COLORADO ODS EXPAND THEIR AUTHORITY

Another state allows optometrists to perform many office-based surgical procedures, including laser procedures.

BY RENÉ LUTHE, SENIOR EDITOR

In a continuing nationwide trend, Colorado granted optometrists expanded scope of practice, including laser procedures. H.B. 22-1233 gives ODs authority to perform certain office-based procedures including:

• Injections for treating conditions or diseases of the eye or eyelid (excluding intraocular injections penetrating the globe)
• Removal and biopsy of eyelid lesions without characteristics or obvious signs of malignancy (excluding lesions involving the eyelid margin or larger than 5 mm)
• Incision and curettage of a chalazion
• Simple repair of an eyelid laceration no larger than 2.5 cm and no deeper than the orbicularis muscle and not involving the eyelid margin or lacrimal drainage structures
• Corneal cross-linking
• Laser capsulotomy, laser peripheral iridotomy and laser trabeculoplasty

The legislation makes Colorado the 10th state to expand optometric authority and the fourth since 2021.

While they respect and appreciate the contributions of ODs they work with, many ophthalmologists remain concerned about the ongoing expansion, says Richard S. Davidson, MD, professor and vice chair for quality and clinical affairs, cataract, cornea and refractive surgery at University of Colorado Sue Anschutz-Rodgers Eye Center and University of Colorado School of Medicine, Aurora.

“I am very proud of the optometrists in our group and the many optometrists I have worked with over the past 20 years of my career,” he says. “That being said, I think the optometry lobby has over-simplified the procedures for which they are now approved, all of which can come with significant complications for the patient.”

Dr. Davidson notes that for him to be approved to perform the same procedures, he was required to complete 4 years of training to become an MD, a 1-year general medicine internship and a minimum 3 years of residency training. “The requirement of the 3-year residency is to allow one to do many of these cases hundreds of times in order to be deemed competent to perform the procedure. Just being ‘taught’ about the procedures or perhaps doing a wet lab during optometry school does not make one competent to perform the procedure. In fact, it leaves the public at high risk for significant ocular complications without them knowing just how at risk they are because these procedures have been ‘approved’ by the legislature.” OM

SURVEY REVEALS BURNOUT AMONG OPHTHALMOLOGISTS

Results reveal higher rates in women and those in academic and hospital settings.

BY ZACK TERTEL, MANAGING EDITOR

A recent survey of US ophthalmologists revealed self-reported burnout. Published in the June 2022 issue of Journal of Cataract & Refractive Surgery, the results showed that 37.8% of respondents (224 of 592 ophthalmologists) have symptoms of burnout.¹ These numbers were highest among uveitis specialists (30 of 66, or 45.4%). Women had nearly twice the odds of reporting burnout, and those employed in academic and hospital facilities reported higher rates of burnout compared with those in large private groups.

Fortunately, most of those reporting burnout (65.2%) were categorized as mild, followed by 29.5% at moderate levels and 5.4% at severe. According to the study by Sedhom et al, “Burnout was associated with self-reported low work control, insufficient time for documentation and misalignment with departmental leaders.”

A 2020 survey that included more occupations uncovered similar burnout rates in ophthalmology (30%). Though ophthalmology was among the least burned-out specialties in the survey, reported rates were higher than nonphysicians.² Another study from 2018 of US ophthalmology residents showed burnout symptoms in as many as 63% of respondents.³

For Blake K. Williamson, MD, MPH, MS, of Williamson Eye Center in Louisiana, the burnout is the result of a variety of influences. “On a very simple level, the reason why is that surgeons are being asked to do more surgery for less money for patients who expect more while using staff who are harder to find and harder to keep.”

With so many contributing factors, solutions to avoiding burnout are far from simple. Still, small changes can make a significant difference. For example, along with adding yoga and meditation to his weekly routine, Dr. Williamson recently opted to no longer see patients on Fridays. “That will be my day to do more administrative tasks, speak to my management team and work on my business rather than work in my business.” OM

REFERENCES

1. Sedhom JA, Patnaik JL, McCourt EA, et al. Physician burnout in ophthalmology: U.S. survey. J Cataract Refract Surg. 2022;48(6):723-729.
2. Kane L. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Medscape. 2020.
3. Feng S, Taravati P, Ding L, Menda S. Burnout in ophthalmology residency: a national survey. J Acad Ophthalmol. 2018;10:e98-e107.