Dr. Les Walls
(Optometrist Testimony)
DR. WALLS: Madam Chair and members of the subcommittee: My name is Leslie L.
Walls, and I am both an optometrist and a medical doctor. And I’m here as a licensed
practitioner of both optometry and medicine in more than one state, in support of H-3303.
I believe that it can be demonstrated that modern optometrists do have the education, the
training and the background to safely use the modalities that are within the scope of this
bill. I would like to offer you some specific observations regarding optometric medical
education. I have been in education all my life, both in optometry and medicine…about
half my career in medicine and half my career in optometry education. And I have
served on the various committees including the curriculum committee of both
institutions, medicine and optometry.
Medical school traditionally prepares the graduates to enter general medical and surgical
postgraduate residency training programs and, therefore, they don’t have the time to teach
the detailed ocular anatomy, ocular physiology and the things related to the eye that
occurs in optometry school. In addition, the exposure to eye care in the medical
education training program, the doctoral program, get very little exposure to
ophthalmology. Personally, I went to medical school at the University of California at
Davis, and I had one afternoon entirely devoted to the eye. The rest of it was catch
as…catch as you can. And there’s a reason for this. Medical education has to do this
because they have four years to produce an M.D. and they have to emphasize the things
that are the biggest killers of our country: Heart disease, cancer, stroke, hypertension,
diabetes and, therefore, the time in subspecialty training like ear, nose and throat,
ophthalmology, etc., is not that common. They do offer selectives in ophthalmology and,
in my experience, the students who take these selectives are interested in ophthalmology,
and not the students who are going into other disciplines. On the other hand, optometry
school is devoted mostly to ocular training. Now, there are courses in general pathology,
general internal medicine and, because the optometrist is responsible for seeing patients
and detecting the eye signs of systemic disease, which are numerous: Diabetes,
hypertension just for a couple of mentions. And the optometrists are well educated in this
area and trained during their program to be quick to confer and consult and refer with
other medical specialists. Particularly, I saw, as a practicing family doctor, I saw a
tremendous number of cases referred that would have otherwise been missed by
healthcare practitioner, where the optometrist saw the eye signs of diabetes and
hypertension, for instance.
I’m not slighting medical education at all. It’s a very rigorous curriculum. There’s just
not enough curriculum time to take care of subjects…subspecialty subjects…like the eye.
The other thing that I would say…and I know I’ve got about one minute left…is that the
Dr. Les Walls
(Optometrist Testimony)
Page Two
clinical education of an optometrist really doesn’t have to parallel the education of an
ophthalmologist any more than a family doctor has to parallel the training of a general
surgeon. As a family doctor, I assisted in surgery. I used medications. I did things on an
outpatient basis, and optometrists can be educated and trained very much the same way.
I would like to point out that I have no axe to grind with ophthalmology. I had an
ophthalmology residency and I turned it down to go into family practice, so this is not a
vendetta. I just truly believe that optometrists have the same little layers on the cerebral
cortex, same 10 fingers and toes, we can be educated and trained to do the things that…
we just need the proper education, proper training…and optometrists can safely utilize
the modalities outlined in Bill 3303.
Thank you very much for allowing me to testify.
CHAIRWOMAN PARKS: Thank you Dr. Walls. Any questions?
MALE PARTICIPANT #1: Can you expound on the training that you were saying that
would be required?
DR. WALLS: That would be required?
MALE PARTICIPANT #1: Yes.
DR. WALLS: Well, the state board…you know, passing of this legislation…I cannot
speak for the state board. And there will be people here who can do a better job than I
do. The only thing that I can assure you is that I’ve never had any reason to believe that a
state board would be careless, that they would outline…they would look at what has been
successful elsewhere. Residents in the State of Oklahoma in which I reside, we’ve been
using laser for over 20 years and have a tremendous track record of safety. But I was
responsible for putting that curriculum together. I was the Dean of the College of
Optometry at that time. We were very careful to bring in the experts to make sure that
we had the proper education and training. Because what you ask is absolutely
critical…it’s absolutely critical…that you have a program that’s defensible and
certifiable, or else it would be a danger to the people. And I do not believe the state
board would ever allow that to happen.
