To the editor:
I commend you on your recent article regarding Oklahoma optometrists' attempting to use their state legislature to expand their scope of practice to include surgery.

Optometrists say that the recently passed law that allows them to perform surgery is not an attempt to expand the scope of optometric practice. They say they are only interested in making sure they get paid for simple, non-invasive procedures such as punctal plugs or epilations.

It's important to remember how this most recent controversy began. It began with Oklahoma optometrists asking to be paid for procedures that involved cutting the eyelids, not for simple, non-invasive procedures.

The problem, as the president of the Oklahoma Board of Optometric Examiners points out in the article, is that Oklahoma law doesn't contain a specific definition of surgery. But instead of pursuing legislation that defines the type of simple procedures optometrists can perform, they opted for an even broader definition that allows them to perform any non-laser surgery as determined by the Oklahoma Board of Examiners in Optometry.

While the law is vague as to the types of surgery that optometrists can perform, it's perfectly clear on who will make the final call, and it's not the medical community: "No agency, board or other entity of this state, other than the Board of Examiners in Optometry, will determine what constitutes the practice of optometry." This truly breathtaking statement seems to imply that the optometry board does not even need the approval of the legislature or governor to define surgery, let alone the input of the only group trained to perform surgery and to make decisions regarding surgery—physicians.

The governor of Oklahoma has generously offered that he will work with all parties, including the medical community, to ensure that the final rules implementing the new law will neither expand nor contract the scope of optometric practice. While we applaud the governor's decision to include the medical community's input into the rule-making process, we still have no veto power. The power to decide who can provide ophthalmic surgery in Oklahoma still firmly remains in the hands of optometry's Board of Examiners and politicians, not medical schools.

Once again, the scope of optometric practice in Oklahoma will be based upon optometrists' ability to lobby the legislature, rather than upon sound medical argument. And once again, Oklahoma residents and patients everywhere will be put at risk.

Sincerely,

David W. Parke II, MD
President and CEO
Dean McGee Eye Institute
Oklahoma City
Senior Secretary for Ophthalmic Practice American Academy of Ophthalmology.


To the editor:
The article "Can Nutritional Supplements Benefit Ocular Health?" that appeared in the February Review of Ophthalmology is a little bit puzzling. I thought at first it was an advertisement for the dietary supplement industry. It is not an objective view of the role of dietary supplements in the prevention or treatment of ocular disease. It is not an objective or accurate review of the Dietary Supplement Health and Education Act of 1994. Anyone who wants to know the details of the Dietary Supplement Health and Education Act can consult a number of sources. However, probably the best detailed and objective information on this and its effect is found on the Food and Drug Administration website (fda.gov).

The sidebar on page 58 with some "myths" about dietary supplements comes from the Dietary Supplement Information Bureau (supplementinfo.org). This is a trade group that manufactures and sells dietary supplements. Whether this website and the information on it is reliable (including those "myths") is a matter of opinion. The first drug that I pulled up on that website was ephedra. Nothing  on the website on April 21 or June 21 pointed out that this drug has been ordered off the market by the FDA effective April 12 because of serious health concerns.

Those want a more balanced, objective review of this topic might consult the article "Doctor, What Vitamins Should I Take for My Eyes?" in the Archives of Ophthalmology, 2004, volume 122, p. 628-635.

Sincerely,

G.E. Sanborn, MD, FACS
Richmond, Va.