On eye medicine, the ‘ayes’ nearly had it

Opinion editor’s note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

•••

Minnesotans have grown accustomed to last-minute surprises in legislative sessions. Often they involve provisions tucked into larger bills that senators and representatives must take up while racing to beat the clock. This year, the closing days of the session brought a different kind of surprise.

House Speaker Melissa Hortman, DFL-Brooklyn Park, ordered that language expanding the “scope of practice” for Minnesota optometrists be stripped from a conference committee report. The measure was not concerned only with optometrists; it also enlarged the permissible practices of dentists and social workers. But only the optometrist language was deleted.

As reported by the Minnesota Reformer, the initiative had enjoyed widespread bipartisan support, garnering more than the permissible maximum number of cosponsors. It would have allowed optometrists to use more of their training. It might have attracted young practitioners to Minnesota or motivated those trained here to stay here, rather than emigrate to other states where they could employ more of their skills.

“There’s definitely a lot of support for making the change,” Speaker Hortman said last week. “But in my judgment, that doesn’t make it the right thing to do.”

Hortman’s position had the backing of the Minnesota Academy of Ophthalmology. That organization had submitted a letter urging legislators “to protect patients in Minnesota, by maintaining our current law’s high standards for medical care that are working well. We strongly urge you to oppose this significant, unsafe, and unnecessary expansion of optometric scope of practice.”

A letter from the Minnesota Board of Optometry took the opposite view: “It is becoming increasingly apparent that Minnesota’s Optometric Practice Act is antiquated and needs revision. Minnesota is lagging behind other states and needs to catch up in its ability to deliver timely, quality care to Minnesotans. Slightly expanding our scope of practice — to fall more closely in line with neighboring states — will help attract new graduates to our state, ensuring better access to care throughout the state.”

A word about the difference between ophthalmologists and optometrists: An ophthalmologist is a medical doctor who specializes in caring for the eye, performing a wide range of procedures up to and including surgery if necessary. An optometrist is a doctor of optometry, able to diagnose and treat some eye problems and determine the right prescription lenses for people who wear glasses. Optometrists greatly outnumber ophthalmologists in Minnesota, and they generally earn less than half of what ophthalmologists do. (Optometry, though, is much easier to spell.)

In an interview with an editorial writer on Thursday, Hortman stressed that optometrists “are not eye doctors” and shouldn’t be referred to as such. “There are conditions people need to see an eye doctor for,” she said. “Sometimes when they go to an optometrist, they are delayed in care that they need, or they are getting the wrong care. … I just have a very strong opinion that there is a difference in the training” that ophthalmologists and optometrists receive.

She’s correct. Ophthalmologists go to medical school, followed by residency and internship. Optometrists take a four-year program after college.

Hortman suggested that the movement in Minnesota and other states to expand the scope of optometrists’ practice has its origins in the rise of online optical suppliers. “I understand that the optometrists have lost a lot of business to online retailers,” she said. “To me, that’s not a reason to change the scope of practice.”

Dr. Tina McCarty, who represents the Minnesota Board of Optometry, strongly disagreed with Hortman’s remark about economic competition. “That has nothing to do with it,” she said.

“The optometrist in Minnesota has a restricted license compared to almost every other state in the union, which is starting to make it hard for optometrists to want to practice in Minnesota, and/or patients having timely access to care,” McCarty said. “A patient may wait months to get in to see an ophthalmologist.”

In Hortman’s telling, the legislation’s fatal flaw was that it attempted to address the balance of practice between ophthalmologists and optometrists without getting consent from both parties. “We very often say to the warring parties, ‘Go work it out,’” she said. “We’re not medical experts. … ‘You guys go, talk to each other, battle it out.’ And in most cases, entities are able to do that. Optometrists and ophthalmologists have not been able to do that over the years that they’ve been warring at the Legislature.”

A bit of unscientific research backs up McCarty’s assertion that it can take months to get an appointment with an ophthalmologist. It might take only (only!) weeks to be seen by an optometrist. That could be a starting point for the consensus that Hortman wants to see: a recognition that the two sides have a common problem, and that they need to work together on possible solutions.

But a negotiated happy ending cannot be the only option. Optometrists in dozens of other states have more discretion in prescribing medications than their colleagues in Minnesota. We admire Hortman’s dedication to finding consensus, but an aging population needs easy access to eye care. If consensus remains elusive, future legislators must be ready to visualize a solution and make it happen.

Editorial Board members are David Banks, Jill Burcum, Denise Johnson and John Rash. Star Tribune Opinion staff members Maggie Kelly, Kavita Kumar and Elena Neuzil and editorial intern Aurora Weirens also contribute, and Star Tribune CEO and Publisher Steve Grove serves as an adviser to the board.