelines.
Michael Mittelman, OD, MPH, MBA, is the president of Salus University in Elkins Park, Pennsylvania, and served with distinction for more than 3 decades as an optometrist and Deputy Surgeon General in the U.S. Navy. Richard Castillo, OD, DO, is an ophthalmologist, and a clinical professor and the principle surgeon at Northeastern State University Oklahoma College of Optometry. He also serves as assistant dean overseeing the surgical training program.
Source: MedicalNewsToday.com
