SB 55-OPTOMETRY & OPTOMETRISTS  2:07:08 PM CHAIR STEDMAN announced the consideration of SB 55. SENATOR CATHY GIESSEL, Alaska State Legislature, sponsor of SB 55, read the sponsor statement: SB 55 modernizes and updates the Alaska Optometry Statute. This bill moves the continuing education (CE) requirements back into regulation, as desired by the Department of Commerce, Community and Economic Development. Continuing education is still required by current statute, but the hours and subjects will be determined by the Board of Optometry, as with other professions. The current regulations require more CE hours than the statute subsection deleted by this bill. SB 55 allows the board to determine prescribed drug schedules anticipating federal regulations that may change again in the future as they did in 2014; that regulation required another statute change, and this bill would allow the board to move in step with its industry. This bill updates the optometry definition to reflect current education and training, but specifically prohibits invasive surgery. This allows for future new and improved diagnostic and therapeutic procedures as determined by the board, while not having to return to the legislature for every new technological advance. It also defines that optometrists must be qualified for any procedure that they perform. SENATOR GIESSEL noted that there are letters in the packet that say the bill would allow optometrists to perform surgery around or on the eye and that is not true. The bill also further defines and clarifies the prohibited surgical procedures under an "invasive surgery" definition. Alaska optometrists already do superficial surgical procedures such as removal of corneal foreign bodies under current statute, but nothing invasive would be allowed. She said the vast majority of Alaskans visit an optometrist for their health care. Nationally, 75 percent of citizens see an optometrist first. Optometrists refer more complicated issues to an ophthalmologist. She stated that the bill updates the scope of practice and statutes pertaining to optometry. 2:11:09 PM SENATOR STOLTZE asked whether any ocular surgery is non- invasive. SENATOR GIESSEL reiterated that removing a corneal foreign body is an example. JANE CONWAY, Staff, Senator Cathy Giessel, presented the sectional analysis of SB 55 on behalf of the sponsor. She read: Section 1 requires the Board of Examiners in Optometry to adopt regulations governing prescription and use of pharmaceutical agents. Section 2 amends AS 08.72.181(d) by removing specified hours and period of continuing education requirements for the renewal of an optometrist's license but retains delegation of those requirements to the board in regulation. Section 3 repeals and reenacts AS 08.72.272(a) to provide that pharmaceutical agents, including controlled substances, may be used by a licensed optometrist if consistent with standards adopted by the board and any limitations on practice under section 5 of the bill. Section 4 reenacts and modifies the prohibition by a licensee to perform an intravitreal injection. Section 5 provides that a licensee may perform only services within the licensee's training and experience as provided by board regulation. Section 6 revises the definition of optometry. Section 7 adds a definition of "invasive surgery." 2:13:54 PM CHAIR STEDMAN asked for the change of the definition in Section 6, line 23, page 2. MS. CONWAY offered to get back to the committee. SENATOR STOLTZE asked what the difference is between OD and MD. SENATOR GIESSEL explained that a doctor of optometry has an extensive degree, but a doctor of ophthalmologist is a medical physician who has had specialized training in surgery of the eye and more complex procedures. An optometrist performs basic eye exams, diagnostic procedures, and some treatment, but not invasive surgery. CHAIR STEDMAN opened public testimony. RACHEL REINHARDT, Ophthalmologist, American Academy of Ophthalmology, testified in opposition to SB 55. She explained her concern with how the bill relates to surgery. The language is misleading and would allow optometrists to do all procedures not mentioned in the bill. The bill does not list all surgical procedures needed; there are more procedures not listed, such as laser surgery. The bill removes existing safeguards about injections. She stressed the importance of understanding that the bill creates loopholes. She described the education needed to become an ophthalmologist; four years of medical school and four years of surgical residency. She concluded by recalling testimony from last year about the prescribing of narcotics, which she said would be allowed this year. 2:24:53 PM SENATOR GIESSEL asked if Ms. Reinhardt has practiced in Alaska and how many ophthalmologists there are in Alaska. DR. REINHARDT replied that she has not, and there are 27 ophthalmologists in Alaska. SENATOR GIESSEL noted there are 179 optometrists in Alaska. JEFF GONNASON, Optometrist, Alaska Optometric Association, testified in support of SB 55. He shared his professional background. He shared the history of Alaska's optometrist journey and the opposition by the American Academy of Ophthalmology the whole way. He described how optometrists work, their limitations on practice, and that they use their professional judgement as to when to refer patients. He thought there were about 160 optometrists in Alaska. 