June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
A Comparison of Performance of Therapeutic Procedures by Ophthalmologists and Optometrists in States with Expanded Scope of Practice
Author Affiliations & Notes
  • David Sanders
    Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Alan Sugar
    Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
  • Joshua D Stein
    Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
    Center for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   David Sanders, None; Alan Sugar, None; Joshua Stein, American Academy of Ophthalmology (F), NEI EY026641 (F), Research to Prevent Blindness (F), WK Kellogg Foundation (F)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5067. doi:
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    • Get Citation

      David Sanders, Alan Sugar, Joshua D Stein; A Comparison of Performance of Therapeutic Procedures by Ophthalmologists and Optometrists in States with Expanded Scope of Practice. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5067.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Optometrists in the states of Oklahoma (OK), Kentucky (KY), and New Mexico (NM) are permitted to perform laser procedures, injections, and minor surgical procedures in an office setting. It is unclear how often optometrists practicing in these states perform these sorts of procedures and how that compares with ophthalmologists who practice in these 3 states.

Methods : Using a health care claims database consisting of 20% of all Medicare enrollees throughout the US during 2008-2012, we used NPI to identify all ophthalmologists and optometrists practicing in OK. For various eye procedures, we determined the numbers and yearly rates of each procedure performed by optometrists and ophthalmologists who performed the procedures at least once. Rate ratios (the rate of procedures performed by optometrists divided by rate of procedures by ophthalmologists) were calculated to summarize differences. Rate ratios <1 indicate procedures performed more frequently by ophthalmologists and ratios >1 indicate procedures performed more frequently by optometrists.

Results : In our 20% sample, 53411 Medicare enrollees visited 621 optometrists ≥1 time and 49169 were seen by 183 ophthalmologists ≥1 time from 2008-2012. Among all optometrists practicing in OK during 2008-2012, the total number of intraocular / periocular injections was just 51 compared with 21427 for ophthalmologists (rate ratio=0.03). Optometrists also performed fewer punctal procedures (751 vs. 1591), chalazion removals (131 vs. 554), ALT/SLT (354 vs. 1276), and LPI (59 vs. 328) than ophthalmologists did and at a lower rate (rate ratios=0.50, 0.64, 0.67, and 0.74, respectively). Optometrists performed more eyelash epilations (1673 vs. 1089) and superficial foreign body removals (551 vs. 256) that ophthalmologists did but still at a lower rate (rate ratios=0.76 and 0.87). Results will be reported for KY and NM as well.

Conclusions : In states with expanded scope of practice, optometrists are performing many fewer intraocular injections, eyelid procedures, and lasers for glaucoma relative to ophthalmologists. It is unclear whether optometrists practicing in these states are able to maintain the necessary skills to perform more complex procedures if they are performing these procedures so infrequently.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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