Eye doctors see problems with bill expanding optometry in NM
House Bill 36, would expand the scope of practice for optometrists in New Mexico and awaits action from the governor. (Photo by Leah Romero / Source NM)
A proposal to allow optometrists to perform several in-office surgeries passed the Legislature and awaits the governor's possible signature, but the New Mexico Academy of Ophthalmology has raised concerns about 'serious risks' to patients.
House Bill 36, sponsored by Majority Whip Rep. Dayan Hochman-Vigil (D-Albuquerque), would expand the Optometry Act and how the 'practice of optometry' is defined. An optometrist holds a doctorate in optometry, or primary eye care, while an ophthalmologist is a medical doctor with surgical training.
Currently, certified ophthalmologists are the only eye professionals who can perform laser procedures in New Mexico.
If enacted, the bill would allow licensed optometrists to perform various laser-involved procedures to treat conditions like clouding or glaucoma, and also require the state Board of Optometry to create standards for training in laser procedures before an optometrist could begin performing them on patients.
An analysis of the bill notes that expanding optometrists' scope of practice could help address the shortage of healthcare providers in New Mexico qualified to care for patients with such needs. The American Academy of Ophthalmology reported that the number of ophthalmologists in the U.S. is predicted to decrease by 12% between 2020 and 2035, while demand for these medical professionals is expected to increase by 24%. The report notes that rural areas in particular do not have adequate access to ophthalmologist services.
Rep. Luis Terrazas (R-Santa Clara), a co-sponsor of the bill, told Source NM he was asked by a local optometrist in his area of rural southwest New Mexico to support the expansions proposed in the bill. Terrazas said he was told that a large number of the optometrist's patients were being referred to care in Tucson due to long wait times.
'Not every family can afford to travel out of town,' Terrazas said. He told Source that he has experienced five eye surgeries himself that required trips to Phoenix. He said as long as the state continues to struggle with access to health care, the longer patients will continue looking for care elsewhere.
However, an analysis by the Department of Health reported that the expansion of 'laser authority' for optometrists in Oklahoma, Louisiana and Kentucky has not proven to increase access to procedures in a significant way and actually poses 'serious concerns' for the safety of patients, particularly due to a lack of standardized guidelines for training in laser surgery.
The DOH report says, 'there is a risk of inconsistent preparation among providers performing these procedures. This inconsistency could lead to an increase in vision loss, blindness, and negative patient outcomes.'
'Lowering the quality of care is not a valid workforce strategy for rural New Mexico,' Rebecca Leenheer, board president of New Mexico Academy of Ophthalmologists, said in a statement. 'Every New Mexican—regardless of ZIP code—deserves the highest level of health care, including qualified, highly trained medical doctors performing delicate eye surgery.'
Terrazas emphasized to Source NM that HB36 does not require optometrists to offer laser procedures, but gives them the choice for what fits best with their practice and their patients' needs.
'I'm not a doctor, but if I was, I would make sure that I had all the proper training that I feel that I need so that I can provide a good service, right, and safe for my patient,' he said. 'I would assume that most doctors are going to do that because they don't want to have any malpractice problems.'
Hochman-Vigil told Source NM that if the bill is enacted, New Mexico would be the 13th state to expand the scope of practice for optometrists, and that medical malpractice insurance has not gone up in those states. She added that optometrists are ethically obligated to consult with or refer patients to ophthalmologists in more complicated cases.
'This actually frees up the ophthalmologist to be able to concentrate on those more complicated cases, so that the optometrist can kind of spend more time working on just your more typical patient care,' Hochman-Vigil said. 'I really feel like, especially for how common these types of procedures are, the argument that it's unsafe [is] just not founded because these types of procedures are performed thousands of times daily and some of them usually take no more than two or three minutes.'
HB36 passed the Legislature and is waiting for Gov. Michelle Lujan Grisham's signature, but the academy is asking the governor to veto the bill. Jodi McGinnis-Porter, a spokesperson for the governor, told Source that 'the bill will be evaluated in its entirety when it makes it up [to the governor's office] and she has until April 11 to act on the bill.'
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