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Optometrist 'Scope Of Practice' Discussion Heats Up In Florida Senate

Sen. Manny Diaz Jr.
News Service of Florida
The Florida Channel
Bill sponsor Sen. Manny Diaz Jr. promised he would make changes as it maneuvers through the legislative session.

Amid heavy opposition from physicians, the Senate Health Policy Committee approved a bill that would authorize optometrists to perform some laser surgeries and prescribe opioids.

Jump-starting an annual tug-of-war over who can treat patients, a Senate panel has approved a bill that would authorize optometrists to perform some laser surgeries and prescribe opioids for patients.

The vote, however, came amid heavy opposition from physicians and suggestions from some Republican lawmakers that they were only voting for the bill out of deference to bill sponsor Manny Diaz Jr., a Hialeah Republican who is chairman of the Senate Health Policy Committee.

“I’m going to support it today, but just under the understanding that I don’t love this bill. But I do love our chairman,” Sen. Ben Albritton, R-Wauchula, said before the Health Policy Committee approved the measure Wednesday. “And I am going to support him in this cause. I know he’s working hard to try to move the ball in an area that is very difficult.”

Lawmakers have had on-again, off-again tussles over the issue of “scope of practice” for doctors, nurses and other health care professionals during the past two decades, including recurring battles between optometrists and ophthalmologists.

Three members of the Health Policy Committee made clear Wednesday they were troubled by the latest bill to steer more business to optometrists. Sen. Jason Brodeur, R-Sanford, joked that he, too, loved Diaz but said that he would seek to amend the bill to require that “these non-physicians using lasers and opioids” face liability insurance requirements.

Sen. Ileana Garcia, R-Miami, voted for the bill but said she wouldn’t again unless it was altered to ban what she called invasive eye procedures. “I think that should be left to ophthalmologists,” she said.

Sen. Lauren Book, a Plantation Democrat whose district includes the Nova Southeastern University College of Optometry, noted “there’s a lot of different sides to these issues” and said she would support the bill but “continue to work on it.”

Supporters of expanding the scope of practice for optometrists say it would benefit patients.

Florida Optometric Association president Michelle Levin told the Health Policy Committee last week that the bill would expand access to health care and lower health care costs, a common theme from supporters of scope of practice expansions.

"I can tell you eye health care is in high demand," said Levin, an optometrist who works in Miami.

Despite COVID-19 precautions that prevent face-to-face testimony at Senate meetings, four physicians traveled to Tallahassee for Wednesday’s meeting to oppose the bill, including Florida Society of Ophthalmology president Sarah Wellik, a Miami physician. People have to testify remotely by video from a civic center a few blocks from the Capitol.

“This is confusing for non-doctors. Ophthalmologists and optometrists both start ‘opt’ and they both have to do with the eye, and most members of the lay public don’t understand the difference,” Wellik said, adding that lawmakers shouldn’t be confused by what laser procedures involve.

“Do not be swayed by some of the language in this bill,” she said. “Even lasers cut, disrupt and burn tissues inside the eye and are, as such, invasive procedures.”

Ophthalmologists are medical doctors with between eight and 10 post-graduate years of medical education and clinical training in surgery, according to the ophthalmological society. Optometrists complete a four-year program from optometry school.

The Legislature in recent years has passed several bills to expand scopes of practice. For instance, in 2020 lawmakers approved bills that allowed pharmacists to treat certain patients for chronic medical conditions and also gave the green light for advanced practice registered nurses who specialize in primary care to practice independently from physicians.

Lawmakers in 2013 expanded the scope of practice for optometrists, agreeing to allow them to prescribe topical medications. The compromise was touted as the end of the long-running “eyeball wars” and was a priority of Sen. Don Gaetz, a Niceville Republican who later ascended to Senate president.

Under the Gatez-negotiated deal, optometrists were authorized to prescribe certain topical medications that appear on a drug formulary. They were not authorized to perform surgery.

Currently, five states --- Oklahoma, Kentucky, Alaska, Louisiana and Arkansas --- permit optometrists to perform advanced procedures such as laser treatments, injections and removal of lesions and growths. If Diaz’s bill passes, Florida would be the sixth.

In addition, the bill would require the Florida Board of Optometry to pass rules addressing the surgeries that could be performed, which is something that Bruce May, an attorney representing the Florida Society of Ophthalmology called bad policy.

“Think about that for a moment. The Board of Optometry is an appointed board of seven members,” May said, noting that five members are optometrists and two are consumer members. “No member of the Board of Optometry has ever gone to medical school, no member has performed surgery. It’s difficult to believe that the Florida Legislature would put non-surgeons in charge of overseeing surgery, particularly surgery of the eye which has no margin of error, But that’s precisely what this bill would do.”

Diaz promised that he would make changes as the bill maneuvers through the 60-day session.

“This bill has a long way to go, and I do recognize that, so I do appreciate all the comments from the committee. It truly will make it better and that’s what the process is about,” Diaz said.

A House version (HB 631), filed by Rep. Alex Rizo, R-Hialeah, has not been heard in committees.

Christine Sexton - News Service of Florida