Alberta becomes 1st province to allow optometrists to perform minor surgeries

Alberta has become the first province in Canada to allow qualified optometrists to perform certain minor surgical procedures in their offices. 

The changes came into effect on Nov. 1. According to an Oct. 26 announcement from the provincial government, the expanded services that qualified optometrists can provide will include removal of benign skin lesions, treatments of styes and certain laser procedures for cataracts and glaucomas. 

“This means eligible patients will be able to receive more advanced eye care from an optometrist without being referred elsewhere for those services,” the government said in a news release.

“More Albertans will have opportunities to get the care they need sooner and closer to home.”

Optometrists must complete additional training before they can provide these advanced health services and will need to comply with new standards of practice and oversight from the Alberta College of Optometrists (ACO).

But some groups representing eye surgeons, including the Canadian Ophthalmological Society (COS), are calling on the province to reverse the decision.

Colin Mann, the COS’ chief of advocacy, said he was concerned about optometrists performing such procedures.

“I worry that patients may not receive treatment by someone with the appropriate training needed to do that treatment,” he said. 

“Surgery needs to be done by surgeons.”

In a post on its website, the Canadian Association of Optometrists says it supports the changes in Alberta and now hopes to see an expansion of services delivered by optometrists across the country.

While speaking about the changes at an unrelated news conference last month, Primary and Preventative Health Services Minister Justin Wright said he “hear[s] the concerns” of the COS and other groups, and noted his government did say no to a number of other expansions optometrists wanted.

COS voices concerns about training

Only optometrists who complete approved education, examinations and clinical supervision will be authorized to offer the expanded services. Alberta’s government says the ACO will establish standards of practice and oversee implementation.

CBC News asked the Ministry of Primary and Preventative Health Services if the standards to be applied for that training had yet been decided on, and if not, why the regulation was implemented already. Though CBC News received a response, the ministry did not answer the question. 

Mann, also a past president of the COS, said that based on discussions he’s been privy to over the years, he has concerns about whether the training requirements will be as rigorous as he believes they should be.

“You just can’t learn surgery in the equivalent of a week, or two weeks, or a number of weeks.”

At his news conference last month, Wright told reporters that patient safety is the government’s priority. 

“We’re removing unnecessary barriers to care, not lowering the standards to protect patients.”

Increasing access

The provincial government says ophthalmologists will continue to provide the services that qualified optometrists will now also be allowed to perform. But with more medical professionals doing such work, the government says it believes ophthalmologists will be able to focus their specialized capacity on more complex eye conditions. 

“Instead of being referred to another city for a procedure, Albertans may receive that care directly by their local qualified optometrist,” Wright said at his news conference last month. “That means fewer appointments to co-ordinate, less time waiting, less time travelling and more time at home. For those living in rural and remote Alberta, it can be a real difference in access to health care.”

Other jurisdictions which currently allow this include some places in the United States, the United Kingdom and New Zealand.

But Mann said the American equivalent of the COS, the American Academy of Ophthalmology, also did not support optometrists performing surgery. He said he believes Alberta allowing optometrists to perform such procedures will not achieve the goals the government has established.

“In the very limited jurisdiction in the [United] States where this has been approved — and there’s only a small number of states — there have been studies that show that, in fact, it doesn’t improve access,” he said.

“These are costly lasers to buy and purchase and put in an office, and that the optometrists in those limited areas that perform these are in the same areas where there’s ophthalmologists.”

Mann said over the five years that the COS has been discussing the issue with provincial officials, the organization had asked to see evidence that access is currently an issue and was not supplied with it. 

CBC News also asked the Ministry of Primary and Preventative Health Services for such evidence but did not receive it. However, the ministry did respond with a statement that said the changes are “about recognizing the skills of qualified health professionals, strengthening our health system and ensuring Albertans can access the care they need, closer to home.”