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“Eyeball Wars” are back for the 2021 Legislative Session

Tuesday, February 02, 2021

Lawmakers file bills expanding optometrist scope-of-practice [allowing] optometrists to perform certain types of eye surgery and prescribe medications.

A pair of bills filed Monday (HB 631/SB 876) would allow optometrists to perform certain types of eye surgery and prescribe medications.

Proponents have argued that expanding their scope of practice would give Floridians better access to eye care. But ophthalmologists are staunchly opposed.

Optometrists are generally primary eye care providers. They are licensed to prescribe corrective lenses and have limited prescription powers, that mostly encompass topical medications such as eye drops. They hold doctorates in optometry.

Ophthalmologists, meanwhile, are medical doctors who specialize in eye care. They argue optometrists do not have the education and training needed to perform surgery or prescribe certain controlled substances.

The scope-of-practice battle between the two eye-care professions has raged for years in much the same way as doctors battled APRN scope of practice expansion. The 2021 sponsors are Sen. Manny Diaz Jr. and Rep. Alex Rizo, both Hialeah Republicans. Diaz sponsored optometrist scope of practice expansions when he was in the House.

As stated in the lawmakers’ bills, the state Board of Optometry would determine parameters for optometrists to become licensed to perform surgeries. Upon certification, optometrists would be allowed to perform eyelid and tear duct surgery, as well as a host of procedures that require incisions.

Current law states: “optometrists may administer and prescribe ocular pharmaceutical agents for the diagnosis and treatment of ocular conditions of the human eye and its appendages … without the use of surgery or other invasive techniques.”

The Florida Society of Ophthalmology on Monday released a statement in opposition to the bills, claiming it would “drastically expand the scope of optometric practice in Florida and threaten patient safety” if passed.

“I’m saddened by the filing of this dangerous and harmful legislation” said Dr. Sarah Wellik, the President of the statewide association. “This legislation is a misguided attempt that would grant broad and unprecedented surgical privileges to Optometrists, who have not completed medical school and are not Medical Doctors. Ophthalmologists, on the other hand, are medical doctors who spend over a decade receiving extensive clinical education and surgical training.

“There is no doubt that Optometrists are an important member of the eye care team. With the training they receive, they are fully capable of diagnosing a variety of vision problems and in many cases are able to recognize issues that need to be referred to an Ophthalmologist for appropriate diagnoses and treatment. However, that training is in no way equivalent and does not make them capable of performing surgery,” she continued.

“The idea that an Optometrist could become licensed to perform surgery through legislation, instead of completing medical school and residency training, is a dangerous threat to patient safety. With Florida being the epicenter of the opioid epidemic, it would be catastrophic for the Legislature to expand Optometry’s prescribing authority to over 4,000 non-medical professionals.”

The current “Eyeball War” is not the first. In 2013, optometrists scored a victory via legislation that allowed them to prescribe a limited number of oral medications and forbid them from prescribing Schedule I and II controlled substances. It also said optometrists must complete 20 hours of added training, pass an examination, and carry medical malpractice coverage at the same level as medical doctors. The bill also required optometrists to report all adverse medical incidents — the same as ophthalmologists and other practitioners.

As of Monday, neither of the 2021 bills had committee references.

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