Alaska Legislators try to put lid on ‘eye wars’

If you have a moment, Alaska’s eye surgeons would like your ears.

On public radio and KINY-AM, they’re advertising their message. Part of it goes like this: “It is important to learn the difference between ophthalmologists and optometrists.”

That innocent message — you’ve probably heard it several times without remembering — is the latest psalm in what some lawmakers in the Alaska Legislature call the “eye wars,” a decades-old rhetorical and political battle.

“It’s been going on for a long time,” said Sen. Cathy Giessel, R-Anchorage and sponsor of Senate Bill 36, which would close the lid on the eye wars by giving more authority to the state board of optometry.

A partner bill, House Bill 103, is advancing in the House with the support of Rep. Ivy Spohnholz, D-Anchorage.

The two bills directly affect only the state’s 150 or so optometrists and its handful of ophthalmologists, but indirectly, they will touch any Alaskan who wears eyeglasses or suffers an eye injury.

The key question in the “eye wars” is where the boundary lies between ophthalmology and optometry, and whether — through changes in technology and improvements in medicine — that line can change.

To start, think back to the radio ad. You’ve probably seen an optometrist at least once in your life — it’s the person who checks your eyes and prescribes your glasses.

Unless you’ve had an eye injury, you’ve probably never seen an ophthalmologist, a medical doctor who works as an eye surgeon.

“I’m a medical doctor, the same as a pediatrician and the same as a neurosurgeon,” said Dr. David Zumbro, an ophthalmologist in Anchorage.

Most optometrists also go through years of training and education, but they typically aren’t medical doctors.

HB 103 and SB 36 would allow the board of optometry to define the menu of services an optometrist can provide. The state already allows its dental and medical boards to take similar action, but optometrists must have the Legislature approve any changes.

Zumbro and other ophthalmologists say HB 103 and SB 36 are dangerous because the board could allow optometrists to do things currently done only by them.

“This issue is about patient safety. I don’t look at this as a turf war. I am concerned about potential harm if a profession which is not a surgical occupation is granted the authority and latitude to decide what surgical procedures they can do,” he said by email.

Mike Bennett is an optometrist in Juneau and the former president of the Alaska Optometric Association.

“You kind of have to take the predictions of terrible things happening with a grain of salt,” he said.

Bennett said dentists haven’t caused problems because they’re regulated by the board of dentistry, and similar concerns were raised when the state changed the regulation process for nurse practitioners.

“I just renewed my malpractice insurance yesterday, and I’m paying $418 for this year. I think that speaks volumes for us being cautious and conservative,” he said.

Spohnholz said she wouldn’t be supporting the bill if she did not think it could be done safely.

“What this does is get the Legislature out of the business of regulating by law something that can be done by a board,” she said.

Disagreements between family members can be some of the most unpleasant fights around, and the eye wars are no different.

Last year, when a bill similar to HB 103 failed to pass on the last day of the regular session, the radio ads were a great deal harsher. “If optometrists want to be eye surgeons, send them to medical school — not the Legislature,” one proclaimed.

In Alaska, optometrists refer cases to ophthalmologists, and ophthalmologists in turn refer cases back to optometrists for follow-up care.

“I absolutely hate having to talk to you about this issue. I don’t want to do this because it does create acrimony,” Zumbro said.

Jill Matheson is an optometrist in Juneau.

“We refer back and forth all the time. It’s very cordial and respectful, but we differ on the trust level of the optometry board. I guess that’s what it comes down to,” she said.

One compromise suggested by the ophthalmologists would be to write a definition of eye surgery and exclude specific procedures from the optometrists. Washington state took that approach in its legislation.

Matheson said optometrists might have a problem with that. If the goal is to leave things up to the board, and technology is improving all the time, it makes sense to leave things open-ended.

“I’m hesitant to define surgery at this point in time, knowing that definition may change,” she said.

Jeremiah Myers has been an optometrist in Kodiak for 30 years, delivering eye exams throughout the Kodiak archipelago and as far west as Dutch Harbor.

He was raised in Wrangell, but as he said by phone, “you never go back to be a doctor where you sold newspapers in the bar.”

Myers said he’s seen huge changes in his profession.

“We have increased our capabilities as time and the science of the profession has improved,” he said.

Those changes have meant that while he still sends patients to specialists, he can help more people than he did before. He sees no reason why a laser tool that costs $500,000 today might one day be the equivalent of “a portable radio or something.”

“The road ahead, with technology, should be under the control of our board,” he said.

Where does that leave the ophthalmologists?

“We’re not shuffling against them. We just want to control our own quality,” he said. “We’re brothers.”

 


 

• Contact reporter James Brooks at james.k.brooks@juneauempire.com or call 419-7732.

 


 

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