2:29:30 PM SCOTT LIMSTROM, Ophthalmologist, Alaska Academy of Eye Physicians, testified in opposition to SB 55. He maintained that the bill is misleading and allows optometrists to perform many surgical procedures. He provided examples of patients who lost their eyes and the procedures that were needed. He stressed the importance of those who perform the procedures to be trained. The bill would allow optometrists to perform laser and Lasik procedures. He concluded that the Alaska State Medical Association, the American Academy of Ophthalmology, and the Alaska Academy of Eye Physicians, and the Interior Independent Practice Association are opposed to the bill. 2:34:34 PM SENATOR STOLTZE asked if his concern is that medical doctors should also be limited regarding eye procedures. DR. LIMSTROM said his main point was these procedures require careful analysis of the patient and extensive training. SENATOR STOLTZE asked if any medical doctor can perform these types of retinal procedures. DR. LIMSTROM explained that medical doctors limit their practice to their specialties and surgical procedures are highly regulated. He said he is not aware of regulations applying to the procedures done in private offices. SENATOR STOLTZE asked if there is a legal prohibition to practices by individual hospitals. 2:39:00 PM SENATOR GIESSEL said medical statutes do not limit, in general, the practice of physicians to specific specialties. The ophthalmologist was describing hospital privileges and the inappropriate diagnosis was made in an outpatient setting. Physicians are not limited in any way. 2:39:44 PM PAUL BARNEY, Chairman, Alaska Board of Examiners in Optometry, testified in support of SB 55. He shared his professional background. He described his role as the director of, and optometrist with, the Pacific Cataract and Laser Institute, a referral center limited to surgical and medical eye care. He said his involvement concerns medical eye care and pre-surgical and post-surgical care. PCLI's approach is to work collaboratively as a team. The ophthalmologist performs the surgery. He said the arguments against SB 55 are that only an ophthalmologist is trained to do specific procedures, some of which he and the nurse anesthetist at PCLI are qualified to perform. The bill prohibits injections into the eye globe and prohibits optometrists to do surgery. The bill allows the Board of Examiners in Optometry to set the details of the practice of optometry. He assured that the primary concern of the board is the safety of the public. He maintained that in the four years he has served on the board, there have been no public complaints that were serious enough for disciplinary action. He concluded that SB 55 would be good for Alaska. It modernizes the definition of optometry and allows the board to determine the details of pharmaceutical prescribing. Optometry provides about 70 percent of eye care in the U.S. In rural Alaska optometrists are sometimes the only provider of eye care. 2:44:04 PM JILL MATHESON, Optometrist, testified in support of SB 55. She shared her background and professional experience. She related that the four times there have bills related to optometrists, there has been opposition by ophthalmologists. All four times the legislature listened to optometrists and passed bills that allow them to practice as they currently do. Optometrists treat patients promptly, safely, and effectively. The optometrist profession is a safe profession and the malpractice rate is very low. She said SB 55 allows the Optometry Board to regulate the profession, puts continuing education requirements back into regulation, and it modernizes definitions of optometry and invasive surgery for optometrists. She opined that the bill would allow the board to update regulations in the future. She concluded that the bill allows the board to react as technology advances and it opens the door for expansion in the future. It allows optometrists to practice at the highest level of training which equals protection of the public because it ensures that optometrists, who are the first line of eye care in Alaska, can treat Alaskans with the most modern methods available to them. She clarified that the opposition's statement that the bill lowers surgical standards is not true. The Optometry Board is very conservative and would not allow optometrists to do anything without proper training. Optometrists currently have authority to do injections around the eye. 2:49:35 PM FORREST MESSERSCHMIDT, Optometrist, testified in support of SB 55. He said he is serving his third year on the State Board of Optometry. He opined that SB 55 puts the regulation of optometry where it belongs, with the board. He said the profession has changed and more than 50 percent of his practice is medical care. He listed several of the procedures he deals with, such as complex eye diseases, diabetic retinopathy, glaucoma, macular degeneration, and others. These issues involve relationships with ophthalmologists that are based on mutual trust. He described how the care optometrists provide has changed over the years. He provided an example of why the bill is needed. There are not enough skilled ophthalmologists to serve the rapidly aging population. He stated that optometrists will continue to provide quality care and the board is capable of providing oversight. SB 55 is good for Alaska. 2:53:24 PM SENATOR GIESSEL inquired how many ophthalmologists are in Juneau. DR. MESSERSCHMIDT said one. SENATOR GIESSEL said if that individual goes on vacation there are none. CHAIR STEDMAN doubted there were any in Sitka. DR. MESSERSCHMIDT said some ophthalmologists travel through Sitka to provide services. REPRESENTATIVE KELLY asked if he was confirmed by the legislature to serve on the Board. DR. MESSERSCHMIDT did not know. REPRESENTATIVE KELLY requested that the ophthalmologists who oppose the bill submit a list of why the bill is wrong regarding surgical procedures and injections. 2:55:36 PM SENATOR STOLTZE requested a list of where the ophthalmologists are located in Alaska. He requested assurance that insurance providers are not opposed to the bill. CHAIR STEDMAN held SB 55 in committee.