Turf war over eye care erupts in the Legislature -- and on the radio

JUNEAU — A decades-old battle inside Alaska's eye care industry has flared up again in Juneau in a nasty, tongue-twisting turf war between the state's optometrists and ophthalmologists.

The fight centers on a bill that currently sits in a Senate committee — and the two sides can't even agree about what it does.

Optometrists — health care professionals with four years of graduate school but no doctorate of medicine — say the bill would bring outdated state laws in line with advances in technology and training in their field.

The ophthalmologists — doctors who finished medical school and residencies — say the measure, Senate Bill 55, amounts to a dangerous expansion in the scope of work that optometrists are allowed to perform.

This week, after the bill emerged from the Senate's health committee, the ophthalmologists raised the stakes, debuting a radio commercial, complete with a dramatic cymbal clap, that alerts listeners to a "medical emergency emerging in the halls of the Alaska Legislature."

"Optometrists want Alaskan politicians to give them the authority to operate on Alaskans' eyes with lasers, scalpels, and needles, all without completing their required clinical and surgical training that physicians and surgeons do," warns the narrator, who urges listeners to contact their elected officials. "If optometrists want to be eye surgeons, send them to medical school — not the Legislature."

The fight has provoked strong feelings, especially from the optometrists, some of whom see the ophthalmologists' campaign as a show of condescension.


"We're the underdog that keeps getting stepped on by these egomaniacal bastards," said Jeff Gonnason, an optometrist and past president of the Alaska Optometric Association, who said he wrote the bill. "This is all over turf and it's all over money — it's nothing to do with anything but denying access to care."

Gonnason, who practices in Anchorage, said the eye care dispute stretches back 45 years. Past skirmishes include an episode in 2000 when then-Gov. Tony Knowles vetoed a bill expanding optometrists' authority to prescribe drugs, even after it passed the Senate by an 18-2 vote and the House by a 37-2 vote.

The two fields work together when it comes to treating patients, with ophthalmologists often relying on optometrists for referrals.

But they play hardball against each other in Juneau and pay eye-popping sums to energetic lobbyists. Jerry Mackie, a former state senator who sponsored the bill vetoed by Knowles, is paid $30,000 a year by the Alaska Optometric Association.

Frank Bickford, who's also the executive director of the Alaska Society of Eye Physicians and Surgeons, earns $70,000 annually to lobby for the American Academy of Ophthalmology.

"It's a long, drawn-out war," said Jane Conway, an aide to Sen. Cathy Giessel, the Anchorage Republican who sponsored Senate Bill 55.

"Ask the old-timers and they'll just throw their hands up," Gonnason said. "They'll go, 'Oh, the optometrists and the ophthalmologists.'"

The optometrists and the ophthalmologists found a common vision in 2013 when they worked together to pass a bill allowing patients to get early refills of eye drops if they ran out before a prescribed date.

But Giessel's bill has renewed the hostilities.

The measure is just two pages. It contains several provisions, including one allowing optometrists to perform new diagnostic and treatment procedures if authorized by the state's optometry board, which is made up of four optometrists and a public member.

The state's ophthalmologists argue that optometrists can't be trusted to regulate their own industry. And they say the bill fits in with a national push by optometrists for expanded powers they're not qualified to use.

An American Medical Association review in 2010 found optometrists had tried 46 times to "legislate surgery privileges" in 21 states since 1997, and were blocked all but once.

Giessel's bill currently contains a ban on optometrists performing "invasive" surgery techniques. But it explicitly defines the term "invasive" to include six different types of surgery, which the ophthalmologists say leaves a gaping loophole.

Scott Limstrom, an Anchorage ophthalmologist and president of Alaska's eye doctors and surgeons society, prepared a white paper last year in response to the bill. It lists four types of cornea surgeries, three laser surgeries, and three types of eyelid surgeries that he says would be authorized by Giessel's legislation.

"I know the optometrists really well. They're good people — they worked hard to get where they are, and they provide excellent care. But throughout the country, they keep on submitting legislation in different states to try to increase their privileges," Limstrom said in a phone interview. "This is very fine, meticulous surgery — you've got your patient's vision in your hands. It's not something that the Legislature should be legislating."

The fight, Limstrom said, is not an attempt by ophthalmologists to protect their market share. There are only about two dozen of them in the state, he said, compared to about 150 optometrists.

"I work seven days a week, oftentimes over 70 hours a week," said Limstrom. "It's all about providing the best quality care."


Giessel, a nurse practitioner who this week reported a $1,000 campaign contribution from the optometrists' political action committee, said in an interview the ophthalmologists' objections to the bill are "absurdly dramatized." And she insisted her legislation was not written to authorize optometrists to perform the types of procedures described in Limstrom's paper.

"There is absolutely nothing in this bill that would allow an optometrist to do eye surgery," Giessel said. "No eye doctor would want to do that."

Writing the bill to more broadly bar optometrists from doing surgeries, or to specifically ban each of the types listed by Limstrom, would be unnecessary and overreaching, Giessel said.

"My nursing statutes do not prohibit me from doing brain surgery," she said.

Before the start of the legislative session, Limstrom, Gonnason, and two other colleagues met at the Petroleum Club in Anchorage to try to broker a truce. But the summit failed to produce an agreement, leaving the bill in play in Juneau.

Last week, it moved out of the Senate's health committee and now rests in the Senate's labor and commerce committee, where a hearing hasn't yet been scheduled. Before taking effect, the measure would still have to pass the full Senate, then work its way through the committee process in the House, which has temporarily shut down work on legislation that doesn't address the state's massive budget deficit.

Nonetheless, the ophthalmologists have mounted a vigorous assault against the bill on the airwaves — a campaign that Mackie, the optometrists' lobbyist and a distant cousin of Gonnason, said was "literally laughable."

Mackie, in a phone interview, accused the ophthalmologists of trying to subvert the legislative process.

"Because they can't make the case on the merits there in Juneau, they're trying to resort to spreading lies and mistruths through a radio campaign," Mackie said. "Last time I checked, there's not one legislator in Juneau that's not available for them to come and make the case about the merits. I've never seen anything like it."

Nathaniel Herz

Nathaniel Herz is an Anchorage-based journalist. He’s been a reporter in Alaska for nearly a decade, with stints at the Anchorage Daily News and Alaska Public Media. Read his newsletter, Northern Journal, at natherz.substack.com