Virginia Regulatory Town Hall
Agency
Department of Health Professions
 
Board
Board of Optometry
 
chapter
Regulations of the Virginia Board of Optometry [18 VAC 105 ‑ 20]
Action Regulations for laser surgery certifications
Stage Proposed
Comment Period Ended on 10/25/2024
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529 comments

All comments for this forum
Page of 11       comments per page    
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9/20/24  2:44 pm
Commenter: Dr. Jeffrey Michaels

Support Laser Regulations as Presented Without Changes
 

Support the draft regulations as presented without changes.  Optometrists have been performing these procedures since the 1990s.  

 

CommentID: 227872
 

9/20/24  2:46 pm
Commenter: Jacqueline Theis

Support for Laser Regulations
 

I support the draft regulations as presented without changes.  I am an optometrist practicing in the state of Virginia, and attest that optometrists are properly and highly trained to perform these laser procedures.  These regulations were developed with input from a regulatory advisory panel and included input form both optometry and ophthalmology. 

CommentID: 227873
 

9/20/24  2:47 pm
Commenter: Michael Polo

Support for Laser regulations
 

I am a OD practicing in Colonial Heights, Virginia. I fully support these draft regulations as they are presented. 

CommentID: 227874
 

9/20/24  2:50 pm
Commenter: Lisa V. Gontarek, OD

Support in office lasers by doctors of optometry as presented
 

Please support the draft regulations that were developed from a regulatory advisory panel that included input from both optometrists and ophthalmologists. No changes.

More than 146,000 of these laser procedures have been performed by optometrists across the country and Virginia optometrists are trained to perform these procedures as well.

CommentID: 227875
 

9/20/24  2:52 pm
Commenter: Dr Scott Mann - Invision

Support for laser regulations as written
 

This legislation will prevent our patients from duplicate visits with duplicate co-pays and out of pocket expenses. It will reduce waiting times from 3 months down to 3 days and decrease travel burdens and costs for our rural patients.

CommentID: 227876
 

9/20/24  2:53 pm
Commenter: Anthony Zarella, OD, Horizon Family Eye Care, PLLC

Support draft regulations as presented
 

I support the draft regulations as presented without change!

Optometrist's are trained and qualified to perform these procedures, and the draft regulations have been prepared with input from a regulatory advisory panel that includes both Optometry and Ophthalmology experts in the field. Our patients are fully protected and will benefit from increased access to these procedures using the current language.

Thank you!

CommentID: 227877
 

9/20/24  2:54 pm
Commenter: Mandy Pennington

Support laser regulations
 

I support the draft laser regulations as presented with no changes.  I support the quality assurance review process as stated.  I have been practicing for almost 20 years and optometrists are properly and highly trained to perform these laser procedures. 

CommentID: 227878
 

9/20/24  2:54 pm
Commenter: David Rose

Support for Laser Regulations
 

I am voicing my support for the draft regulations as presented with no changes.  I also support no more than 2 proctored sessions for each of the laser procedures.  Optometrists are properly and highly trained to perform these procedures.  

CommentID: 227879
 

9/20/24  2:54 pm
Commenter: Katherine Rachon, OD, FAAO, Dipl ABO, Virginia Optometric Association

Support for proposal as submitted
 

Twelve states include in-office laser procedures done by optometrists, including a state in which I practiced and safely performed these procedures before moving to Virginia. More than 146,000 procedures have been performed by optometry with no unseen outcomes as shown by Nighthizer N, et al. ND: YAG Laser Capsulotomy: Efficacy and Outcomes performed by Optometrists. Optom Vis Sci 2023 100(10) 665-669. As is currently stands, draft regulations were developed with input from a regulatory advisory panel (RAP) that included input from both Optometrists and Ophthalmologists. I support the draft regulations AS presented without further changes and support the quality assurance review process as presented. 

CommentID: 227880
 

9/20/24  2:55 pm
Commenter: Christine Paschal, OD

Support Draft Regulations as Presented
 

I support the draft regulations as presented with no changes. I am an optometrist who has been practicing in Virginia for 7 years and am certified to perform YAG, SLT, and ALT procedures. I support that an educational attestation from a dean or designee of a school of optometry or instructor or a laser certification course approved by the board be sufficient evidence of appropriate training. We are highly trained doctors who can perform these procedures, and already treat patients who have had these procedures done.  Also, optometrists themselves have been performing lasers in other states since the 1990s, more than 146,000 procedures in total. 

CommentID: 227881
 

9/20/24  2:56 pm
Commenter: Dr. Joseph Droter OD

Support for the proposal as submitted
 

There are 12 states that already include in-office laser procedures by optometrists. There have been over 146,000 procedures performed by optometrists across the country.  Optometrists have been preforming lasers since the 1990’s. 

CommentID: 227882
 

9/20/24  2:59 pm
Commenter: Lisa Wallace-Davis, OD

Support for Laser Regulations
 

I am writing in support of the current laser bill as it is written.  It is important to move this legislation forward with no changes.  The legislation was developed with input from a regulatory advisory panel which included both optometrists and an ophthalmologist.

