Optometrists’ Surgery Scope ExpandsMore optometrists in the United States are now performing office-based cataract and glaucoma surgical procedures, according to a US academic. The trend will be of particular interest to New Zealand optometrists, who are now allowed to perform ophthalmic laser surgery, after the Optometrist and Dispensing Opticians Board approved a new scope of practice. Associate Professor Nathan Lighthizer from Northeastern State University College of Optometry in Tahlequah, Oklahoma – who is also a practising optometrist, and a regular speaker at Australian optometry conferences – says there is a growing suite of treatments offered in optometrists’ offices, saving patients time and money. A/Prof Lighthizer says the most common laser-based procedure performed in an optometrist’s office is the yttrium aluminum garnet ( YAG) capsulotomy. For individuals who find floaters problematic, laser floater removal – or laser vitreolysis – is a solid inoffice option, according to A/Prof Lighthizer. He estimates that he conducts 150 laser floater removal procedures in a month, saying they are far less invasive than vitrectomy. A/Prof Lighthizer also nominates selective laser trabeculoplasty (SLT) for the management of glaucoma as a first-line treatment for US optometrists performing in-office procedures. For patients with eyelid lesions – seborrheic keratosis, squamous papilloma, chalazion, or nevi – optometrists can perform excisions with precision and control using new technology. A/Prof Lighthizer says his preferred method is to use a radiofrequency unit that uses a small radio wave-emitting probe to remove lesions layer by layer, with minimal to no bleeding or scarring. In most US states and in Australia, patients must visit an ophthalmologist for these procedures. However, a number of US states – including Oklahoma, where A/Prof Lighthizer has his practice – have granted optometrists wide discretion to perform these procedures. Still more states allow optometrists to perform in-office surgical procedures, but with greater restrictions. In New Zealand, as of July 2022, optometrists can be authorised to perform both neodymiumdoped yttrium aluminium garnet (Nd: YAG) laser capsulotomy and laser peripheral iridotomy in an approved hospital setting. The change in scope of practice in NZ followed a successful pilot study and comprehensive consultation. It is hoped that allowing optometrists to perform minor laser surgeries will reduce the burden on the private and public ophthalmology sectors and lower geographical barriers to accessing care. A/Prof Lighthizer presented on in-office procedures being performed by US optometrists at Vision Expo East 2022, held earlier this year in New York.
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