Opinion: Minnesota legislators must not lower the standard on eye surgery

Opinion editor’s note: Strib Voices publishes a mix of guest commentaries online and in print each day. To contribute, click here.

•••

High standards of medical care matter in Minnesota — especially when it comes to eye surgery. Minnesotans do not want unqualified, non-physicians putting needles into their eyes.

Proposed legislation — SF 1144 and HF 1011 — would allow optometrists, who are not medical doctors or trained surgeons, to operate on the delicate tissues surrounding the eye and inject powerful pharmaceuticals directly into the eyeball itself. It’s being sold as a way to expand access, but the real result is lower safety standards.

However, a new survey found that 85% of Minnesotans would rather have surgical eye procedures — including injections — done by a trained surgeon than by an optometrist, even if it means driving farther. Nearly 75% oppose legislation in Minnesota which would let optometrists do just that.

This isn’t about routine checkups or glasses. It’s about high-risk procedures where one wrong move can cause permanent visual impairment or blindness.

Precision is everything. A slight error in the eyelid can spread cancer, scar tear drainage systems or paralyze nerves. A misdirected needle or lapse in sterile protocol can lead to infection, retinal detachment, painful high pressure, optic nerve damage or severe hemorrhaging. Experience of the surgeon matters — not because of straightforward cases, but because complex, unpredictable complications require the skill that only comes with experience.

All ophthalmologists must complete four years of medical school, a hospital-based internship and at least three years of surgical residency, performing hundreds of surgeries under the direct supervision of an experienced eye surgeon. Many also complete an additional one- to two-year subspecialty fellowship. That equates to more than 17,000 hours of education and clinical training before they ever operate on their own.

In contrast, optometrists don’t attend medical school and generally receive no surgical training except for an optional 32-hour certification course that can be done over a long weekend with no requirements to perform surgeries on live patients. Fortunately, only five states (constituting 8% of the U.S. population) allow optometrists to insert needles into a human’s eye.

Despite a wide margin of opposition from voters and the medical community, some lawmakers continue to push for this legislation. Proponents have downplayed the complexity of eye surgery. They trivialize eyelid lesions as “lumps and bumps,” which oversimplifies a very complex area of pathology. That “lump” or “bump” could be cancer, which could spread and cause disfigurement or worse if improperly removed or injected.

Minnesota law currently — and appropriately — prohibits optometrists from performing “invasive surgery.” But that term is left undefined in Minnesota statute. The language of the proposed legislation exploits the loophole and disregards the American Medical Association’s definition of surgery by deeming that surgeries on the eyelid or intraocular injections (where a needle goes directly into the eyeball) are “not invasive.”

All surgery, by its nature, is invasive. To suggest there is “non-invasive surgery” is not only misleading — it is dangerous.

Advocates of these bills inappropriately cite geographic access to ophthalmology care as a reason to expand scope. They fail to recognize the standard triage process that occurs throughout organized health care and that telemedicine remains an option for those with mobility challenges. Additionally, Medicare data shows that over 95% of Minnesotans live within 30 minutes of an ophthalmologist. Of the remaining 5%, approximately half will have no need for vision care services, and the vast majority of the remaining half will have vision care needs that can be fully addressed by optometrists under their current scope.

Optometrists play a critical role in primary vision care and eye health care, and Minnesota has welcomed nearly 200 new optometrists who have chosen to practice here over the past decade. However, when it comes to safely performing highly sensitive surgeries and delicate injections into and around the eye, only ophthalmologists have the proper medical education, clinical training and surgical experience needed to ensure the highest standard of care and patient safety.

Minnesota lawmakers should listen to their constituents and reject any bill that allows optometrists to start injecting medications and anesthetics into and around the eye. Minnesotans overwhelmingly oppose lowering eye surgery safety standards. They understand that doing so comes with unacceptable risks to their eyes and vision.

Eye surgery should be performed by surgeons. Anything else puts the vision of Minnesotans at risk.

Dr. Amanda Maltry is president of the Minnesota Academy of Eye Physicians and Surgeons.