CommentID: 227883
 

9/20/24  3:00 pm
Commenter: Kristy Robinson-Lee OD

Support in-office lasers by Optometrists
 

I am writing to support the draft regulations for laser surgery certifications as written. In Virginia, optometrists have been treating the conditions in these regulations since the early 1980s. Optometrists are highly and properly trained to treat theses conditions. There are 12 states that include in-office laser procedures. Optometry scope has evolved in Virginia since the 1980s and the regulations should be approved. Again, I support the draft regulations as written.

CommentID: 227884
 

9/25/24  10:34 am
Commenter: Bo Keeney, Virginia Optometric Association

Support Draft Regulations as presented
 

The Virginia Optometric Association (VOA) thanks the Regulatory Advisory Panel (RAP) for drafting the proposed regulations and the members of the Board of Optometry for their continued work. We believe these draft regulations present a consensus amongst all stakeholders, including the Optometrists and Ophthalmologists who both served on the RAP. As proven, we know that Virginia’s Optometrists are properly and highly trained to perform these laser procedures. The draft regulations provide the appropriate measures needed to regulate Virginia licensed Optometrist who wish to perform these Ophthalmic laser procedures while protecting the interest of the public. We believe the draft regulations related to initial certification are more than adequate to qualify a provider. We support the educational attestation from a dean or designee of a school of optometry or an instructor of a laser surgery certification course approved by the board to be sufficient evidence of obtaining the appropriate didactic and clinical laser surgery training. We support the quality assurance review process as presented. We support the language that "Proctored session" means any surgery on a live patient or procedure performed on a model eye. We support no more than two proctored sessions for each of the laser procedures. In the end, we thank for board for their work and encourage you to proceed with the draft regulations exactly as presented with no modifications or changes.

CommentID: 227904
 

9/25/24  12:37 pm
Commenter: Adam Parker

Support optometry regs
 

Please support the optometric laser regulations as currently presented. They were developed collaboratively with input from both optometrists and ophthalmologists. Optometrists are thoroughly educated, trained, and certified to perform these procedures. Additionally, in-office laser procedures by optometrists are already permitted in 12 states, with over 146,000 procedures performed nationwide. Supporting the regulations as written will ensure consistent and safe practice standards.

Thank you for your consideration.

Regards,
Adam Parker, OD 

CommentID: 227907
 

9/25/24  5:28 pm
Commenter: Walter Whitley

Support in-office lasers by doctors of optometry
 

I am writing in support of the draft regulations as presented without any changes.  This draft was developed with input from optometry and ophthalmology and should be supported as presented. 

CommentID: 227934
 

9/30/24  3:56 pm
Commenter: Jenny Alsop, OD

Support optometry proposal as submitted
 

Please support regulations as presented, they were developed with input from optometry and ophthalmology and should be supported as presented for the well being of the public.

Optometrists are educated, trained and certified to perform the procedures outlined in the regulations within their doctoral programs. 

Twelve (12) states include in-office laser procedures by optometrists, dating back to the 1990s.

CommentID: 228028
 

10/18/24  11:19 am
Commenter: david mcclure

lasers
 

laser surgery needs to be performed by people who are trained in the proper use of and complications  for proper patient care; please take care of patient  best interests; thank you

CommentID: 228138
 

10/24/24  7:36 am
Commenter: Mary Beth McAteer

Concerned regarding regulations
 

Kelli Moss, Executive Director
Virginia Board of Optometry
Virginia Department of Health Professions 9960 Mayland Drive, Suite 300
Henrico, VA 23233 Kelli.Moss@dhp.virginia.gov

Dear Ms. Moss:


As a member of the Northern Virginia Academy of Ophthalmology, I write to you
today to express my deep concern regarding the particular section in the draft
regulations regarding proctoring for those individuals seeking certification for laser eye
surgery.

As the Board of Optometry finalizes the regulations for laser surgery certification, I
strongly recommend amending the draft regulations to reflect a proctoring process that
requires both didactic and live proctored cases, whether or not a plastic model is
involved. Currently, the draft regulations are written so that proctoring can be done on a
model eye or on a live patient, and in many cases proctoring is not even required.

There is a wide spread list of physiological issues that can affect individuals’ ability to
remain still during a laser eye surgery procedure. Some examples of these varying
factors can include, but are not limited to, tremors, anxiety, or breathing movements
particularly for obese patients. The smallest movement of the patient’s eye, even a
centimeter, can result in dangerous and detrimental outcomes for the patient because
laser eye surgery treatment is measured in the sphere of microns.

This request comes with patient safety as the top priority and ensuring quality, safe care
is provided throughout the Commonwealth. I strongly hope you will consider this change
to the draft regulations to ensure optometrists across the state are trained to the highest
standard.

 

Sincerely,

Mary Beth McAteer

CommentID: 228216
 

10/24/24  11:30 am
Commenter: Jason Goldberg MD

laser surgery certifaction
 

As a member of the Virginia Society of Eye Physicians and Surgeons, I write to you today to express my concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery.

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved.

Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient. There is a wide spread list of physiological issues that can affect individuals’ ability to remain still during a laser eye surgery procedure. Some examples of these varying factors can include, but are not limited to, tremors, anxiety, or breathing movements particularly for obese patients. The smallest movement of the patient’s eye, even a centimeter, can result in dangerous and detrimental outcomes for the patient because laser eye surgery treatment is measured in the sphere of microns.

