As an experienced teacher of eye surgeons, I implore North Carolina’s state legislators to reject two misguided proposals, House Bill 36 and Senate Bill 342, which would let optometrists — who are not medical doctors, much less surgeons — perform hundreds of kinds of eye surgery with scalpels and lasers. Such a move would needlessly threaten patient safety across North Carolina while raising the cost of health care for everyone.

Not only would HB 36 and SB 342 remove the current law’s common-sense requirement of a medical license to perform eye surgery, but also they would remove the full ability of the North Carolina Medical Board to determine the standards of medical education and surgical training. That would cast aside vital safety protections for vulnerable patients throughout North Carolina.

“Ophthalmology” and “optometry” sound similar, but they’re very different. Ophthalmologists graduate from four years of medical school, followed by four more years of specialized medical training, including surgery.

Optometrists have an important and valuable role to play in health care, but they are not medical doctors. Some optometrists believe they can learn to perform surgery properly during a 32-hour weekend course. Most optometrists in North Carolina have no surgical training at all.

I have been training ophthalmology medical residents how to operate for more than a decade. It takes three to five years of intense training to learn how to perform surgery safely and effectively. A weekend course won’t cut it.

Optometrists say the legislation would let them do three or four “simple” laser surgeries and remove “benign” lesions from the eyelid, but the bills exclude only a handful of procedures — opening the door to more than 200 kinds of eye surgery by non-surgeons, including treatment with radioactive plaques for choroidal melanoma and eye injections for macular degeneration and diabetes.

Optometrists cite “access to care” as a justification to let them go beyond their proper professional scope. But there are no major access problems in North Carolina. An optometrist in Kernersville recently claimed that her patients must travel to neighboring Winston-Salem (10 miles) or Greensboro (17 miles) to see an ophthalmologist, as if that were untenable. Meanwhile, there’s an ophthalmology office only a mile and a half away.

Never mind the distances people travel routinely to reach a Walmart or a shopping mall or to attend a college basketball game or other sporting event. To drive 20 minutes or so for something as critical as ensuring that your eyes are operated on by a medical doctor with extensive surgical training does not pose the extreme access burden that optometrists often portray.

Optometrists claim the legislation would save money. But under federal law, Medicare and Medicaid pay ophthalmologists and optometrists the same for the same work. And a recent peer-reviewed study in Oklahoma — one of only three states that allow optometric surgery, with Kentucky and Louisiana — found that for a common procedure, optometrists had to re-do the surgery more than twice as often as ophthalmologists, raising concerns of taxpayer costs as well as patient safety and comfort.

Perhaps optometrists worry that now that patients can buy glasses and contact lenses online, they will have nothing to do, so they want to redefine their profession as a surgical specialty, despite their lack of medical or surgical training. That would not be fair to patients, who would be subjected to potentially blinding surgical procedures performed by non-surgeons.

After a similar law passed in Kentucky in 2011, a statewide poll there showed that four out of five Kentuckians considered it a mistake. Why repeat that blunder in North Carolina, where a recent statewide poll showed that nine out of every 10 voters oppose the idea?

There is a proper, established pathway for people who want to perform delicate eye surgery to learn how to do it right: go to medical school and complete an ophthalmology residency.

Please, for the sake of North Carolina’s 10 million people, don’t put medical patients at undue risk. Leave eye surgery to trained surgeons.

For more information, go to

Make sure you never miss our editorials, letters to the editor and columnists. We’ll deliver the Journal’s Opinion page straight to your inbox.

Dr. Susan Burden is an associate professor in the Department of Ophthalmology at Wake Forest University Baptist Medical Center.

Load comments