When one goes to the ophthalmologist to correct an eye issue, you often expect the person doing the procedure to have the education and hours required to be able to safely conduct it. In fact, they do – ophthalmologists have medical school degrees and more than 17,000 hours of patient contact before they can practice on their own.
However, state lawmakers in Tallahassee may change the law to allow unqualified individuals to perform eye surgeries, putting patients at risk.
The proposal being considered, House Bill 449, would vastly expand the scope of practice for optometrists, who usually see you for your annual eye exam. Under this proposal, optometrists would be allowed to perform eye surgery and be granted broader prescribing authority for narcotics. The problem is optometrists are not medical doctors and are not trained to perform surgery.
Rather than go to medical school, optometrists attend a four-year course in optometry, some of which do not even need a college degree for admittance. In comparison to the number of hours required for ophthalmologists, optometrists only complete 2,500 hours of clinical training and no surgical training. While optometry is an excellent and rewarding career field, patients want to feel safe and expect a certain level of both education and training when doctors are performing a procedure on them.
This bill throws that safety away. Peer reviewed medical research published in the Journal of the American Medical Association on a type of laser surgery to treat glaucoma shows there is a significantly increased incidence of required follow-up surgery when the initial procedure was performed by an optometrist when compared to when it was performed by an ophthalmologist. We’ve also seen documented cases of sight threatening complications occurring after optometrists performed surgical procedures on patients in other states, including Oklahoma, Louisiana, and Kentucky.
Even the optometrists agree with this. During the 2013 legislative session, lawmakers visited a similar scope of practice issue involving optometrists and the optometrists agreed that they would be prohibited from performing surgery of any kind, as they were not qualified.
The bill also gives optometrists significantly broader prescribing authority, including the ability to prescribe opioids. Florida has made strides in combating the opioid crisis, with former Attorney General Ashley Moody recently announcing a 11% drop in fentanyl deaths from 2023 to 2024. Allowing optometrists, who are not medically trained, to prescribe opioids could increase the risk of reversing some of this progress.
Further driving the point home that this proposal is dangerous, the bill gives the Board of Optometry – none of whom attended medical school nor have performed surgery – broad discretion to define which surgeries optometrists are permitted to perform.
The Board of Optometry’s authority to define those “permitted” surgeries is virtually unchecked. The bill vaguely describes 12 types of eye surgery that are off limits to optometrists, but all other eye surgeries not expressly excluded could be performed by optometrists if approved by the Board of Optometry.
Optometrists are an important part of the eye healthcare team, but they do not have the same level of education, training or clinical surgery skills to perform any procedure on or near the eyeball that requires lasers, scalpels or injections like an ophthalmologist does. This dangerous bill should not proceed through the legislative process and lawmakers should vote no.
Dr. Raquel Goldhardt is a professor of Clinical Ophthalmology at the University of Miami and President of the Florida Society of Ophthalmology.
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