A clear vision for improved access to glaucoma care

Shutterstock/Sergio Stakhnyk

Two groups of Massachusetts eye care professionals are facing off over what is becoming a common scenario across the spectrum of health care: an effort to make it easier for patients to gain access to basic services at lower costs. The dispute, between ophthalmologists and optometrists, comes down to preserving the status quo versus taking a new approach to care.

A long-festering bill recently passed by the Senate and awaiting action by the House would allow optometrists to treat glaucoma and certain other eye conditions that now require going to an ophthalmologist. Optometrists, though highly trained, aren’t medical doctors; ophthalmologists are. Under state law, an optometrist can diagnose glaucoma, but then must refer the patient to an ophthalmologist for treatment.

Massachusetts — touted as a leader in progressive health care measures — is the only state that still has such a requirement on the books, and it should go. By allowing optometrists to treat glaucoma in their offices, patients would be able to receive immediate care. Instead, they have to make an appointment with an ophthalmologist, which usually results in the same course of treatment — after a long wait, duplicate testing, additional copays, and out-of-pocket expenses. The financial burden is heavier if the patient doesn’t have eye-care insurance.


Glaucoma — which technically is a group of diseases involving the optic nerve — is a leading cause of blindness. It affects more than 3 million Americans, according to the Glaucoma Research Foundation, but because the incurable condition often is symptom-free in its early stages, many people don’t know they have it until their vision is affected. Optometrists, who routinely conduct eye exams and screen patients for glaucoma, are in the best position to catch the disease in its early stages. “We’ve been diagnosing glaucoma for years,” says Matthew Forgues, president of the Massachusetts Society of Optometrists. When patients find out he can’t offer them treatment, Forgues says, “they are shocked.” And because he and other optometrists can’t write prescriptions for oral antibiotics or limited supplies of narcotic pain medications to treat styes and other infections, patients might needlessly suffer, or end up in a hospital emergency room.

The law would be of particular benefit to lower-income residents, including those in nursing homes, who are underserved by ophthalmologists. More than 90 Massachusetts state senators and representatives have cosponsored the legislation, and the Federal Trade Commission and US Department of Justice’s antitrust division sent a letter to the State House in support of it, citing greater patient access and cost savings.


For years, opponents, including the Massachusetts Medical Society and the Massachusetts Society of Eye Physicians and Surgeons, have succeeded in keeping the bill from advancing beyond the Senate. Their objections center around concerns about safety and skill levels. John Mandeville, president of the Society of Eye Physicians and Surgeons, says optometrists are trying “to very aggressively expand the scope of their practice.” They make glaucoma “seem like something simple,” he says. “It’s actually a very complicated disease.”

He’s correct about the condition’s complexity, but the legislation sets limits on what kinds of glaucoma-related treatments optometrists can offer — it doesn’t preempt the specialized care, including surgery, that only an ophthalmologist can provide. The law also would mandate additional training for optometrists, followed by a certification test, and it requires the reporting of medical errors to the Betsy Lehman Center, part of the state’s Executive Office of Health and Human Services.

There’s no reason why the House shouldn’t follow the Senate by approving the glaucoma bill before the current session adjourns. Making health care better and cheaper requires solving lots of problems. This is an easy answer to one of them.