The Optometrists and Dispensing Opticians Board (ODOB, the Board) of New Zealand has received a lot of interest regarding the complaint from the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) about the Board’s approved and gazetted ‘Specialist optometrist scope of practice – ophthalmic laser surgery’. Full details can be read on the Regulations Review Committee’s website and social media platforms. At the time of this letter’s publication, the outcome was still unknown.
To recap, in 2018, the Board was approached by New Zealand-based ophthalmologists and senior optometrists to ask whether optometrists could train and perform YAG laser surgery, with the first formal submission received in 2019. Having optometrists available to perform this surgery would streamline the patient experience and increase clinical throughput in hospital clinics, and reduce wait-time or the need for patients to return for a separate YAG appointment. The latter is particularly problematic for those travelling some distance or who find it difficult to take time off work or commute to the hospital. This change was intended to help improve inequities in health outcomes – a problem highlighted in a 2018 Ministry of Health report which showed that there was insufficient ophthalmology cover but adequate optometrist cover across New Zealand.
The expansion of optometry practice into limited laser surgeries has occurred in many comparable overseas jurisdictions, so research by the Board showed that this was a natural move for modern optometry internationally. In the UK, for example, the number of public eye departments using optometrists to perform laser surgery tripled between 2015 and 2020, while US-based optometrists have performed more than 100,000 laser surgeries, with good public and professional perceptions and no reported increase in harm. Thus, the Board agreed to conduct a pilot study to assess whether an optometrist could be safely trained in limited laser surgery procedures.
Following the successful completion of a 10-month controlled pilot study over 2020 and 2021, a six-week public consultation on the specialist scope of practice and qualifications opened in November 2021, which provided information on international trends, the pilot programme and its outcomes and the Board’s proposals. RANZCO was expressly invited to respond to the consultation. The Board received a total of 23 responses, with the vast majority in support of the specialist scope of practice. All the submissions were carefully considered by the Board alongside all other evidence, including peer-reviewed publications of overseas experiences. As with all its decisions, the Board also took into account its responsibility to ensure public safety within the practice of optometry. Having consulted on the proposal and considered all the information, the Board was satisfied that the specialist scope of practice was an appropriate, albeit limited, expansion to optometry practice in New Zealand. It was also satisfied that the prescribed qualification was robust and provided the appropriate and necessary training to ensure public safety. The Board also considered that the strict prerequisites for applying for registration, and its requirements for ongoing competence and supervision, provided additional protections for public safety.
