Eyelid Surgery Without Training - What is Iowa Thinking?

Eyelid surgery, AKA blepharoplasty, is performed to improve the vision of a person who has excess skin and fat in the eyelids that can block their vision. In addition, eyelid surgery can remove bags that are located under the eyes as well as correct the look of puffy eyelids. Blepharoplasty can be performed on both the upper and lower eyelids of a person, and it should always be performed by a board-certified surgeon who is properly trained in the procedure and also has the necessary experience to provide results that are long-lasting and natural in appearance. Having said all of that, there are some people in the state of Iowa who are trying to eliminate the need for surgical training when it comes to eyelid surgery.

Eyelid Surgery with No Training – It Might Happen in Iowa

A recent ad regarding legislation that is being considered in Iowa was recently posted online. The ad read, “HF 347 would allow unqualified providers to inject anesthesia into your eyelid and perform invasive scalpel surgery – with no surgical training requirements!”

This online ad was sponsored by the Iowa Academy of Ophthalmology, and it asks residents of Iowa to oppose House File 347. The bill would enable a licensed optometrist to “administer local anesthetic prior to a minor surgical procedure authorized by law.” The bill also states that current Iowa law requires a licensed optometrist to receive the approval of the Board of Optometry before they are able to administer some injections.

The reason for the push to expand the type of care that optometrists can provide across the country is the anticipated shortage of ophthalmologists that was detailed in a 2021 report issued by the Department of Health in the state of Washington.

There are some organizations that support the Iowa expansion such as the Iowa Optometric Association and Americans for Prosperity (a libertarian political group). Those who oppose the bill include multiple groups that represent medical doctors including the Iowa Independent Physician Group and the Iowa Medical Society.

An In-Depth Look at the Ad – Is it Accurate?

There are multiple claims made in the ad including the idea that optometrists are not qualified to perform injections of anesthesia or scalpel surgery. The ad also claims there are not any training requirements related to the proposed expansion of care.

Let’s analyze the accuracy of the ad and get started by discussing the difference between optometrists and ophthalmologists.

Optometrists are able to receive a Doctor of Optometry degree after earning a bachelor’s degree and attending four years of optometry school. They can provide primary vision care including services such as the management of vision changes and the testing of eyesight.

On the other hand, ophthalmologists are medical doctors who have attended both college and medical school and have completed an internship as well as a residency. These medical professionals are trained to perform surgical eye care along with plastic surgery.

When it comes to the scope of practice of optometrists in Iowa, the following is included in Iowa Code Chapter 154: “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.”

In 2020, a law was passed that allows optometrists in Iowa, who have undergone the proper training, to treats some eye conditions with injections as well as administer injections of Botox for cosmetic reasons. Plus, the 2020 bill also stated optometrists could only perform the new procedures if they demonstrate to the Board of Optometry “sufficient educational or clinical training”. The bill also requires the board to adopt the necessary rules for training.

While HF 347 is only one paragraph in length, it does not identify or share the requirements for training, and it also does not ask the Board of Optometry to develop any rules.

Does Iowa Have an Optometry School?

As part of its review process, the Washington Health Department reviewed the curriculum of twenty-five optometry schools located across the country as well as two postgraduate programs located in Oregon and Oklahoma. The 2021 report from the Washington Department of Health revealed all of these programs provided some amount of injections training along with training on “eyelid lesion removal”. When it came to training with live patients, only six of the schools provided firsthand training. The report noted, “This is largely due to scope restriction in state law in the state in which the school exists. 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.”

It should be noted that Iowa does not have an optometry school and any programs that are located in neighboring states do not provide any level of extensive training in scalpel surgery.

Even though the law in Iowa does not allow optometrists to inject anesthesia, this does not mean there are not some licensed optometrists that have the proper training from one of the small numbers of optometry schools across the country that offer hands-on training in injections. If someone has not been trained, they are not qualified to perform the treatment. Hf 347 does not include any provisions for additional training for an optometrist who wants to expand their scope of care.

Cosmetic Town News will continue to monitor this story and provide updates when they are available.

- MA