January 30, 2011
Area(s) of Interest: Advocacy Scope of Practice 

The California Medical Association (CMA) joined with the California Academy of Eye Physicians and Surgeons (CAEPS) on Jan. 11 in filing a lawsuit in San Francisco Superior Court to block the implementation of new standards to certify optometrists to treat glaucoma.

The physician groups took this step in an effort to ensure Californians afflicted with glaucoma get appropriate medical treatment.

The regulations, which went into effect on Jan. 8, provide a pathway by which optometrists can complete the entire certification process without having to treat a single patient with glaucoma. The prior process required the treatment of 50 glaucoma patients over two years under the supervision of a board-certified ophthalmologist.

"Let's be clear: These new regulations are not up to snuff and in fact jeopardize the quality of eye care Californians deserve," said James Hinsdale, M.D., CMA president. "Failing to require certification that includes treating actual glaucoma patients is the equivalent of handing out driver's licenses to people who have read a driving manual and attended a class but have never driven a car."

Frank a. Scotti, M.D., CAEPS president, noted while the new process mandates that optometrists attend certain classes, it does not require them to have any experience treating patients using anti-glaucoma medications.

"Although we had hoped to be able to support the new standards, they simply do not adequately protect patients, but instead focus on streamlining the prior certification process. Not requiring any hands-on treatment of actual glaucoma patients is ridiculous on its face," Scotti said. "Glaucoma is a blinding disease and any certification process to treat it should respect that fact."

Widely reported incidents at the Palo Alto Veterans Affairs hospital highlight the potential consequences. Substandard care in that facility's optometry department apparently resulted in eight veterans with glaucoma going blind and many others suffering "progressive visual loss."

Two of these patients reached out-of-court legal settlements for $250,000 and $400,000.

CMA and CAEPS do not oppose optometrists treating glaucoma, but rather aim to ensure training is adequate so the quality of care is not compromised. Both organizations remain willing to consider certification standards that will sufficiently protect glaucoma patients.