Dr. Rebecca Leenheer went through 13 years of education and training to become an ophthalmologist, or eye surgeon. That included college, medical school, and four years of residency working with patients under the supervision of a fully trained and certified eye surgeon, and another year to specialize in working with children.
Leenheer is the president of the New Mexico Academy of Ophthalmology, and said under a bill recently passed by the New Mexico Legislature, optometrists would only need to take a 32-hour course, and then a 4-hour practice session working on models unsupervised by an actual eye surgeon.
“So the first time they'll be doing surgery on live patients isn't with anybody supervising them. I mean, that won't be required. It will be an unsuspecting New Mexican in their office,” she said.
That’s why she and other ophthalmologists want Gov. Michelle Lujan Grisham to veto House Bill 36. Supporters say the bill is aimed at making it easier for people to get the care they need, especially in rural areas, by increasing the options of where to get these procedures done. They turned out during the session to offer testimony at committee hearings along with bill opponents.
Daniel Mayes, an optometrist in Hobbs, says there are no ophthalmologists practicing in Lea County, and patients often have to travel up to an hour and a half to Artesia to get to the closest practicing eye surgeon.
“It takes an average of six months to get them scheduled, and the patients have to wait,” he said. “They cannot go into Texas because the ophthalmologist does not take New Mexico Medicaid.”
But Leenheer points to a 2022 study that found states where these laws have already passed didn't see an increase in access. She says the lasers used to perform these operations are expensive, and so optometrists who do start performing these surgeries usually open their clinics in major metropolitan areas where they can be closer to more people.
“So patients would actually drive past qualified eye surgeons to get their lasers done by optometrists,” Leenherr said. “So in two states, it decreased access to care.”
Leenheer stressed she works with optometrists often and respects the work they do, but likened them to primary care doctors, who most patients wouldn’t want doing their surgeries when they have never received the proper training to do so.
“For me, it's all about safety and what's right,” she said, “and I don't want unsuspecting New Mexicans to be the first or 20th person getting that laser treatment by unsupervised people.”
Optometrists are not medical doctors, but do four years of training beyond college to get a doctorate of optometry. Emily Kozakowski, a fourth-year optometry student, said they receive extensive training on laser and ocular procedures, like injections and surgeries.
“We discuss the indications, complications, risks, management of the complications and risks, and expected outcomes,” she said. “To go along with this, we have a lab component where we have time practicing with the lasers on model eyes.”
Sarah Bortz, an optometrist and the former president of the New Mexico Optometric Association, said that training means optometrists can safely perform these delicate surgeries.
“Our training has been proven safe and effective by both 146,000 laser procedures being performed by optometrists with only two adverse events, and the fact that medical malpractice rates have not increased in the 12 states that allow optometrists to do these procedures,” Bortz said.
But Leenheer and other opponents of the bill said there’s a big difference between working on models and actual patients, and that the report of only two negative outcomes is a grossly misrepresented number.
During one committee hearing on HB36, Dr. Ben Harvey, an ophthalmologist practicing in Oklahoma, presented six cases of optometric complications that were never documented or properly reported, saying there are many more examples of negative outcomes.
“What I report is only a fraction of misdiagnoses and bad outcomes,” he said. “To claim otherwise is untrue.”
One of those bad outcomes was Vicki Rutledge, of the Choctaw Nation of Oklahoma, who testified at a different committee hearing that she lost her sight because of a botched optometric eye surgery.
“I am living proof that lack of knowledge and proper training in our vision health care providers is both dangerous and preventable,” she said.
HB36 was sponsored by two Republicans, Reps Luis Terrazas and John Block, and two Democrats, Speaker of the House Rep. Javier Martinez, and lead sponsor Rep. Day Hochman-Vigil.
All four sponsors received campaign donations from the New Mexico Optometrics Association, with Speaker Martinez receiving the most at $5,000, putting the group amongst his highest campaign donors. Hochman-Vigil received $2,000 from them in two separate donations. Terrazas and Block each received $500.
Terrazas was the only sponsor to reply to requests for comment before publishing.
Terrazas said he chose to co-sponsor the bill because he was approached by an optometrist in his district who told him 3 to 4 patients a week were being referred to ophthalmologists up to 200 miles away just to get seen in a timely manner. He said campaign donations are never a determining factor in the way he votes, or the bills he supports.
“My vote is never for sale,” he said. “I’ve done lots of things to improve life for New Mexicans, everything from supporting crime bills to medical malpractice bills, and that benefits all doctors, not just optometrists.”
Terrazas said he has had to deal with serious eye issues himself, and has undergone several eye surgeries, and he thinks it is up to each individual to determine if they feel comfortable getting a procedure done by any doctor.
“It's one of those things that it doesn't matter what procedure you're getting,” he said. “You, at the end of the day, are going to sign that paper that gives them permission, and you have to take the stand of whether you feel comfortable or not.”
The governor has until April 11 to act on the bill. If she does nothing, it will be pocket-vetoed.
Support for this coverage comes from the W.K. Kellogg Foundation.
