Optometrists practicing within the Veterans Health Administration can perform therapeutic laser procedures, but only if they are fully trained, appropriately licensedand do so under the supervision of an ophthalmologist, under a new policy announced by the department earlier this month.

In announcing the policy, Secretary of Veterans Affairs Anthony J. Principi said, Our department has no higher priority than to ensure veterans receive the highest possible quality health care at all our facilities.

Sharon Atkin, O.D., president of the National Association of Veterans Affairs Optometrists, describes this policy as the better of two outcomes. The bottom line is that our director was told that there was no way that the VA would allow optometrists to be independently privileged to perform laser procedures, she says. So he had a choice between putting out a directive that O.D.s could not perform laser procedures at all, or have the bill that we have now that O.D.s could perform lasers under supervision.

Dr. Atkin adds that she hopes that by the end of the three-year period for this latest directive, We will have O.D.s performing laser procedures under ophthalmologists, that it will prove they can perform these procedures and that it will lead to them being licensed.

This latest policy is in response to the proposed Veterans Eye Treatment Safety Act (HR 3472) being considered in Congress. The text of the legislation says that eye surgery at VA medical centers can only be performed by either a licensed medical doctor or doctor of osteopathy. The VETS Coalitionwhich consists of the American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and various other medical groupssupports the legislation.

The coalition says the Act is in response to an Oklahoma-licensed optometrist performing laser eye surgery on veterans in a Kansas VA facility, even though this is beyond the scope of optometric practice in Kansas.

Optometrists, however, are concerned that the text of the legislation may include all minor procedures, including epilating eyelashes, punctal plug insertion and foreign body removal.

Ironically, only about three optometrists have been performing laser procedures at VA Medical Centers, with no adverse outcomes, Dr. Atkin says.