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard. 

Respectfully,

Jason Goldberg MD 

CommentID: 228220
 

10/24/24  12:18 pm
Commenter: Mark Mannis

LAser Surgery by Optometrists
 

Dear Madams, Sirs:

The proposal to allow optometric practitioners to perform laser surgery on the eye represents a clear and present danger to the patient population of Virginia.  Laser surgery is performed inside the eye , and without adequate surgical training and the experience to know how to deal with surgical complications, optometrists should not be performing these procedures. Proposals such as this demonstrate a misunderstanding of how competent surgeons learn their craft.  It is not feasible to assume that practice on a plastic model without proctored instruction is in any way adequate to prepare a non-surgically trained optometrist to undertake this kind of intra-ocular surgery. We would ask every legislator to consider whether he or she would submit to surgery by a practitioner without solid surgical training.  I certainly would not.  There are adequate resources in Virginia's ophthalmologic community to provide these procedures, so it is not a problem of access.

We urge the legislature to defeat this proposal in the interest of the safety of Virginia's citizens.

Mark J Mannis, MD, FACS

California Academy of Eye Physicians and Surgeons

 

CommentID: 228221
 

10/24/24  12:34 pm
Commenter: Daniel Montenegro MD

Laser Surgery by Optometrists
 

Dear Madams, Sirs:

The proposal to allow optometric practitioners to perform laser surgery on the eye represents a serious and dangerous risk for the population of Virginia. As Ophthalmologists, we perform over 200 laser procedures with direct supervision on live patients before being allowed to perform these on our own. The risks of laser procedures include bleeding inside the eye, high pressure inside the eye, retinal detachment, and many more. If one of these complications were to occur, we as Ophthalmologists are prepared to handle these complications for our patients. Our medical school education and rigorous Ophthalmology Residency training is what prepares us to perform surgery around and inside the eye. I agree with Dr. Mannis in that it is not feasible to assume that practice on a plastic model without proctored instruction is in any way adequate to prepare a non-surgically trained optometrist to undertake this kind of intra-ocular surgery. We urge the legislature to not approve this proposal in order to protect the health of the citizens of Virginia. Thank you for your time and consideration.

Sincerely,

Daniel Montenegro, MD

Miami, FL

 

CommentID: 228222
 

10/24/24  12:41 pm
Commenter: Anonymous

LASER eye Surgery by Optometrists
 
Dear Madams, Sirs:

 

The proposal to allow optometric practitioners to perform laser eye surgery is flat out dangerous. 

The proposal to allow optometric practitioners to perform laser surgery on the eye represents a clear and present danger to the patient population of Virginia.  Laser surgery is performed inside the eye , and without adequate surgical training and the experience to know how to deal with surgical complications, optometrists should not be performing these procedures. Proposals such as this demonstrate a misunderstanding of how competent surgeons learn their craft.  It is not feasible to assume that practice on a plastic model without proctored instruction is in any way adequate to prepare a non-surgically trained optometrist to undertake this kind of intra-ocular surgery. We would ask every legislator to consider whether he or she would submit to surgery by a practitioner without solid surgical training.  I certainly would not.  There are adequate resources in Virginia's ophthalmologic community to provide these procedures, so it is not a problem of access.

We urge the legislature to defeat this proposal in the interest of the safety of Virginia's citizens.

Sherief Raouf MD

New York Ophthalmic Society 

 

CommentID: 228224
 

10/24/24  12:45 pm
Commenter: Anonymous

Opposition to optima performing laser
 

I write to you today to express my deep concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery. 

 

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

 

There is a wide spread list of physiological issues that can affect individuals’ ability to remain still during a laser eye surgery procedure. Some examples of these varying factors can include, but are not limited to, tremors, anxiety, or breathing movements particularly for obese patients. The smallest movement of the patient’s eye, even a centimeter, can result in dangerous and detrimental outcomes for the patient because laser eye surgery treatment is measured in the sphere of microns. 

 

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard. 

Kenneth mathys MD

CommentID: 228225
 

10/24/24  1:06 pm
Commenter: Michael R Keverline, MD

Need for proctoring on live patients
 

As I presented personally at the public comment meeting, I believe that proctored procedures done on live patients are an essential safety measure and should be included in this legislation.

Approximately 80% of difficulties in performance of the included procedures are due to patient movement, body habitus and active resistance.  You can not replicate these things with an eye model or computer program.  

For the safety of Patients in the Commonwealth, proctored procedures on live patients must be a part of the regulations.

Michael Keverline, MD

Chesapeake, VA

CommentID: 228226
 

10/24/24  1:24 pm
Commenter: John T McAllister, M.D.

Highly Concerning Regulations
 

Kelli Moss, Executive Director

Virginia Board of Optometry

Virginia Department of Health Professions

9960 Mayland Drive, Suite 300

Henrico, VA 23233

Kelli.Moss@dhp.virginia.gov

 

Dear Ms. Moss:

 

The Virginia Society of Eye Physicians and Surgeons (VSEPS) is the largest organization of eye physicians and surgeons in the Commonwealth. As a society, we protect sight and empower lives through ophthalmic education and advocating for our patients as well as the public. We strive to ensure the delivery of the highest-quality eye care in the Commonwealth.

