New Hampshire’s legislators are considering bipartisan legislation to increase access to vision and medical eye care for all Granite Staters. Recent columns by Peter Schmidt, Bill Boyd and Mark Pearson have cited a proposed North Country partnership between a group of Seacoast ophthalmologists and Androscoggin Valley Hospital, as well as a recent University of New Hampshire survey, as reasons for opposing HB 349. As an optometrist practicing in North Conway and Berlin since 2013, this partnership is a welcome addition, but it does not negate the need for HB 349 nor solve many of the challenges associated with providing eye care services in our area or across the state.
Over the last 13 years, I have watched many ophthalmologists commit to providing care in our area, only to end their partnerships as their practices in other, more populated parts of the state grew or travel became unsustainable. While many of these partnerships were successful for a short time, none have delivered a permanent solution.
This latest partnership will utilize a number of rotating providers, with a general ophthalmologist visiting once a month and a specialized ophthalmologist seeing patients once a month. While this eases their travel burden, the patient’s consultation and procedure will either be with different providers whom they have not met or patients will wait many months for their provider to return. While this proposal brings cataract surgery back to the North Country and introduces advanced retinal care, these much-needed services are well beyond the narrow procedures included in HB 349.
HB 349 allows optometrists to perform three in-office, minor, non-invasive laser procedures to treat chronic and acute emergency glaucoma and remove a film that commonly develops after cataract surgery. Optometrists already manage these conditions with medicinal care when possible, by advising surgical intervention when indicated, and with management of post-operative care and complications. This is especially true in areas like mine where patients often travel hours for procedures yet seek pre- and post-care with local optometrists. In addition, optometrists already perform other minor, in-office surgical procedures such as the removal of foreign bodies and surrounding damaged tissue in order to promote wound healing.
Regardless of when and where patients see an ophthalmologist, they undergo duplicate evaluations and pay additional co-pays for treatment they could receive from educated and trained optometrists. They also must establish relationships with new providers rather than receiving services from their long-established doctor of optometry. This redundant and duplicative care increases costs for patients, providers and insurers. Passing HB 349 will help reduce the gaps in care for these procedures, provide more continuity of care for patients, decrease costs and allow ophthalmologists to focus on more complex care that only they can provide.
As New Hampshire’s population ages, demand for eye care continues to increase. At the same time, the number of practicing ophthalmologists continues to decline. In fact, the American Association of Medical Colleges anticipates a 12% decline in the number of ophthalmologists in the next 10 years while the demand for these specialists is expected to increase 24%. New Hampshire should be fully utilizing eye care providers to meet these demands by allowing providers to practice at the highest level of their education and training.
I have read multiple reports of a UNH survey suggesting public opposition to this legislation. These results are not available to the public, and with any survey or research study, it is important to know who funded it and what questions were asked to determine if any bias exists. For example, you may get different results when asking, “Should a non-surgeon do surgery?” versus “Should a doctor of optometry perform in-office procedures within their education and training?” Remember, New Hampshire’s optometrists already perform some in-office, minor surgeries.
There are currently 14 states that allow optometrists to perform these procedures, and a dozen others are working to pass similar legislation. For more than 30 years, optometrists have safely performed more than 145,000 optometric laser procedures without any increase in rates of complication or malpractice rates. Every optometry school in the country teaches these procedures, and graduates want to practice in states that allow optometrists to utilize the full extent of their training and education.
My optometrist colleagues and I have never supported legislation authorizing procedures that we were not prepared to safely and effectively provide. There has never been a repeal of optometric advancement in New Hampshire, nor in any state, and malpractice rates have not increased in states offering these optometric laser procedures. Optometrists are committed to providing safe and effective care for our patients. Passing HB 349 will not change that.
Angelique Sawyer, OD, FAAO, Diplomate ABO, is the owner Conway Eye Care in North Conway and Berlin. She is a past president of the New Hampshire Optometric Association and lives in Conway.