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Invited Commentary
October 2016

Laser Trabeculoplasty Use Patterns Among Optometrists and Ophthalmologists in Oklahoma

Author Affiliations
  • 1College of Optometry, State University of New York, New York
  • 2Optometry Section, Department of Veterans Affairs, New York Harbor Health Care System, Brooklyn
JAMA Ophthalmol. 2016;134(10):1101-1102. doi:10.1001/jamaophthalmol.2016.2567

In the article by Stein et al,1 the authors’ stated objective was “To compare outcomes of LTPs [laser trabeculoplasties] performed by ophthalmologists with those performed by optometrists to determine whether differences exist in the need for additional LTPs.” However, the conclusions seem misleading and not supported by their data.

The authors found that “The proportion of eyes undergoing LTP by an optometrist requiring 1 or more subsequent LTP session (35.9%) was more than double the proportion of eyes that received this procedure by an ophthalmologist (15.1%).” They conclude that “Health policy makers should be cautious about approving laser privileges for optometrists practicing in other states until the reasons for these differences are better understood.” It is unclear how the authors could have made this conclusion. Using Medicare claims data as their only resource, they did not have access to LTP outcomes—the goal of their study—and hence, only reported procedure utilization rates. It is hard to understand the meaning of their conclusions without knowing whether treatments were performed in more than 1 session with 180° treatments or a single session with 360° treatments. Moreover, there was no information about intraocular pressure reduction, associated complications, or any other measure of the safety or efficacy of the laser treatment. Without the aforementioned information, the number of LTP sessions cannot be a substitute for the quality of the procedure.