 

Surgery should be done by surgeons. The Commonwealth has unfortunately decided to part from this seemingly self-evident truth. It is the duty of the Commonwealth to ensure the safety of its citizens. We therefore submit these comments regarding the proposed Board of Optometry regulations.

 

As the Board of Optometry finalizes the regulations for laser surgery certification, the VSEPS expresses great concern with the regulations as stated and we strongly recommend amending the current draft to reflect more stringent requirements around proctored sessions to ensure critical patient safety. We appreciate the Board’s work to focus on the provisions for proctored care, the requirement of logging complications, and the requirement that didactic education include indications and complications. However, we would like to raise our concern with the section of the draft regulations that state an individual can meet the certification requirements by attending a didactic course or by performing these procedures in a proctored session on either a model eye or on a live patient. We strongly recommend amending the proposed regulations to require both didactic and live proctored cases, whether or not on a plastic model eye.

 

Understanding the theory of laser therapy and the internal structure and shape of the eye, is not the same as performing the same surgery on living tissue. Patients come to the laser treatment with a myriad of physiologic conditions that can impact these surgeries. Eye movements, tremors, neurologic conditions, anxiety, and even at times breathing (especially in obese patients) can move the eye centimeters, when laser eye surgery treatment is in a sphere of microns. Errors on this scale due to simple patient movement can change the outcome for these patients and increase their risk of complications. Carefully proctored practice mitigates and substantially lowers that risk to a much more tolerable level.

 

If you look across various industries that involve safety risk, it is typical to require supervised live practice in addition to standard didactics. Pilots must have substantial amounts of proctored hours flying a plane prior to being able to do so alone or with customers, all after taking didactics and a test. The Commonwealth requires a minimum of 45 proctored hours of driving a car prior to getting a driver’s license, again after didactics and tests. These standards ensure the safety of the public. We strongly believe it is in the best interest of patient safety to require proctored cases in live patients after didactics and testing prior to the Board approving an optometrist to operate one of these procedures.

 

Ophthalmologists are required to have extensive didactics as well as more than two hundred live proctored cases performed in their training prior to obtaining a medical license to practice. While we understand this number would be impractical to request, we believe it is reasonable to request ten live proctored capsulotomies, ten live proctored laser trabeculoplasties, and eight live proctored iridotomies for the safety of patients in the Commonwealth.

 

VSEPS created the recommendations above with patient safety at the forefront of each objective, and while we understand the desire to decrease patient wait times and streamline business operations, we believe patient safety takes primacy over business concerns and convenience and it is our strong hope that the Board of Optometry will include these suggestions to strengthen patient safety in their draft regulations.

 

In response to allegations of endorsement, the Virginia Society of Eye Physicians and Surgeons (the largest organization of ophthalmologists in the Commonwealth), the Northern Virginia Academy of Ophthalmology (the second largest organization of ophthalmologists in the Commonwealth), and the American Academy of Ophthalmology (the largest organization of ophthalmologists in the nation) as organizations have not supported, endorsed or collaborated with organized optometry or with the Board of Optometry in the process of their developing these regulations, which as they stand represent a dangerous decrease in the standard of care of the citizens of the Commonwealth.

 

Additionally, it is important to highlight that there has been very little opportunity for the overwhelming opinion of ophthalmologists to be considered in the development of these regulations. That includes a single in-person comment opportunity that was opened within 48 hours of publication of the proposed regulations. It also includes the presence of only one single ophthalmologist (whose placement we were not requested to assist with) on the Regulatory Advisory Panel that was responsible for reviewing various sections of the draft regulations. That Panel was otherwise comprised of four optometrists (to include a representative from the Virginia Optometric Association) and one citizen member. The representation on this panel was heavily geared toward the optometric profession, leaving room for minimal input from ophthalmologists, specifically regarding the required training and proctoring needed to maintain the highest level of patient safety.

 

The Board of Optometry’s mission statement speaks of assuring patient safety. The VSEPS encourages the Board to hearken back to its mission statement, protect the citizens of the Commonwealth, and tighten standards of approval to require in-person proctoring in all cases, and place patient safety ahead of convenience or practice business concerns.

 

Thank you,

A signature on a white background

Description automatically generated

John T. McAllister, MD

President, Virginia Society of Eye Physicians and Surgeons

CommentID: 228228
 

10/24/24  1:30 pm
Commenter: Andrew Siegel, MD - Eye Physicians of Virginia

Amendment to Proposed Regulations to Preserve Patient Safety
 

October 24th, 2024

 

Kelli Moss, Executive Director
Virginia Board of Optometry
Virginia Department of Health Professions 9960 Mayland Drive, Suite 300
Henrico, VA 23233 Kelli.Moss@dhp.virginia.gov 

 

Dear Ms. Moss: 

 

As a member of the Virginia Society of Eye Physicians and Surgeons, I write to you today to express my deep concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery. 

