The America Optometric Association (AOA) has described as “contentious” a study cited by ophthalmologists in its argument against optometry expanding its scope of practice.
The study published in JAMA Ophthalmology in 2016 compared the outcomes of laser trabeculoplasty (LTP) between optometrists and ophthalmologists in Oklahoma where both have been allowed surgical privileges to perform LTP to treat glaucoma patients since 1988. The report stated that “Medicare beneficiaries undergoing LTP by optometrists had a 189 per cent increased hazard of requiring additional LTPs in the same eye compared with those receiving LTP by ophthalmologists… after adjusting for potential confounders.”
According to AOA, patients treated by optometrists required additional LTPs in the same eye because optometrists performed the procedure in two, 180-degree treatments as opposed to one 360-degree treatment procedure.
They noted that at the time of the study (2013), doctors of optometry trained and certified to perform LTP followed the American Academy of Ophthalmology Primary Open Angle Glaucoma Preferred Practice Pattern statement that ‘treating 180 degrees reduces the incidence and magnitude of post-operative IOP elevation compared with 360-degree treatment”.
When JAMA Ophthalmology sought commentary from glaucoma expert Dr. Murray Fingeret, he said, “When SLT (selective LTP) was first introduced, it was understood that you can get the desired reduction in the eye pressure with only half the eye being treated, and fewer complications were seen… This is a perfectly reasonable method, and the American Academy of Ophthalmology’s own practice guidelines discuss this method.”
The AOA also contended that the study size was too small with only six doctors of optometry nationwide performing the procedure at least 10 times for Medicare patients in 2013 (averaging 1.78 procedures per patient) and 14 physicians nationwide reimbursed for three or more SLT treatments per patient, only one of which was a doctor of optometry.