Study Highlights Safety of OD-Performed Laser Procedures

HOT TOPIC

Review of OD Laser Training Confirms Competence

Researchers recently evaluated the safety of laser procedures performed by optometrists in the United States, Canada, the United Kingdom (UK), New Zealand (NZ), and Australia. Their investigation focused on the rate of complications associated with these procedures in regions where ODs have an expanded scope of practice. (As of 2024, qualified optometrists in the UK, in 12 states in the United States, and specialist optometrists in NZ perform laser procedures.) Lasers are not within the scope of optometric practice in Australia and Canada.

The study notes that the outcomes of more than 146,000 laser procedures conducted by optometrists across the United States have produced only two adverse events, resulting in a complication rate of just 0.001%. This finding supports the argument that optometrists across the United States possess the necessary skills and education to perform laser procedures safely. The study also highlights specific states where optometric laser procedures have been implemented successfully—notably, Oklahoma and Louisiana (Geaux us!)—and those that have seen minimal complications arising from laser procedures performed by optometrists. These positive outcomes help to reinforce the case for expanding the scope of optometric practice to include laser procedures.

My Two Cents

Kudos to the authors of this study. Nate Lighthizer, OD, FAAO, and David Cockrell, OD, have both been superstars in this profession for years, and special congratulations go to Dr. Lighthizer, who was named dean of the Northeastern State University College of Optometry effective July 1st!

The safety record observed in this study underscores the impressive competence and proficiency of optometrists in managing and performing laser treatments. As our profession continues to evolve, studies like this must continue to be conducted to show even the most discerning of politicians why as a profession and as providers, scope expansion is appropriate. Optometry can and should play an even more significant role in enhancing patient outcomes and addressing the ocular health needs of our patients.

OUTSIDE THE LANE

New Research on the Glaucoma Front

Researchers from the University College of London and Moorfields Eye Hospital in London have identified potential markers in the blood that may change our treatment of glaucoma. The study was recently published in Nature Medicine and specifically looked at mitochondrial function in white blood cells.

Researchers examined the various proteins, metabolites, and genetic factors found in the blood samples of patients with glaucoma to identify patterns associated with disease severity and progression. The blood of 139 patients who were already receiving glaucoma treatment was compared with that of 50 healthy individuals. The researchers specifically looked at how efficiently peripheral blood mononuclear cells (PBMCs) used oxygen and measured levels of nicotinamide adenine dinucleotide (NAD), a molecule essential for energy production derived from vitamin B3.

They found significant differences between patients with glaucoma and patients without glaucoma. Specifically, patients with glaucoma showed altered oxygen use by their PBMCs and there was a strong correlation with those who showed lower oxygen use experiencing faster rates of vision loss. In addition, lower levels of NAD in blood cells were found in patients with glaucoma compared with healthy patients, suggesting a potential link between mitochondrial dysfunction and accelerated vision loss. (Read more here.)

My Two Cents

Although glaucoma isn’t exactly my specialty (or my passion), this is the type of thing you can’t help but get excited about. Imagine incorporating a blood-based test into your clinical practice for your patients with glaucoma. This could potentially allow us to improve patient outcomes by identifying and treating certain patients more aggressively than we originally thought was required.

CAN YOU RELATE

Most of you reading this newsletter don’t know me personally, so you probably don’t realize just how obsessive I am about figuring things out when presented with a problem.

A couple things continue to elude me when it comes to dry eye: a simple, comfortable, affordable, and effective way to help my patients with nocturnal lagophthalmos (kudos to Paul Karpecki, OD, FAAO, and Doug Devries, OD, for the SleepTite/SleepRite daily nighttime lid closure device [Ophthalmic Resources Partners], as that seems to be the best in a category without many options) and something we can apply directly to the eyelid area that may actually help our meibomian glands.

I’ve spent hours poring through the literature, and even searched through Eastern medicine for anything promising, with little success. See those horrific glands in the photos below? Those are mine, imaged on July 31st. Awful, right? And that’s after numerous rounds of intense pulsed laser (IPL) therapy, regular use of heat masks, and taking various supplements designed for dry eye disease.

For those of us with rough meibomian glands, the challenge has been present for many years, and the difficulty of treatment is all too well known. Many companies have risen to address this need; however, it seems as though they all run into challenges.

With recent incidences regarding Medicare administrative contractors published fee schedules and rising costs of disposable units, the market is rife with opportunity for meibomian gland treatments. But sometimes it seems like we lose an option for every one we gain!

Let’s be real. If you are developing a product to unclog meibomian glands, do not make us purchase disposable components for each patient. At this point, that water has been poisoned, and it’s going to be very difficult to get any eye care provider to sign on for a machine with single-source disposables. That’s one of the big allures of both IPL and radiofrequency.

Our office has two IPL units, from different manufacturers, one of which also offers radiofrequency (RF) therapy. (Honestly, I have yet to be sold on the efficacy of RF, as the research is not nearly as robust as it is for IPL; however, the fact that the units do not have a click fee or disposables is a pro to a profession that is understandably wary of anything that requires ongoing purchases from the device’s manufacturer.) I suggest that those developing treatments for meibomian gland dysfunction look to the IPL/RF model of quality machinery with no disposables if they hope to be successful in a space where we have been burnt numerous times.