 

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

 

There is a wide spread list of physiological issues that can affect individuals’ ability to remain still during a laser eye surgery procedure. Some examples of these varying factors can include, but are not limited to, tremors, anxiety, or breathing movements particularly for obese patients. The smallest movement of the patient’s eye, even a centimeter, can result in dangerous and detrimental outcomes for the patient because laser eye surgery treatment is measured in the sphere of microns. 

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard. 

 

Please know that in ophthalmology residency, we have hundreds (sometimes thousands) of directly supervised laser procedures - giving patients anything less is a disservice to their health and autonomy. 

 

Thank you for your consideration,

Andrew Siegel, MD 

CommentID: 228229
 

10/24/24  2:20 pm
Commenter: Makesha L Sink, OD, FAAO, ABCMO

I support this bill as written
 

I support the draft regulations as presented without changes. These regulations were written conjointly by a regulatory advisory board consisting of highly trained optometrists and ophthalmologists alike who agreed that laser procedures are safely performed by optometrists and ophthalmologists alike. 

A recent study highlights that optometrists have been performing these procedures safely since 1988 in the United States, currently in 12 states, and also in the United Kingdom and New Zealand alike. With well over 150,000 of these procedures performed by optometrists as recorded in the US, there has been a complication rate of 0.001%.  I am sure ophthalmologists on this comment board, who have raised opposition to this regulation change, can agree that these statistics on procedures performed on REAL patients by optometrists show that their skills and outcomes are inarguably safe and similar outcomes to what ophthalmologists perform. 

I have been practicing for over 20 years and optometrists are properly and highly trained to perform these laser procedures. I have included a link to the referenced study above and am happy to advise further. Study Confirms Safety of Optometric Laser Surgery (reviewofoptometry.com)  Published 7/31/2024. 

   

Thank you

 

CommentID: 228230
 

10/24/24  2:22 pm
Commenter: Brooke A. Smith, OD FAAO

Support for Laser Regulations
 

I support the draft regulations as presented without changes and the quality assurance review process as stated.  These regulations were developed with input from a regulatory advisory panel and included input form both optometry and ophthalmology for safe laser practice.  

I have been practicing for almost 18 years and optometrists are properly and highly trained to perform these laser procedures. These laser procedures have been performed by optometrists across the country and Virginia optometrists are trained to perform these procedures as well. 

An article was published this past July 2024 regarding the safety of optometric laser surgery (Lighthizer N, Patel K, Cockrell D, et al. Establishment and review of educational programs to train optometrists in laser procedures and injections. Clin Experiment Optom. July 24, 2024).  This study represents the first published data from multiple decades and numerous states highlighting the competency and safety of ODs performing advanced procedures.  “The outcomes of over 146,403 laser procedures performed by optometrists across the US have shown only two negative outcomes, equating to 0.001%,” the researchers reported.

Again, I support the draft regulations for optometry laser as presented without changes. 

 

CommentID: 228231
 

10/24/24  2:51 pm
Commenter: ERIN VOGT STROMBERG, Blink Eyecare

support of the draft regulations
 

I am also writing in support of the draft regulations as presented without any changes. This draft was developed with input from optometry and ophthalmology and should be supported as presented.

CommentID: 228232
 

10/24/24  3:04 pm
Commenter: Anonymous

Support as written
 

I support the bill as written.

CommentID: 228233
 

10/24/24  3:19 pm
Commenter: Richard E. Castillo, OD, DO

Support the draft as written
 

Virginia’s Optometrists are properly and highly trained to perform these laser procedures. The draft regulations provide the appropriate measures needed to regulate Virginia licensed Optometrist who wish to perform these ophthalmic laser procedures while protecting the interest of the public.

I support passage of the National Board of Examiners in Optometry's  Laser and Surgical Procedures Examination as a certying mechanism, or a course approved by the Virginia optometric licensing board to be evidence of appropriate didactic and clinical laser surgery training.

 

CommentID: 228234
 

10/24/24  3:35 pm
Commenter: Chris Wroten

Support optometry regulations as presented
 

I write in support of the draft regulations as presented without any changes. In-office lasers have been safely and effectively performed by doctors of optometry since the 1990s.

CommentID: 228235
 

10/24/24  3:42 pm
Commenter: Amanda Umlandt OD FAAO

Support optometry regulations as presented
 

I am in support of draft regulations as presented without any changes. Draft regulations as presented were developed with thoughtful input from optometry and ophthalmology and should be supported as presented.  I do support the regulations including proctored sessions with model eyes. Optometrists are educated, trained and certified to perform the procedures outlined in the regulations. I have performed these procedures numerous times when licensed in another state but have been unable to perform them since living in Virginia. My education and training will provide significant value to my patients and lessen their burden of travel to receive these procedures, in most cases out of state as I live near the border in an low population area. Optometry education and training supports the regulation requirements of 2 proctored sessions per procedure. 

CommentID: 228236
 

10/24/24  4:00 pm
Commenter: Sonya Shah, MD

Amendment to Proposed Regulations to Preserve Patient Safety
 

It is the duty of the Commonwealth to ensure the safety of its citizens. I therefore submit these comments regarding the proposed Board of Optometry regulations.