MALE PARTICIPANT #1: Well I guess I’m a little confused because the bill….and if
I’m not correct, please let me know…is asking to allow certain procedures to be done.
And maybe I’m misunderstanding you, but there is some training that will need to take
place before they can do it?
Dr. Les Walls
(Optometrist Testimony)
Page Three
DR. WALLS: Absolutely.
MALE PARTICIPANT #1: And so, can you tell me what that training will be, and
would it be going back to school for a year, or for continuing educational hours?
DR. WALLS: I am not from South Carolina. And I do not know what the state board
has in mind or what the legislative body would have in mind, but I can assure you that it
would be patterned after the success in other states in order to make sure that the people
of South Carolina are protected. We have a good track record in other states.
MALE PARTICIPANT #1: Thank you.
CHAIRWOMAN PARKS: Representative Jackson?
REPRESENTATIVE JACKSON: To follow up on the question here: I believe that
there’s one state where this has already been approved. The optometrists are able to do
certain things in one particular state in the United States so far?
DR. WALLS: There’s no question that, if you look at all of the things in the bill, there’s
different components. Each state has its own practice act. The State of Oklahoma
certainly has been using laser and doing procedures like this, and one of my fellow
testifiers will be up here in a little while, Dr. Cockrell, and he has been doing these
procedures for over 20 years.
REPRESENTATIVE JACKSON: Okay, your request right now is you would like to be
able to use laser as an optometrist?
DR. WALLS: Not all lasers. Certain lasers. There’s…some of the lasers…there’s a
whole variety of lasers. And the ones that would be relevant to optometry are outlined in
the Bill, and it also outlines things that they cannot do. And that’s a very important
thing…not only what you can, but what you cannot do.
REPRESENTATIVE JACKSON: Okay, so let me ask another question. What you are
requesting now, how many other states have requested what you are requesting to have
done in the State of South Carolina, and how successful has it been in one state, or
whatever amount of states it’s presently being done?
DR. WALLS: Well certainly I can speak for the great State of Oklahoma.
REPRESENTATIVE JACKSON: So Oklahoma’s the only one right now?
Dr. Les Walls
(Optometrist Testimony)
Page Four
DR. WALLS: It’s the one I’m most familiar with, because I am from Oklahoma. But
there are components of this in almost every state. Every state has its own practice act
and they all are different.
REPRESENTATIVE JACKSON: Okay, so up to this point, how successful…really,
truthfully…how successful has this program been in the State of Oklahoma?
DR. WALLS: It has been very successful. I was responsible for putting the educational
program together for it. And you will hear from one of my fellow testifiers in a little
while the various procedures that he has done for over 20 years, and will hear about the
safety of it and the complications. I think that’s an excellent question.
CHAIRWOMAN PARKS: Dr. Walls, have you ever been contacted by other states,
other than South Carolina, to put together a curriculum to expand the scope of
optometry?
DR. WALLS: I have. I was the dean of the college there, of optometry, in Oklahoma,
and there are only like 16 accredited schools of optometry in the United States when I
was the dean there. There are like 19 now. But we were contacted by, especially, states
that did not have an optometry program, to put a curriculum together, and to come in and
administer it, under what we called “transcript quality”. In other words, it had to meet
the standards up through the U.S. Department of Education for accreditation.
CHAIRWOMAN PARKS: Can you tell me what states those were?
DR. WALLS: Well we did Washington, Oregon, Colorado, New Mexico, North Dakota,
South Dakota. I’m sure we did a couple others, but those are the ones that really jump
into mind.
CHAIRWOMAN PARKS: Are there any other questions? Thank you sir.
DR. WALLS: Thank you very much.
MALE PARTICIPANT #2: I would like for the staff to get us some information, if they
could, on the utilization….
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