5 considerations if you’re thinking about adding laser procedures to your practice

October 19, 2023
Doctors of optometry are performing office-based laser procedures in 11 states, as AOA affiliates have seen historic scope expansion wins in the past four years and momentum continues to build. Doctors of optometry are pursuing legislation in other states that would allow them to serve their patients at the highest level of their education and training. Some of these optometrists, who have performed hundreds of laser procedures, share key considerations in providing this care to patients.
YAG capsulotomy

First things first when it comes to consideration of adding laser procedures to the list of eye care services provided by doctors of optometry in their practices.

Doctors of optometry are now performing office-based laser procedures in nearly a dozen states. Some of these optometrists, who have performed hundreds of the office-based surgical procedures, such as YAG capsulotomy (after cataract surgery) or selective laser trabeculoplasty (SLT, for glaucoma) for the past couple of years, share key considerations.

Ryan Ames, O.D., MBA, practices in Wisconsin and performs about 20 procedures a month between patients at his practice and those of a colleague’s. President of the Wisconsin Optometric Association, Dr. Ames is no optometrist-come-lately to the procedures. He has performed YAG and SLT procedures for the past two years. Prior to that, he had spent 16 years providing pre- and post-operative care to the patients of ophthalmologists.

“I schedule most of my procedures one Monday a month,” Dr. Ames says. “This morning, between 8 a.m. and 12:30 p.m., I performed seven procedures. They are among the safest, low-risk procedures that can be done in eye care.”

Not that Dr. Ames takes providing this care lightly. He has made considerable investment in training and equipment for the safety and convenience of his patients, never mind years of education and training before he augmented his practice with the service.

Here are five considerations from doctors who decided to proceed with the procedures.

1) Know your law

No two scope laws are the same, says Paul M. Barney, O.D., AOA Board of Trustees member, who played a key role in passage of Alaska’s laser authority in 2017. So read your state law, and accompanying regulations, closely.

“It’s important to understand your state’s scope and what it allows and doesn’t allow,” Dr. Barney says. That information can help inform your decisions on what kind of certification you might need or even the kind of equipment to purchase, he says.

2) To add or not to add laser procedures?

So, your state has authorized doctors of optometry to perform laser procedures; should you? Every doctor has to make that decision for themselves.

There are many considerations. Dr. Ames says, for him, it was a matter of convenience to his patients.

“This is a natural extension of what we do every day,” he says. “The patients who need these procedures are mostly elderly. And they don’t want to go to another doctor’s office for a procedure that is so quick (about 15 minutes) and safe. Years ago, my parents would come back to my office very frequently after they had had a laser procedure done with an ophthalmologist and say, ‘Why don’t you do that here?’ Or rather than go to another office, they’d forgo the procedure altogether,” Dr. Ames says.

3) Preparing your practice

Doctors say laser equipment can be bought brand new or used. In one of his patient exam rooms, Dr. Ames has easy access to his combination YAG/SLT laser—the technology is available from multiple companies. “You can buy just a YAG laser or just an SLT laser,” he says. “But most people buy a combination unit.”

Doctors can educate themselves on laser systems by searching online and attending conferences with vendors exhibiting lasers, Dr. Barney says.

Perhaps the best source to find out more about the technology?

“What better way than to talk to people who are doing the procedures and see what instrument they are using, especially those optometrists in states where they are doing the procedures. Find out what they like and don’t like about it.”

4) Find training for your state certification

See your state association for training opportunities. And once again, an extended course (led by Rich Castillo, O.D., D.O.) and also a workshop (Jeffrey Michaels, O.D.) on office-based surgical procedures will be offered at Optometry’s Meeting ® 2024 in Nashville, Tennessee, June 19-22. (Stay tuned to aoa.org/news for dates and times for continuing education to be announced.)

Further, the AOA is offering a comprehensive micro-credential program designed to equip paraoptometric staff with specialized skills and knowledge for optometric surgical assisting.

The National Board of Examiners in Optometry administers a Laser and Surgical Procedures Examination for fourth-year optometry students, optometry residents and doctors of optometry.

Go to EyeLearn, the AOA's professional development hub, to view courses related to laser procedures.

5) A final consideration

“Choose your early cases wisely,” says Nate Lighthizer, O.D., associate dean at Northeastern State University Oklahoma College of Optometry, who leads the school’s well-known and well-traveled 32-hour Advanced Procedures Course. Once state-certified, doctors of optometry should consider taking the time to get comfortable with the new procedures and gain valuable experience through repetition. With that additional experience, doctors of optometry will be prepared to take on more difficult cases.

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