The optometry regulator in New Zealand has approved a major scope-of-practice change allowing the profession to perform ophthalmic laser surgery, dismissing ophthalmology objections regarding safety and lost training opportunities for registrars.
The Optometrists and Dispensing Opticians Board (ODOB) – which carries out functions determined by the Health Practitioners Competence Assurance Act – made the change following a pilot and consultation with the sector, with the policy coming into effect on 1 July.
Specifically, an optometrist now with a Specialist Optometrist Scope of Practice – Ophthalmic Laser Surgeries on their registration is authorised to use a neodymium: yttrium aluminum garnet (Nd:YAG) laser for capsulotomy and/or peripheral iridotomy in an approved hospital setting.
It’s hoped the move can help overcome a significant lack of ophthalmology cover in many areas across New Zealand, which ODOB highlighted in a 2018 report.
With there being sufficient optometrists in those areas, ODOB said allowing some to perform minor laser surgeries would reduce the burden on the private and public ophthalmology sector, and lower geographical barriers to accessing care.
“This in turn would free up ophthalmologists to do the more complicated procedures, effectively reducing overall wait-times for all ophthalmic procedures, improving treatment efficiency, and reducing unnecessary impairment of vision,” OBOD said.
“The patient experience would also be improved, as the same person who diagnoses the condition could then undertake the treatment, often at the same visit.”
After several meetings with key stakeholders, and a preliminary literature review, the board approved a pilot study to run in the ophthalmology department at Greenlane Clinical Centre, in Auckland. Its purpose was to ensure the board could safely introduce a specialist optometrist scope-of-practice in ophthalmic laser surgery.
According to ODOB, the pilot was successfully completed in 2021 and it was satisfied that it could safely ensure the training and practise of these practitioners.
During the consultation phase there were 23 submissions, most in favour of the proposal.
“While favourable submissions from within the optometric community could be seen as biased, it is important to note that the profession of optometry is risk adverse and has been slow to adopt previous expansions in scope,” ODOB stated.
However, the proposal did not receive unanimous support. Although it did not name those who lodged submissions, an ODOB summary said those opposed “were from an ophthalmology perspective, and hinged on the following four themes”.
These were:
- A potential for misdiagnosis of the visual condition and the decision-making process about surgical intervention.
- Laser surgery is done with a surgical device with critical safety requirements and has the potential for complications.
- The proposed training is too short and not sufficient for optometrists to safely practise.
- There may not be a need for additional capacity to perform laser surgeries and may take training opportunities away from ophthalmology training registrars.
In response, the ODOB said concerns regarding diagnosis and management “appear dated and unsupported by the literature, and do not reflect the current optometry scope-of-practice where consideration for surgical referral is routine”.
“The concerns regarding safety are not supported by published literature of international experience, and patient experience is at least as high when an optometrist performs the procedure,” the board stated.
“Concerns regarding accountability and continuity of care are not novel or unique to this procedure, and are already part of the optometrist scope. Many models of co-management of conditions between ophthalmology and optometry already exist.”
Finally, ODOB said issues with implementation costs were short-term in nature and quickly recovered, and enable efficiency gains in more complex areas of ophthalmology for which there is greater requirement for specialist care.
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