As the Board of Optometry finalizes the regulations for laser surgery certification, I am concerned about the regulations as stated and recommend amending the current draft to reflect more stringent requirements around proctored sessions to ensure critical patient safety.

While there are provisions for proctored care, the requirement of logging complications, and the requirement that didactic education include indications and complications. However, it seems an individual can meet the certification requirements by attending a didactic course or by performing these procedures in a proctored session on either a model eye or on a live patient. I strongly recommend amending the proposed regulations to require both didactic and live proctored cases. 

Understanding the theory of laser therapy and the internal structure and shape of the eye, is not the same as performing the same surgery on living tissue. Patients come to the laser treatment with a myriad of physiologic conditions that can impact these surgeries. Eye movements, tremors, neurologic conditions, anxiety, and even at times breathing (especially in obese patients) can move the eye centimeters, when laser eye surgery treatment is in a sphere of microns. Bleeding and inflammation can obscure the view for accurate treatment. Errors on this scale can change the outcome for these patients and increase their risk of complications. Carefully proctored practice mitigates and substantially lowers that risk to a much more tolerable level.

If you look across various industries that involve safety risk, it is typical to require supervised live practice in addition to standard didactics. Pilots must have substantial amounts of proctored hours flying a plane prior to being able to do so alone or with customers, all after taking didactics and a test. The Commonwealth requires a minimum of 45 proctored hours of driving a car prior to getting a driver’s license, again after didactics and tests. These standards ensure the safety of the public. We strongly believe it is in the best interest of patient safety to require proctored cases in live patients after didactics and testing prior to the Board approving an optometrist to operate one of these procedures. 

Ophthalmologists are required to have extensive didactics as well as more than two hundred live proctored cases performed in their training prior to obtaining a medical license to practice. While we understand this number would be impractical to request, we believe it is reasonable to request ten live proctored capsulotomies, ten live proctored laser trabeculoplasties, and ten live proctored iridotomies for the safety of patients in the Commonwealth. 

Would you allow your parent or child to have eye laser done by someone who has only ever worked on a plastic eye, and was proctored only once or twice?

It is my strong hope that the Board of Optometry will include these suggestions to strengthen patient safety in their draft regulations.

In response to allegations of endorsement, none of the following organizations have supported, endorsed or collaborated with the Board of Optometry in the process of their developing these regulations: the Virginia Society of Eye Physicians and Surgeons (the largest organization of ophthalmologists in the Commonwealth), the Northern Virginia Academy of Ophthalmology (the second largest organization of ophthalmologists in the Commonwealth), or the American Academy of Ophthalmology (the largest national organization of ophthalmologists). 

Additionally, it is important to highlight that there has been very little opportunity for the overwhelming opinion of ophthalmologists to be considered in the development of these regulations. That includes a single in-person comment opportunity that was opened within 48 hours of publication of the proposed regulations. It also includes the presence of only one single ophthalmologist (whose placement was not coordinated with the Virginia Society of Eye Physicians and Surgeons) on the Regulatory Advisory Panel that was responsible for reviewing various sections of the draft regulations. That panel was otherwise comprised of four optometrists and one citizen member. The representation on the panel was heavily geared toward the optometric profession, leaving room for minimal input from ophthalmologists, specifically regarding the required training and proctoring needed to maintain the highest level of patient safety.

The Board of Optometry’s mission statement speaks of assuring patient safety. I encourage the Board to hearken back to its mission statement, protect the citizens of the Commonwealth, and tighten standards of approval to require in-person proctoring in all cases, and place patient safety ahead of convenience or practice business concerns.

 

CommentID: 228238
 

10/24/24  4:39 pm
Commenter: Charles McGuffey MD

Amendment to Proposed Regulations to Preserve Patient Safety
 

Dear Ms. Moss: 

As an ophthalmologist, I write to you today to express my deep concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery. 

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

There is a wide spread list of physiological issues that can affect individuals’ ability to remain still during a laser eye surgery procedure. Some examples of these varying factors can include, but are not limited to, tremors, anxiety, or breathing movements particularly for obese patients, positioning of the patient, etc. Furthermore, different implant materials respond differently to laser and merit different techniques. Multifocal implants, as an example, can very easily lose their refractive properties with YAG laser defects. Without proper live patient experience and proctoring in this area, providers will be learning on the job at the patient’s expense. A plastic model in isolation cannot possibly be sufficient to teach any provider safe and effective laser technique. 

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard. 

CommentID: 228239
 

10/24/24  6:25 pm
Commenter: Jon Pederson, OD

Support draft regulations as presented without any changes
 

I support the draft regulations as written. These draft regulations were developed with good-faith input from ophthalmology and optometry. They align with other states that have seen optometrists safely perform over 146,000 procedures. 

CommentID: 228241
 

10/24/24  8:00 pm
Commenter: A Concerned Ophthalmologist and Citizen

Patient Safety First! Amendment to Proposed Regulations to Preserve Patient Safety
 

Kelli Moss, Executive Director Virginia Board of Optometry

Virginia Department of Health Professions

9960 Mayland Drive, Suite 300 Henrico, VA 23233 

Kelli.Moss@dhp.virginia.gov

Dear Ms. Moss:

As a member of the Virginia Society of Eye Physicians and Surgeons and the Northern Virginia Academy of Ophthalmology, I write to you today to express my deep concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery.

