"The Minnesota House was wise to stop unrestricted prescribing of risky medications by optometrists," the writer says. (DENIS FARRELL/The Associated Press)

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We appreciate the Star Tribune’s editorial on the critical issue of eye care debated during Minnesota’s 2024 legislative session (“On eye medicine, the ‘ayes’ nearly had it,” June 16). As the leading voice for physicians and surgeons in Minnesota, our organization considers access to safe quality eye care vitally important. While expanding access to health care services in Minnesota is essential for our aging population, Minnesotans deserve a physician-led eye care team involving both ophthalmologists and optometrists.

Unfortunately, the editorial gave an incomplete picture of the recent vision care debate. The Minnesota House was wise to stop unrestricted prescribing of risky medications by optometrists. The bill lacked safety guardrails, such as physician consultations prior to initiating certain medications with potentially dangerous side effects. Optometry’s legislation also proposed they perform injections into the eye and eyelids allowing them to perform surgery. While this provision was removed in committee in 2024, it is all but certain to be debated again in 2025.

Although optometrists are not medical doctors, their profession claims that optometry school sufficiently prepares them to expand into medical and surgical care. They assert that they are ready immediately after finishing school to perform “advanced medical procedures” including surgeries on and around the eye, injections into the eyelid, and to prescribe any medication, including highly addictive narcotics. They maintain that they are equipped to assess and manage critical medical and surgical complications, even in babies, children and the elderly. For example, optometrists asked the Legislature to allow them to prescribe prednisone, a potent steroid medication, which can cause life-threatening diabetic coma.

More than 90% of optometry students do not practice advanced treatments on live patients with real conditions. Instead, they rely on classroom instruction with videos and handling models. Optometry’s national board examination for advanced medical procedures, promoted as a national standard, is limited and does not measure ability and skill with real patients. By contrast, advance practice nurse practitioners complete 2,080 hours of collaboration with a physician before independently prescribing and treating patients in Minnesota.

Conversely, ophthalmologists are physicians specially trained in comprehensive medical and surgical care of the eye and the entire human body. Their proficiency is acquired through four years of medical school, another four-year minimum apprenticeship-style surgical residency program including one year of required hospital-based general medical/surgical training, totaling over 17,000 hours of supervised clinical training. This includes treating and performing complete surgeries on live patients with real conditions under the direct supervision of an experienced ophthalmologist. Ophthalmology residents acquire clinical expertise with the singular attention of leaders in the field, and like other physician specialists, ophthalmologists only practice independently after their supervising physician has approved their skills and abilities.

Minnesota enjoys a slightly greater number of ophthalmologists per capita than the national average and 95% of Minnesotans live within a 30-minute drive of an ophthalmologist. While wait times can seem long for some patients, patient access and wait time issues are not solved by modifying scope of practice for individuals with insufficient training. Insurance companies’ prior authorization requirements or network adequacy often cause these delays. Current law allows optometrists to play a valuable and important patient care role in collaborative consultation with a physician. Eye care patients who require immediate treatment can be seen by an ophthalmologist straight away.

We need only look to other states that permit optometrists expanded scope authority to assess if patient access has actually improved. Medicare fee-for-service data shows only a small proportion of optometrists provide these services to seniors, the population supposedly necessitating the proposed change. Furthermore, Minnesota does not currently, nor has it previously had the problem of optometrists leaving the state. Data from the biennial report for the health licensing boards shows that since 2012, the number of newly licensed optometrists has increased every year, with approximately 15% more optometry licensees issued in the 2020-22 reporting period compared with the same figures from 2010-12.

Medical standards in Minnesota should not be compromised. Minnesotans and their elected legislators should not want undertrained professions practicing complex medicine. We applaud House Speaker Melissa Hortman and all of Minnesota’s legislators — on both sides of the aisle — who prioritize patient safety over political convenience.

Dr. Amanda C. Maltry is president-elect of the Minnesota Academy of Ophthalmology.