By Rachel Spillane / For The Herald
Imagine finding a small bump on your eyelid and asking the optometrist you’ve seen for the last decade to check it out. You’re told it’s benign and removal is relatively simple.
Your relief doesn’t last when you’re then told that Washington state law won’t let your optometrist perform the procedure. If you were in Oregon or Idaho, it could be taken care of then and there, but not here.
That’s the problem facing patients here in Snohomish County and across the state. Washington’s optometry scope of practice laws haven’t been updated since 2003, before the original iPhone was launched. Just as personal technology has changed dramatically since then, advances in optometric procedures, technologies, medications, and education have improved how we can care for our patients.
Unfortunately, we can’t deliver those improvements to you because we live in Washington.
The Legislature needs to fix this problem and provide everyone in our state better access to high quality, affordable eye care. The changes won’t cost anything; they’ll actually save money in additional visits and co-payments.
Lawmakers should allow optometrists to perform a range of minor procedures, deliver injections around the eye, and prescribe certain oral medications; all of which we are trained to do, and which our colleagues in other states already safely do. These changes will improve access and reduce cost for everyone, but especially benefit patients who are older, low income, people of color and rural residents.
Optometrists are well-trained medical professionals who serve as primary eyecare providers for almost everyone. We complete four years of intense post-graduate training on the anatomy, diseases and treatment of the eye. Many of us get additional specialized training, and we all meet strict continuing education requirements to maintain our licenses. I spent 12 years after high school in college, residency and pursuit of a certificate in gerontology through the University of Washington. I love what I do and stay current to ensure I provide my patients with the highest level of care.
There are about three times as many licensed and practicing optometrists in Washington as there are ophthalmologists, the practitioners who currently would receive the referral to treat the minor eyelid bump mentioned earlier. Allowing optometrists to perform these services in keeping with our education and training would improve access to timely, professional and cost-effective care.
When I am forced by Washington’s scope of practice rules to refer a patient for a procedure I’m trained to perform, they suffer a delay in care and incur unnecessary costs. Wait times for a referral can be three months or longer. The patient must make at least one additional appointment and pay a second insurance co-pay which is costly and frustrating.
As often as not, there could be one appointment in the ophthalmologist’s office to confirm my diagnosis and for the patient to meet a new provider they don’t know, followed by a second appointment at an ambulatory surgery clinic for the actual procedure. These clinics impose a facility charge on top of the provider’s fee, roughly doubling the total cost. Not to mention the additional time off work, travel time and related expenses; all for something I could have taken care of in my office. One visit, one co-pay, no delay.
Patients facing this additional cost and inconvenience may delay treatment or not follow through at all. For more serious conditions, that can put both their vision and their overall health in jeopardy.
As an optometrist, I recognize that there are many conditions that legitimately require the additional training of an ophthalmologist. We are committed to our patients’ safety and aren’t asking for authority to provide this more comprehensive care. There are many local ophthalmologists that I love working with and I will continue refer patients to them in these cases.
My education and training prepared me to safely carry out many procedures that I am currently barred from performing. My patients look to me for this care and I want to deliver it to them.
The Department of Health has conducted an extensive review of this proposal and concluded that additional procedures can be safely added to optometry’s scope of practice.
For the sake of patients across Washington, it’s time for lawmakers to look at the evidence and update optometry’s scope of practice.
Dr. Rachel Spillane is an optometrist practicing in Everett.
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