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

There is a wide spread list of physiological issues that can affect individuals’ ability to remain still during a laser eye surgery procedure. Some examples of these varying factors can include, but are not limited to, tremors, anxiety, or breathing movements particularly for obese patients. The smallest movement of the patient’s eye, even a centimeter, can result in dangerous and detrimental outcomes for the patient because laser eye surgery treatment is measured in the sphere of microns.

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard.

Sincerely,

Your local, caring ophthalmologist (and many more who write under a pseudonym for fear of retaliation).  

CommentID: 228242
 

10/24/24  8:02 pm
Commenter: Philip Chung, MD

Amendment to Proposed Regulations to Preserve Patient Safety
 

Thursday, October 24th, 2024

Dear Ms. Moss:

As a member of the Virginia Society of Eye Physicians and Surgeons, I write to you today to express my deep concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery.

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

There is quite a bit of difference between doing laser cases when there is a clear model eye and the variety of patient's presentations.  There are many potential complications that a model eye or one or two proctored cases will not encompass.  A doctor should perform at least 20 to 30 proctored cases to feel somewhat comfortable with a laser procedure.  Also, the doctor should see a wide variety of cases.  The requirements to be certified will not be sufficient for someone to feel comfortable going solo on a laser procedure on a live patient.  

There is a wide spread list of physiological issues that can affect individuals’ ability to remain still during a laser eye surgery procedure. Some examples of these varying factors can include, but are not limited to, tremors, anxiety, or breathing movements particularly for obese patients. The smallest movement of the patient’s eye, even a centimeter, can result in dangerous and detrimental outcomes for the patient because laser eye surgery treatment is measured in the sphere of microns.

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard.

Sincerely,

Philip Chung, MD

CommentID: 228243
 

10/24/24  8:02 pm
Commenter: Mohsin Ali, MD - Secretary, Northern Virginia Academy of Ophthalmology

Serious concerns regarding laser surgery certification
 

As the Secretary of the Northern Virginia Academy of Ophthalmology and a member of the Virginia Society of Eye Physicians and Surgeons, I write to you today to express my deep concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery. 

 

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases. A plastic model is not enough. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required. This method of training is simply inadequate for anyone wishing to perform lasers and obviously threatens the safety of patients. As someone who is closely involved in the training of ophthalmology residents and vitreoretinal surgery fellows, I know the nuances of teaching procedural skills such as laser treatment to trainees. I would not allow my trainees to perform laser procedures unless they have been appropriately trained because I know the risks involved with laser treatment, especially by improperly trained individuals. I would not allow an optometrist with the minimum level of training included here to perform laser treatment on any of my patients or  my family members because it is clearly inadequate. No patient should accept this and no regulatory body should find it acceptable to have such a low standard for patient safety.

 

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider change to the draft regulations to ensure optometrists across the state are trained to appropriately high standards.

 

Mohsin Ali, MD

Co-Director of Vitreoretinal Surgery Fellowship Program

Retina Group of Washington

Secretary, Northern Virginia Academy of Ophthalmology

CommentID: 228244
 

10/24/24  8:18 pm
Commenter: Jason Huang

Optometry laser training
 

As a member of the Virginia Society of Eye Physicians and Surgeons, I am writing this letter to express my concern regarding a section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery.

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

No type of training can truly replicate a procedure in a live patient. Live patients often have difficulty remaining still during a laser eye surgery. Some patients may have tremors, anxiety, or labored breathing which causes movement of their eyes. The eye is a small organ, and the smallest movement of the patient’s eye, even a fraction of a centimeter, can result in dangerous and detrimental outcomes for the patient because laser eye surgery treatment is measured in the sphere of microns.

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard.

Jason Huang

CommentID: 228245
 

10/24/24  8:38 pm
Commenter: Heather Gitchell, OD

Support Regulations as Presented
 

The certification requirements in the proposed regulations are more than adequate to ensure competency and public safety. It is important to remember that these procedures are not new to optometrists; they are being done safely and effectively by qualified optometrists across the country.

CommentID: 228246
 

10/24/24  8:42 pm
Commenter: Eric Lee, MD; The Retina Group of Washington

Amendment to Proposed Regulations to Preserve Patient Safety
 

As a member of the Virginia Society of Eye Physicians and Surgeons, I write to you today to express my deep concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery.

 

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

 

There is a wide spread list of physiological issues that can affect individuals’ ability to remain still during a laser eye surgery procedure. Some examples of these varying factors can include, but are not limited to, tremors, anxiety, or breathing movements particularly for obese patients. The smallest movement of the patient’s eye, even a centimeter, can result in dangerous and detrimental outcomes for the patient because laser eye surgery treatment is measured in the sphere of microns.

 

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard.

CommentID: 228247
 

10/24/24  8:57 pm
Commenter: Anonymous

Amendment to Proposed Regulations to Preserve Patient Safety
 

Dear Ms. Moss:


As a member of the Virginia Society of Eye Physicians and Surgeons, I write to you
today to express my deep concern regarding the particular section in the draft
regulations regarding proctoring for those individuals seeking certification for laser eye
surgery.


