https://www.city-journal.org/veterans-admin-unwise-laser-eye-surgery-policy
The Department of Veterans Affairs is the federal government’s second-largest department. As of 2021, it operated approximately 1,600 health-care facilities, 144 medical centers, and 1,232 outpatient sites, of varying complexity. The VA has long been plagued by a wide spectrum of problems, including long delays in scheduling appointments, substandard care, and years of trying to get a $10 billion electronic system to work effectively.
As a veteran myself (I have never received medical care through the VA, though I did numerous medical school clinical rotations at a VA hospital), I know that veterans deserve better. And yet, the VA seems to be committed to a change in policy that would further degrade the quality of their care—specifically, by allowing underqualified practitioners to perform laser eye surgery.
Last September, the VA modified its eye-care guidelines for treatment from community providers by letting optometrists, who are neither medical doctors nor surgeons, perform some surgical procedures. Without soliciting input from the public or medical community, it removed language from the Community Care guideline, which had ensured that “only ophthalmologists can perform invasive procedures, including injections, lasers and eye surgery.” This change would permit optometrists to perform surgical procedures such as laser trabeculoplasty—an operation on the eye to treat glaucoma—rather than restricting them to ophthalmologists (who are highly trained, experienced, qualified surgeons), as had been the policy. The change would be felt immediately in a small number of states that already allow optometrists to perform laser surgery. But the VA is considering a broader policy change that would make it possible for optometrists in all VA facilities to perform these procedures.
The differences in the amount of training and the scope of competence between optometrists and ophthalmologists are vast. Ophthalmologists log over 17,000 hours of clinical experience in general medicine, surgery, and emergency management during medical school and specialized postgraduate training.