June 20, 2023

Leslie L Knachel, Executive Director

Virginia Board of Optometry

Virginia Department of Health Professions

9960 Mayland Drive, Suite 300

Henrico, VA 23233

leslie.knachel@dhp.virginia.gov

Dear Ms. Knachel:

As the Board of Optometry drafts the preliminary regulations for laser surgery certifications, the Virginia Society of Eye Physicians and Surgeons (VSEPS) strongly recommends that the following items are included in the draft to ensure critical patient safety. The directing legislation, passed in the 2022 legislative session, tasks the Board of Optometry with creating regulations for optometrists to perform laser surgery in which they must address six high level provisions. The following recommendations were chosen based on those guidelines.

VSEPS’ number one priority in drafting the regulations for laser surgery is patient safety. We urge the Board to suggest separate certifications for each of the named procedures given their dramatically different indications, safety profiles, and complications.

In creating these new regulations, VSEPS also believes that the regulations require individuals performing these procedures to have medical education, with medical testing and surgical proctoring. We support an independent third party overseeing the medical testing process, rather than a self-regulated approach. This testing should be completed in the beginning of the process, prior to surgical proctoring.

In addition to these education and training requirements, VSEPS recommends that the current baseline requirements of the Accreditation Council for Graduate Medical Education (ACGME) be expanded to ensure patient safety as recommended below. The ACGME requirements for these procedures are in the setting of comprehensive surgical training. Comprehensive surgical training requires a minimum of 200 surgical cases, and while we recognize that number is likely not realistic in this situation, VSEPS strongly believes that the minimal number of surgical cases as follows should be the core baseline to ensure proper experience and patient safety.

• Yag capsulotomy (10)
• SLT (10)
• Iridotomy (8)

As these procedures are performed, VSEPS suggests that the requirements include live proctoring with real-time monitoring with a training scope by an ophthalmologist certified by the American Board of Ophthalmology. Additionally, to create a quality assurance system, VSEPS believes that the regulations should include the creation of a data repository that includes pre-op, intra-op, and post-op data collection, along with an annual renewal policy demonstrating safety and currency (minimum number of cases safely performed per year).

VSEPS created the recommendations above with patient safety at the forefront of each objective, and it is our strong hope that the Board of Optometry will include these suggestions in their draft regulations. We appreciate the opportunity to provide comments and look forward to future opportunities to participate in this regulatory drafting process.

Sincerely,

Kapil G. Kapoor, MD, FACS, FICS, FASRS

President