A year-long standoff between ophthalmology and optometry over ODs’ plans to provide advanced procedures in Vermont has ended with ophthalmology on top. 

In February of 2019, the Vermont Optometric Association asked state officials to allow ODs to offer laser procedures, lid injections, lid lesion treatments and other forms of care currently restricted to medical doctors. The Vermont Office of Professional Regulation turned down the request on January 15. “After consulting with stakeholders and conducting extensive and thorough research, the OPR cannot conclude that optometrists are properly trained in and can safely perform the proposed advanced care procedures,” the regulatory agency stated in a 40-page report. “Further, OPR finds that there is little need for, and minimal cost savings associated with, expanding optometric scope of practice to include advanced procedures.”

Amy A. Gregory, MD, president of the Vermont Ophthalmological Society said her organization was “very pleased” with the regulatory board’s decision. “We were also thankful that we had the opportunity to present all of our information and data and that the regulators who made that decision were very thoughtful in reviewing all of the evidence when coming to their decision. Basically, the concern was that patient safety and vision would be put at risk if optometrists who don’t have appropriate training were allowed to do lasers and eye surgical procedures.”

Besides gathering input from the Vermont Ophthalmological Society, the OPR received input from eight ODs and their patients and asked the state optometric association questions about optometrists’ education and training, patient safety, access to care and costs. The OPR asked 21 U.S. optometry schools to provide curricula, course descriptions, syllabi and other information about optometric training and education on the proposed procedures. No school responded, although Elizabeth Hope, OD, MPH, DrPH, president of the Association of Schools of Schools and Colleges of Optometry, contacted the OPR to discuss optometric education and training. Dr. Hope referred questions to the VOA and the American Optometric Association. 

 “More and more states are taking action to recognize optometry’s essential and expanding role in health care, especially with regard to leading-edge treatment of glaucoma, cataracts and other threats to vision and health,” said David A. Cockrell, OD, Diplomate of the American Board of Optometry and past president of the AOA. “Although some of my medical colleagues and even some policymakers remain fearful of health care’s advancement, the profession of optometry—from our outstanding educational institutions to our forward-looking professional associations to our highly skilled doctors—is embracing and helping to shape the future.” 

The OPR noted in its report that optometric scope of practice was expanded in Vermont in 1983, 2004 and 2019. ODs in Vermont are permitted to prescribe oral medications, including Schedule II (hydrocodone-combination products), III, IV and V drugs; as well as oral steroids, antibiotics, antivirals and antifungals. Vermont ODs are also permitted to diagnose and treat glaucoma with topical and oral drugs, perform foreign body removal, dilation and irrigation, punctal occlusion and eyelash epilation, as well as order laboratory tests required for the examination, diagnosis, and treatment of a disease or condition related to the eye.

 

Eye MD in the Vanguard Versus the Coronavirus

While an ophthalmologist may at first appear to be an unlikely epidemic whistleblower, that’s just what Li Wenliang, MD, became when he shared some news about a possible re-emergence of SARS with his medical school alumni friends and warned them to take precautions. “On December 30th, I saw a test report of a patient that detected a high confidence coefficient for SARS coronavirus,” he wrote on his Weibo, the Chinese social media website. SARS, or severe acute respiratory syndrome, is the result of a less-powerful coronavirus, but one with many similarities to the current strain. In 2003, a SARS pandemic allegedly covered up by the government killed hundreds in China.¹

Dr. Li warned his friends on WeChat, the Chinese messaging app, that seven SARS cases were identified at the Huanan Seafood Market, with the suspected patients quarantined in the ER at Wuhan Central Hospital, Tongji Medical College, where he worked and researched genetic influences on diabetic retinopathy. Screenshots of his SARS warnings went viral. 

A few days later, the Public Security Bureau tracked down Dr. Li and seven other doctor whistleblowers and accused them of spreading rumors and disturbing the social order. Dr. Li was forced to sign an official letter acknowledging that if he continued with his illegal activity and rumor-spreading he would be brought to justice. Around this time, Chinese authorities were investigating 27 cases of viral pneumonia, but taking careful steps not to mention SARS or coronavirus.

Dr. Li himself contracted the coronavirus while treating a glaucoma patient. Ophthalmologists are more likely to catch a contagious disease from patients than most other doctors because they have to sit or stand so close to their patients. 

“I started to have cough symptoms on January 10,” Dr. Li wrote on his Weibo account page. The next day he had a fever and on January 12, he was hospitalized in the intensive care unit on oxygen support. “I was wondering why [the government’s] official notices were still saying there was no human-to-human transmission, and no medical workers infected,” he wrote.

“I had a nucleic acid test before, but there was no result. After a recent test after treatment, my nucleic acid test was negative, but I still have difficulty breathing and cannot move. My parents are also in the hospital.” On February 1, he posted from Wuhan Central Hospital that “Today the nucleic acid test result is positive, the dust has settled, and the diagnosis has finally been confirmed.” 

On February 7, Dr. Li passed away at Wuhan Central Hospital. He was 34 years old and is survived by his wife and one child, with a second on the way.  

In an interview by text with the New York Times, Dr. Li expressed his frustration with China’s secrecy and failure to act. “If the officials had disclosed information about the epidemic sooner, I think it would have been a lot better,” he said to the Times. “There should be more openness and transparency.”  REVIEW

 

^{1. Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary. Institute of Medicine (US) Forum on Microbial Threats. Knobler S, Mahmoud A, Lemon S, et al, eds. Washington, D.C.: National Academies Press (U.S.), 2004.}