Three major medical organizations are demanding Alberta reverse its decision to allow optometrists to perform certain laser surgeries and other procedures, warning the changes could put patients' eyesight at risk.The Canadian Ophthalmological Society (COS), Eye Physicians and Surgeons Association of Alberta (EPSAA) and Alberta Medical Association's Section of Ophthalmology are calling on the provincial government to rescind regulations expanding optometrists' scope of practice.The changes, announced October 26, make Alberta the first province in Canada to authorize specially trained optometrists to perform certain laser procedures, minor surgeries and injections.The government says the expansion will improve access to eye care, particularly for Albertans living in rural and underserved communities.However, ophthalmologists argue the additional training required for optometrists falls far short of the medical education and surgical experience needed to safely perform the procedures.“Patient safety must remain our highest priority when considering changes to the delivery of eye care,” said Dr. Nina Ahuja, president of the Canadian Ophthalmological Society.“We need to be confident that patients will receive safe, high-quality care, regardless of who provides it or where they live. Decisions like this must be guided by evidence and meaningful consultation with medical and surgical experts.”The organizations pointed to the University of Waterloo's Office-based Laser and Minor Surgical Procedures for Optometrists course, which includes approximately 40 hours of training.Only 12 of those hours involve in-person practical laboratory instruction, according to the university's published curriculum.By comparison, ophthalmologists must complete medical school followed by at least five years of accredited residency training, including extensive supervised surgical experience and competency assessments.The medical groups argue that learning to perform a procedure does not necessarily provide the clinical judgment required to determine whether it is appropriate for a particular patient.“Learning how to perform a procedure is not the same as knowing when – and perhaps more importantly, when not – to perform it,” said Dr. Colin Mann, chair of advocacy for the Canadian Ophthalmological Society.“That judgment requires a comprehensive understanding of eye disease, an appreciation of the alternatives and risks, and the experience to manage complications when they occur.”.The organizations warned that even relatively simple laser procedures can result in serious complications, including permanent damage to a patient's vision.They also raised concerns about the removal of apparently harmless eyelid lesions, noting some growths may actually be cancerous and require specialized surgical treatment.Although Alberta's new regulatory framework requires optometrists to complete additional training, examinations and supervised clinical procedures before receiving authorization, the ophthalmologists say those safeguards have not been independently evaluated.They want greater scrutiny of how optometrists will select patients, recognize complications and manage emergencies arising from procedures.The groups also questioned whether the government has demonstrated that expanding optometrists' surgical authority will significantly reduce wait times.They are seeking evidence of existing access problems for the specific procedures being authorized, along with proof the changes will improve care in rural and remote communities.Dr. David Ehmann, president of the Eye Physicians and Surgeons Association of Alberta, said ophthalmologists have been raising their concerns with successive provincial governments for years.“We have worked with successive Alberta governments for several years to raise these concerns and to ensure that patient safety remains central to any proposed changes,” Ehmann said.“Despite our longstanding engagement, important questions remain unanswered. We are disappointed that the decision was made without the further consultation we had anticipated.”Under the changes, qualified optometrists will be permitted to perform certain procedures traditionally carried out by ophthalmologists, including the removal of benign skin lesions, treatment of styes and specified laser treatments.The province has said the changes will allow more patients to receive treatment in community clinics without requiring appointments with specialists..Implementation is being phased in, with optometrists required to obtain additional authorization before performing the expanded procedures.The three medical organizations acknowledged that optometrists play an important role in primary eye care and said they support efforts to improve access to treatment.However, they maintained that expanding surgical authority must be supported by evidence demonstrating that practitioners have the training and expertise needed to protect patients.They are urging Alberta to halt the changes and conduct further consultations with ophthalmologists before proceeding.The groups also proposed improving referral systems, strengthening collaboration between optometrists and ophthalmologists, and expanding access to specialists as alternatives to broadening optometrists' surgical responsibilities.With Alberta becoming the first Canadian province to authorize the procedures, the organizations warned the decision could influence future regulatory changes elsewhere in the country.They said they remain willing to work with the government and other eye care professionals to improve access to treatment, but insist patient safety must take priority over expanding the number of practitioners authorized to perform surgical procedures.
