[Congressional Record Volume 150, Number 135 (Saturday, November 20, 2004)]
[Extensions of Remarks]
[Page E2097]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      IMPROVING VETERANS EYE CARE

                                 ______
                                 

                        HON. MICHAEL C. BURGESS

                                of texas

                    in the house of representatives

                       Friday, November 19, 2004

  Mr. BURGESS. Mr. Speaker, as health care consumers we all expect the 
highest quality of care available when we visit a health care facility. 
However, a recent decision by the Department of Veteran Affairs 
subjects our Nation's veterans to a lower standard of care that 49 out 
of 50 states permit. This directive, which permits optometrists to 
perform laser eye surgery in VA health facilities, only confuses the 
public and veterans about the difference between ophthalmologists and 
optometrists. In a recent survey of veterans who use the VA health 
system, 30 percent mistakenly thought optometrists were medical 
doctors. Further, over 95 percent of veterans think it is important to 
have a licensed medical doctors specializing in eye care performing 
their eye surgery in the VA. Our nation's veterans deserve better.
  I submit the following for the Record:

       Optometrists attend four-year Schools of Optometry but have 
     no required postgraduate training or national board 
     certification process. Beyond state optometric licensure, 
     there is no ongoing, national re-certification process to 
     assure the public of the competency of optometrists who are 
     already in practice. In contrast, ophthalmologists are 
     medical doctors who attend four years of medical school. They 
     then complete one post-graduate year of general medical or 
     surgical internship, three years of an ophthalmology 
     residency training program, a national Board certification 
     examination, and mandatory re-certification testing.


                               EDUCATION

       Optometry School (4 years in length): Curriculum includes 
     contact lenses, optics, vision sciences, sensory processing, 
     vision therapy, practice management etc., and courses related 
     to basic medical sciences and eye diseases. Average hours of 
     course work based on a comparison of SUNY Optometry School 
     are 597.3 hours. Optometrists have an average of 335.5 hours 
     of lab and instruction on ocular disease and management.
       Medical School (4 years in length): Curriculum focuses on 
     fundamental principles of medicine and its underlying 
     scientific concepts, including required courses on 
     anatomy, biochemistry, genetics, physiology, microbiology 
     and immunology, pathology, pharmacology and therapeutics 
     and preventive medicine, including laboratory. Clinical 
     sciences encompass all organ systems, including the 
     important aspects of preventive, acute, chronic, 
     continuing, rehabilitative and end-of-life care. Clinical 
     experience includes family and internal medicine, 
     obstetrics, gynecology, pediatrics, psychiatry and 
     surgery. Average hours of coursework based on average 
     across medical schools are 1, 436.10. In addition, 
     ophthalmologists spend a minimum of 626 hours (not 
     including medical school) of lab and instruction on ocular 
     disease and management.


                    MANDATORY POST-GRADUATE TRAINING

       Optometry: There is no mandatory post-graduate training. 
     About 15% go on to an optional 1yr training program.
       Ophthalmology (Additional 4 years in training): To become 
     an ophthalmologist after medical school, one must complete 1 
     year of general medical or surgical internship, and 3 years 
     of an ophthalmology residency training program. About 40% go 
     on to a 1 or 2 year fellowship program to concentrate 
     training and experience in a particular subspecialty. The 
     Accreditation Council in Graduate Medical Education has 
     standards in place for patient care responsibilities, minimum 
     outpatient visits and minimum surgical numbers for residency 
     programs.


      CLINICAL EXPERIENCE DURING MANDATORY EDUCATION AND TRAINING

       Optometry: A 1995-1996 survey of optometric curriculum 
     found a range of 1,215 to 2,240 hours, with an average of 
     1,910 hours, for clinical experience across schools (a more 
     recent study was not able to be located). During training, 
     optometrists have no minimum requirements for the number of 
     patient visits with ocular diseases or ocular surgical 
     operative experience. There is also no requirement for 
     systemic disease consultation.
       Ophthalmology: Based on an estimate of an average of 60 
     hours per week (including on-call duty the maximum duty hours 
     for residents is 80 hours per week) x 48 weeks x 5 years, at 
     least 17,280 hours are for clinical experience throughout 
     medical school internship and residency for ophthalmologists. 
     During training, the ACGME requires that ophthalmologists 
     have a minimum of 3,000 outpatient visits with a broad range 
     of disease presentation and they must perform and assist at 
     sufficient surgery to be skilled. There are also requirements 
     for systemic disease consultation.


                        PROFESSIONAL REGULATION

       Optometry: There is no national ``Board certification'' 
     process in place for optometry. Beyond state licensure, there 
     is no ongoing ``Board certification'' process to assure the 
     public of the competency of optometrists who are already in 
     practice.
       Ophthalmology: There is a Board certification process to 
     assure the public of successful completion of an accredited 
     course of education and examination process by certified 
     ophthalmologists. In addition to state licensure, an ongoing 
     process, Maintenance of Certification, requires renewal of 
     certification every 10 years for ophthalmologists certified 
     in 1992 or later, and many other ophthalmologists voluntarily 
     enter this process.
       This data has been collected from SUNY State College of 
     Optometry, Liaison Committee on Medical Education 
     Accreditation Standards, U.S. Department of Education and 
     ACGME.




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