It is the duty of the Commonwealth to ensure the safety of its citizens. I therefore submit these comments regarding the proposed Board of Optometry regulations.

As the Board of Optometry finalizes the regulations for laser surgery certification, I am concerned about the regulations as stated and recommend amending the current draft to reflect more stringent requirements around proctored sessions to ensure critical patient safety.

While there are provisions for proctored care, the requirement of logging complications, and the requirement that didactic education include indications and complications. However, it seems an individual can meet the certification requirements by attending a didactic course or by performing these procedures in a proctored session on either a model eye or on a live patient. I strongly recommend amending the proposed regulations to require both didactic and live proctored cases. 

Understanding the theory of laser therapy and the internal structure and shape of the eye, is not the same as performing the same surgery on living tissue. Patients come to the laser treatment with a myriad of physiologic conditions that can impact these surgeries. Eye movements, tremors, neurologic conditions, anxiety, and even at times breathing (especially in obese patients) can move the eye centimeters, when laser eye surgery treatment is in a sphere of microns. Bleeding and inflammation can obscure the view for accurate treatment. Errors on this scale can change the outcome for these patients and increase their risk of complications. Carefully proctored practice mitigates and substantially lowers that risk to a much more tolerable level.

If you look across various industries that involve safety risk, it is typical to require supervised live practice in addition to standard didactics. Pilots must have substantial amounts of proctored hours flying a plane prior to being able to do so alone or with customers, all after taking didactics and a test. The Commonwealth requires a minimum of 45 proctored hours of driving a car prior to getting a driver’s license, again after didactics and tests. These standards ensure the safety of the public. We strongly believe it is in the best interest of patient safety to require proctored cases in live patients after didactics and testing prior to the Board approving an optometrist to operate one of these procedures. 

Ophthalmologists are required to have extensive didactics as well as more than two hundred live proctored cases performed in their training prior to obtaining a medical license to practice. While we understand this number would be impractical to request, we believe it is reasonable to request ten live proctored capsulotomies, ten live proctored laser trabeculoplasties, and ten live proctored iridotomies for the safety of patients in the Commonwealth. 

Would you allow your parent or child to have eye laser done by someone who has only ever worked on a plastic eye, and was proctored only once or twice?

It is my strong hope that the Board of Optometry will include these suggestions to strengthen patient safety in their draft regulations.

In response to allegations of endorsement, none of the following organizations have supported, endorsed or collaborated with the Board of Optometry in the process of their developing these regulations: the Virginia Society of Eye Physicians and Surgeons (the largest organization of ophthalmologists in the Commonwealth), the Northern Virginia Academy of Ophthalmology (the second largest organization of ophthalmologists in the Commonwealth), or the American Academy of Ophthalmology (the largest national organization of ophthalmologists). 

Additionally, it is important to highlight that there has been very little opportunity for the overwhelming opinion of ophthalmologists to be considered in the development of these regulations. That includes a single in-person comment opportunity that was opened within 48 hours of publication of the proposed regulations. It also includes the presence of only one single ophthalmologist (whose placement was not coordinated with the Virginia Society of Eye Physicians and Surgeons) on the Regulatory Advisory Panel that was responsible for reviewing various sections of the draft regulations. That panel was otherwise comprised of four optometrists and one citizen member. The representation on the panel was heavily geared toward the optometric profession, leaving room for minimal input from ophthalmologists, specifically regarding the required training and proctoring needed to maintain the highest level of patient safety.

The Board of Optometry’s mission statement speaks of assuring patient safety. I encourage the Board to hearken back to its mission statement, protect the citizens of the Commonwealth, and tighten standards of approval to require in-person proctoring in all cases, and place patient safety ahead of convenience or practice business concerns.