Welcome to the North Carolina Medical Society Legislative Blog update. The first bill that could potentially impact the practice of medicine was filed this week.  House Bill 36, titled  “Amending the Scope of Practice of Optometry in Order to Enhance Access to Eye Care in North Carolina”, was filed by primary sponsors Rep. Justin Burr (R- Stanly) , Rep. Jeff Collins (R– Nash) , Rep. Josh Dobson (R – Avery) and Rep. Julia Howard (R- Davie). The North Carolina Medical Society opposes this bill because optometrists do not have the requisite training necessary to perform surgery.
The first section of the bill states that there are 1,180 optometrists that provide primary eye care in North Carolina. The bill also claims that the expansion of their scope of practice would “greatly improve access and affordability of eye care to the citizens of North Carolina”.
The second portion of the bill strikes their absolute bar on performing surgery and lists eighteen different surgeries that they would NOT be allowed to perform including the following:
(1)        Retina laser procedures, LASIK, and PRK.
(2)        Nonlaser surgery related to removal of the eye from a living human being.
(3)        Nonlaser surgery requiring full thickness incision or excision of the cornea or sclera other than paracentesis in an emergency situation requiring immediate reduction of the pressure inside the eye.
(4)        Penetrating keratoplasty (corneal transplant), or lamellar keratoplasty.
(5)        Nonlaser surgery requiring incision of the iris and ciliary body, including iris diathermy or cryotherapy.
(6)        Nonlaser surgery requiring incision of the vitreous.
(7)        Nonlaser surgery requiring incision of the retina.
(8)        Nonlaser surgical extraction of the crystalline lens.
(9)        Nonlaser surgical intraocular implants.
(10)      Incisional or excisional nonlaser surgery of the extraocular muscles.
(11)      Nonlaser surgery of the eyelid for eyelid malignancies or for incisional cosmetic or mechanical repair of blepharochalasis, ptosis, or tarsorrhaphy.
(12)      Nonlaser surgery of the bony orbit, including orbital implants.
(13)      Incisional or excisional nonlaser surgery of the lacrimal system other than lacrimal probing or related procedures.
(14)      Nonlaser surgery requiring full thickness conjunctivoplasty with graft or flap.
(15)      Any nonlaser surgical procedure that does not provide for the correction and relief of ocular abnormalities.
(16)      Laser or nonlaser injection into the posterior chamber of the eye to treat any macular or retinal disease.
(17)      The administration of general anesthesia.
(18)      Procedures performed under general anesthesia.
The problem with this kind of statutory construction is that the law will not define what they are allowed to do if passed this way.  Currently, Optometrists claim that they only want to do YAG and SLT laser surgeries as well as some skin tag removals.  The list above leaves far more than these three proposed scope expansions as options for their scope as currently written.
Additionally, we oppose this because the proposed language opens the door for optometrists to perform more surgeries as medicine advances in the future without ever having to come back to the NC General Assembly for approval.  This is contrary to the traditional structure of the NC General Statutes that require similar changes for other practitioners to seek legislative approval through a thorough bill process in order to expand their scope of practice.
We believe that optometrists are trained to be primary care givers for eyes. However, we do not think that they have the necessary training and experience to perform surgery safely.  Only a limited few optometric training schools even include any such training in their curriculum and even then further training is required to receive the base level certification used in other states to qualify optometrists to practice laser surgery.  This is not enough to provide for the safety of the citizens of NC.
How would you respond to this bill? What surgical procedures do you notice are not covered by the limited list of exceptions above?  Please post your responses in our comment section below.