SPRINGFIELD — Patients' health would be put at risk if optometrists in Illinois are successful in their quest for state approval to remove benign nodules and lesions, drain cysts and take tissue samples on the eyes and eyelids, according to physicians who are fighting the proposal.
"These procedures are clearly surgery and will clearly jeopardize patient safety if done by someone who hasn't attended medical school and a residency," said Dr. Chris Albanis, an ophthalmologist in the Chicago area and a past president of the Illinois Society of Eye Physicians & Surgeons.
But Effingham optometrist Dr. Matthew Jones, who is part owner of optometry offices in Pana, Taylorville and Decatur, said statements by Albanis and other ophthalmologists are "a gross hyperbole of the truth."
Jones, a trustee of the Illinois Optometric Association, said ophthalmologists — medical doctors specializing in eye care — are overreacting.
Optometrists want to be able to offer "advanced optometric procedures" so they can do "low-risk" procedures and make eye care more convenient and accessible for patients who would rather not travel outside their hometowns or wait to see an ophthalmologist, Jones said.
The proposed expansion of procedures for optometrists could be enacted through a bureaucratic process overseen by the Illinois General Assembly's Joint Committee on Administrative Rules. The 12-member, bipartisan panel of lawmakers from the Illinois House and Senate is expected to decide over the next few months whether administrative rules pertaining to the expansion should take effect.
An initial draft of rules was issued in late December by the Illinois Department of Financial and Professional Regulation. JCAR can take action after a second version of the rules is published. That version may contain modifications by Financial and Professional Regulation's staff to take into account opinions and suggestions by affected groups.
The rules were proposed after a 2016 bill passed overwhelmingly by the General Assembly and signed into law by Gov. Bruce Rauner allowed "advanced optometric procedures" if optometrists fulfilled educational requirements that are "consistent with the recommendations" of a task force created by the law.
The law didn't define the allowable procedures.
The task force, made up of representatives of optometrists, ophthalmologists and the Illinois State Medical Society, met 11 times in 2017 but adjourned without agreeing on any recommendations.
The Department of Financial and Professional Regulation still proposed rules allowing advanced procedures based on minimum educational requirements suggested by a representative of the optometric association on the task force.
Richard Paul, executive director of the Illinois Society of Eye Physicians & Surgeons, said it's not legal or proper for the department to issue proposed rules without a formal recommendation from the task force.
The society wants to see the rules rejected. The specifics of any expansion of optometrists' scope of practice should to be considered by the General Assembly in the form of a bill, Paul said.
Department officials said the proposed rules are legal. They wouldn't address Paul's statement that the department, led by Secretary Bryan Schneider, appears to have a "cozy relationship" with optometrists.
"I don't know why Secretary Schneider is so committed to expanding optometrists' scope of practice," Paul said.
A department spokesman said in a statement that the proposed rules "represent a modest expansion of practice for optometrists to utilize effective treatments."
The statement added the treatments are "based upon proven, minimum educational requirements. Illinois citizens will benefit from the advanced optometric procedures that Illinois' optometrists will be able to safely provide once the rule is implemented."
The statement said, "Several states already permit optometrists to utilize optometric procedures, including the use of lasers, which are not included in the proposed rules."
The proposed rules require 32 hours of training for optometrists wanting to perform the procedures, which include certain injections but not Botox injections.
The eye surgeons' group says the proposed training is inadequate when compared with the four years of medical school and four years of residency that ophthalmologists go through after earning bachelor's degrees.
Optometrists can begin practicing after four years of optometry school after receiving bachelor's degrees.
The average annual pay for an optometrist is about $119,000, according to the U.S. Bureau of Labor Statistics. Ophthalmologists typically earn at least three times more than that.
Jones said the 32 hours of additional training proposed for optometrists are more than what is required in the handful of states that have allowed optometrists to do some or all of the procedures being proposed in Illinois.
Louisiana, Kentucky, Tennessee, Oklahoma and New Mexico allow "varying degrees" of the procedures proposed for Illinois optometrists, Paul said.
Jones said there's no evidence from other states that medical complication rates rise when optometrists perform the procedures.
The procedures in question in Illinois aren't big money-makers for ophthalmologists and aren't among their most commonly performed tasks, Albanis said. In fact, many ophthalmologists refer the procedures to ophthalmologists who devote more time to them, she said.
But she said it's necessary to have physician-level training to deal with the procedures because even though they largely carry low risks for patients, the tasks can result in complications and other problems if handled by professionals without a breadth of medical knowledge.
For example, removing a lesion that is thought to be benign, but later determined to be cancerous, can allow the cancer to spread if the lesion is removed in the wrong way, Albanis said.
Illinois is home to between 700 and 800 ophthalmologists and 2,500 optometrists. But Albanis said the procedures optometrists want to perform aren't so urgent that patients can't wait for an appointment with an ophthalmologist.
Paul said almost all Illinoisans live within a 30- to 45-minute drive of an ophthalmologist.
Over the past several decades, optometrists in Illinois, who most often are associated with prescribing and providing eyeglasses and contacts, have sought and been granted the ability to administer medical eye drops and certain oral medications, Paul said.
Ophthalmologists worry that optometrists won't stop if they win the right to perform minor procedures, he said.
"The goal is to be the same as ophthalmologists without the benefit of medical school," Paul said. "The main motivation of my doctors is their concern for patient safety."
Jones said he can't predict what additional services and procedures Illinois optometrists may want to offer, and receive state approval for, in the future.
But for the procedures now under consideration, he said, optometrists want to make care more convenient for their patients.
"Optometrists are the primary eye-care providers for most of the population," he said.