When patients seek out medical care or particularly complicated, advanced surgery, they trust that the medical professional who is providing that care is capable, knowledgeable and highly trained. As an ophthalmologist, or an eye surgeon, patients put a great deal of trust in me to operate on one of their most precious, valued and vital organs.

I’ve worked hard to earn that trust through nearly a decade of schooling and 13 years of experience performing the procedures patients need to protect their vision and their overall health. However House Bill 1233 that the Colorado State legislature is now considering threatens to break that trust and put Coloradans’ eyesight at risk.

This bill would enable optometrists to perform complicated eye surgeries that include lasers, scalpels and eye injections that have traditionally – and for good reason – only been performed by trained surgeons: ophthalmologists. If this bill moves forward in its current form, it will risk the safety of Colorado patients, but it will NOT reduce health-care costs or increase access to care.

To understand what’s at stake here, it’s helpful to understand the significant differences between optometrists and ophthalmologists. Optometrists are critical to our health-care system and play an important role in the overall health of your eyes. But they just simply aren’t trained surgeons or even medical doctors. Optometrists are required only to undergo four years of optometrist school – not medical school and not a surgical residency.

Ophthalmologists, on the other hand, undergo a minimum of eight years of school including medical school as well as hospital residency and surgical training, resulting in a minimum of eight years of training involving hundreds of surgical procedures. Meanwhile, an optometrist can become “certified” to perform eye surgery after only attending a weekend simulator course – with no requirement that they have ever even seen the surgery performed on a real human eye.

The surgeries that this bill would allow optometrists to perform are major surgeries that include lasers, incisions, and injections, where a surgical error of mere fractions of millimeters can result in vision loss. The human eye is highly sensitive and beautifully complex, and I think most Coloradans would agree when it’s their vision or a loved one’s on the line, no eye surgery is minor.

Proponents of widening optometrists’ scope of practice often say that by allowing these less-trained health providers to perform surgeries, we can lower costs for consumers or expand access to care. There’s no question that many rural communities suffer from a lack of affordable and accessible health-care options, and we should work to remedy that. But the truth is that there’s no shortage of ophthalmologists in Colorado. In fact, 93.9% of Coloradans are within a half-hour drive of an ophthalmologist.

In addition, ophthalmologists and optometrists bill insurance under the same coding, meaning whether your surgery was performed by a well-trained surgeon or an optometrist with only a weekend of training, you as the patient (and your insurance company) are charged the same.

In fact, allowing optometrists to conduct surgery can actually increase health-care costs. A JAMA study out of Oklahoma that compared outcomes of laser surgery performed by ophthalmologists versus optometrists found that surgeries performed by optometrists were over twice as likely to require additional corrective surgery. In fact, over a third of laser trabeculoplasty surgeries performed by optometrists needed to be repeated.

Any way you look at it, that’s an added cost to patients, not a cost savings.

Only seven other states including Oklahoma, Kentucky, Arkansas, Mississippi, Louisiana, Alaska and Wyoming have expanded the scope of practice for optometrists to include the surgical procedures contemplated in this bill. In the last six years, however, it’s been rejected 58 times by 26 other states.

In the era of COVID, we’ve all had to take calculated risks to our health at one point or another, and many of us have had to decide if the risk is worth the reward. But if this bill does not increase health-care access or reduce health-care costs, where is the reward here and what could possibly be worth risking your vision? Unfortunately, we have heard the tragic stories from families firsthand who at best have had to have a surgery completed by an untrained optometrist repeated and, at worst, have lost their vision.

There are many positions within the health-care system that all play a critical role in keeping Colorado patients healthy – from nurses to physician’s assistants to surgeons to doctors to technicians and care givers. But whom do you want to perform surgery on your eyes?

Robert I. Fish, M.D., is a Colorado ophthalmologist who specializes in cornea, refractive and external disease and has been practicing in Littleton for seven years.