As the Board of Optometry finalizes the regulations for laser surgery certification, I
strongly recommend amending the draft regulations to reflect a proctoring process that
requires both didactic and live proctored cases, whether or not a plastic model is
involved. Currently, the draft regulations are written so that proctoring can be done on a
model eye or on a live patient, and in some cases proctoring is not even required.

There is a wide spread list of physiological issues that can affect individuals’ ability to
remain still during a laser eye surgery procedure. Some examples of these varying
factors can include, but are not limited to, tremors, anxiety, or breathing movements
particularly for obese patients. The smallest movement of the patient’s eye, even a
centimeter, can result in dangerous and detrimental outcomes for the patient because
laser eye surgery treatment is measured in the sphere of microns.

This request comes with patient safety as the top priority and ensuring quality, safe care
is provided throughout the Commonwealth. I strongly hope you will consider this change
to the draft regulations to ensure optometrists across the state are trained to the highest
standard.

CommentID: 228248
 

10/24/24  9:02 pm
Commenter: Anonymous

Support optometry
 

I support the present optometry law as is for lasers

CommentID: 228249
 

10/24/24  9:02 pm
Commenter: Imran Khatri, The Retina Group of Washington

Amendment to Proposed Regulations to Preserve Patient Safety
 

Dear Ms. Moss:

As a member of the Virginia Society of Eye Physicians and Surgeons, I write to you today to express my deep concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery.

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

There is a wide spread list of physiological issues that can affect individuals’ ability to remain still during a laser eye surgery procedure. Some examples of these varying factors can include, but are not limited to, tremors, anxiety, or breathing movements particularly for obese patients. The smallest movement of the patient’s eye, even a centimeter, can result in dangerous and detrimental outcomes for the patient because laser eye surgery treatment is measured in the sphere of microns.

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard.

Respectfully,

Imran Khatri, MD

 

CommentID: 228250
 

10/24/24  9:07 pm
Commenter: Sarah Kamal, MD, Retina Group of Washington

Highly concerned regarding laser surgery certification
 

As a member of the Virginia Society of Eye Physicians and Surgeons, I write to you today to express my deep concern regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery.

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

There is a wide spread list of physiological issues that can affect individuals’ ability to remain still during a laser eye surgery procedure. Some examples of these varying factors can include, but are not limited to, tremors, anxiety, or breathing movements particularly for obese patients. The smallest movement of the patient’s eye, even a centimeter, can result in dangerous and detrimental outcomes for the patient because laser eye surgery treatment is measured in the sphere of microns.

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard.

 

Sincerely, 

Sarah Kamal, MD

CommentID: 228251
 

10/24/24  9:21 pm
Commenter: Sundeep Kasi, Retina Group of Washington

Amendment to Proposed Regulations to Preserve Patient Safety
 

As a member of the Virginia Society of Eye Physicians and Surgeons, I write to express my deep concern for patient safety regarding the particular section in the draft regulations regarding proctoring for those individuals seeking certification for laser eye surgery.

As the Board of Optometry finalizes the regulations for laser surgery certification, I strongly recommend amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases, whether or not a plastic model is involved. Currently, the draft regulations are written so that proctoring can be done on a model eye or on a live patient, and in some cases proctoring is not even required.

Many factors can lead to challenges in performing a laser surgery procedures.  A patient may be unable to stay still enough due to medical conditions or even poor positioning by the laser operator.  If the laser application is even a millimeter off target, permanent and irreversible damage may develop in the patient’s eye.  Live proctoring of cases is a MINIMUM to develop the skills required to safely perform these laser procedures - it is NOT automated by the machines.  

This request comes with patient safety as the top priority and ensuring quality, safe care is provided throughout the Commonwealth. I strongly hope you will consider this change to the draft regulations to ensure optometrists across the state are trained to the highest standard.



CommentID: 228252
 

10/24/24  9:29 pm
Commenter: Anonymous

Do not support
 

I agree with the dissenting group opinion.  The regulations as presented are insufficient to prioritize patient safety and visual outcomes.   To achieve competence that a patient would expect of a provider managing a critical procedure with implications of saving (or damaging) sight, there should be only one standard of training and certification.  It should reflect the more academically stringent, highly supervised, and true-to-life methods that MDs employ in training residents and fellows.  Anything less is a disservice to our patients that trust us, and may not fully understand the differences in the training pipeline between MDs and ODs.  Adopt a higher standard - the MD way.

CommentID: 228253
 

10/24/24  9:32 pm
Commenter: Practicing Ophthalmologist

Requirements for Laser Certification
 

Patient safety is the highest priority in medical care. Patients have the right to be treated only by providers who have the appropriate training and experience. Our optometry colleagues seeking to perform laser procedures should be adequately assessed for competency, which I believe can only be demonstrated through treatment of real patients under supervision. 

I support amending the draft regulations to reflect a proctoring process that requires both didactic and live proctored cases on real patients. 


Ophthalmologist in Northern Virginia

CommentID: 228254