Our Opinion: Seeing our way clear to law on eye care

Seeing is believing, but one's vision can become cloudy when it comes to deciding whom to believe in the highly specialized world of eye care. Currently, Massachusetts is the only state in the country that allows optometrists to diagnose glaucoma and general eye infections but not treat them. In the Commonwealth, that is a task reserved for ophthalmologists — medical doctors who specialize in afflictions of the eye.

Optometrists, whose training is less comprehensive than ophthalmologists and tends to concentrate more on optical than physiological issues, seek to lift this restriction, which they claim would allow Massachusetts residents greater access to affordable eye care, spare them the unnecessary costs and inconvenience of having to travel to a specialist, and save MassHealth (according to their estimation) $20 million in Medicaid costs. On the other side, Deanna P. Ricker, M.D., president of the Massachusetts Society of Eye Physicians and Surgeons, worries that optometrists lack the qualifications to effectively treat eye diseases, placing patient health at risk.

"The problem is, they're not trained as physicians," she told The Eagle. "There are all kinds of things that show up in the eyes that can be deadly." She added that there is a broad variation in the degree to which the other 49 states confer upon optometrists the "privilege" of treating glaucoma and eye infections.

Currently several bills have been filed in the Legislature to bring the Bay State into conformity with its brethren as well as the Veterans Administration, which allows optometrists to treat these afflictions in its facilities (including in Massachusetts). Such bills have been passed by the Senate in past years only to founder in the House.

They make sense from the perspective that there are more than 1,500 optometrists versus 325 ophthalmologists in the Commonwealth, but the optometrists' claim that the status quo imposes undue hardship on residents in Central and Western Massachusetts because of limited acces is hyperbolic.

"In our county, we have eight ophthalmologists," said Joseph Gold, M.D., an ophthalmologist who practices in Great Barrington, "and that's just in a small county." He added that with Massachusetts being such a small state geographically, the same criteria cannot be applied here as to, say, Texas, where eye patients may have to travel hundreds of miles to see an ophthalmologist, or have one flown in to their town once a month.

Dr. Gold acknowledges the valuable role optometrists play in the continuum of eye care, and would support their entry into the treatment of glaucoma and eye diseases — with certain important caveats: "We have optometrists around here I support and some whom I would not trust," he said. "How much training have they had? Do they know about the systemic side-effects of certain medications? It's about the level of clinical know-how from experience, from doing it a lot, and about knowing when to ask (an ophthalmologist) for help."

Michael Purdy, O.D., an optometrist who is chief clinical and community service officer at Hilltown Community Health Center in Worthington, has practiced in several other states and feels that the proposed Massachusetts law does not go too far. "It clearly spells out what we can do," he said. As for knowing when to refer patients to ophthalmologists," he said, "We already do that."

Were the Legislature to pass a law favorable to optometrists, Dr. Gold would like to see it include rigorous regulations about continuing education, thorough mentoring, strict competency measuring, mandatory courses in understanding the side effects of medications, and even required assignment to a group of ophthalmologists to ensure proper training.

In other words, for proposed legislation to avoid unintended consequences and inadvertently place Massachusetts eye patients in danger, the Legislature must restrain itself from succumbing to lobbying efforts by organizations such as the Massachusetts Society of Optometrists and make sure such a law contains proper safeguards. As Dr. Ricker of the MSEPS said of legislators, "These people are not experts. When people went to the State House who knew more, they found that they didn't know or understand the details."

There is no question that a state law enabling optometrists to treat eye problems like glaucoma, styes, dry eye and ocular rosacea would benefit some Massachusetts residents, especially those at the lower income level. It would be irresponsible of our lawmakers, however, to enact one before thoroughly informing themselves of all the nuances and ramifications of such a law — information that all involved, expert parties are eager to share with them.


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