Fact Checker: Would Iowa bill allow eye surgery without training?

It’s unusual to see political advertising about bills under consideration in the Iowa Legislature, but this ad caught our eye.

“HF 347 would allow unqualified providers to inject anesthesia into your eyelid and perform invasive scalpel surgery — with no surgical training requirements!”

This is according to an online ad sponsored by the Iowa Academy of Ophthalmology, which asks Iowans to oppose House File 347.

The bill would allow a licensed optometrist to “administer local anesthetic prior to a minor surgical procedure authorized by law.” The bill says Iowa law now requires a licensed optometrist to receive approval from the Board of Optometry before administering some injections.

The push to expand the scope of care for optometrists is happening across the country based on an anticipated shortage of ophthalmologists in coming years, according to a 2021 report by the Washington (state) Department of Health.

The Iowa Optometric Association and Americans for Prosperity, a libertarian political group supported by Charles Koch, are registered in favor of the Iowa expansion. Groups that represent medical doctors — including the Iowa Medical Society and Iowa Independent Physician Group — oppose the bill.

The Fact Checker will look at the claims in the ad, including that optometrists are “unqualified” to perform anesthesia injection and scalpel surgery and that there aren’t training requirements for the proposed expansion of care.

Analysis

First, let’s talk about the difference between optometrists and ophthalmologists.

Optometrists, who received a Doctor of Optometry after four years of optometry school following several years of college, provide primary vision care, including sight testing and management of vision changes.

Ophthalmologists are medical doctors or osteopathic doctors who have gone to college and medical school and then completed an internship and residency. They are trained to do surgical eye care and plastic surgery, among other eye care, WebMD reported.

Iowa Code Chapter 154 outlines the scope of practice for Iowa optometrists.

“A license to practice optometry under this chapter does not authorize the performance of surgical procedures which require the use of injectable or general anesthesia, moderate sedation, penetration of the globe, or the use of ophthalmic lasers for the purpose of ophthalmic surgery within or upon the globe,” the law states.

A law passed in 2020 allows Iowa optometrists with proper training to treat some eye conditions with injections as well as inject Botox for cosmetic reasons.

That 2020 bill said optometrists could perform the new procedures only if they “demonstrate to the board (Board of Optometry) sufficient educational or clinical training” and requires the board to adopt rules for training.

HF 347 is only one paragraph and doesn’t spell out training requirements or ask the Board of Optometry to develop rules.

The Washington Health Department reviewed curriculum of 25 optometry schools across the country and two postgraduate programs in Oklahoma and Oregon. While all provided some classroom training on injections and “eyelid lesion removal,” only six provided hands-on training with live patients, the 2021 report said.

“This is largely due to scope restriction in state law in the state in which the school exists,” the report notes. “If the optometry school is in a state that does not have expanded scope, students in that state cannot legally perform these procedures on live patients as part of their training.”

Iowa does not have an optometry school, and programs in neighboring states do not provide extensive training in scalpel surgery.

The University of Missouri-St. Louis College of Optometry provides a 14-hour clinical rotation in “Ophthalmic Surgical Care,” according to a curriculum outline online. But because Missouri optometrists “may not perform surgery,” according to state law, it’s unlikely optometry students are allowed to do hands-on training in scalpel surgery.

Conclusion

Iowa law doesn’t allow optometrists to inject anesthesia.

That doesn’t necessarily mean some licensed optometrists haven’t been trained to do it. However, given such a small share of optometry schools across the country offer hands-on injections, most optometrists likely would not have this training. If they haven’t been trained, they are not qualified.

HF347 doesn’t include any provisions for additional training for optometrists who choose to expand their scope of care.

We give this ad an A for the claims measured.

Criteria

The Fact Checker team checks statements made by an Iowa political candidate or officeholder or a national candidate/officeholder about Iowa, or in advocacy ads that appear in our market.

Claims must be independently verifiable. We give statements grades from A to F based on accuracy and context.

If you spot a claim you think needs checking, email us at factchecker@thegazette.com.

Members of the Fact Checker team are Tom Barton, Elijah Decious, Erin Jordan and Vanessa Miller. This Fact Checker was researched and written by Erin Jordan.