Privatization of VA Eye Care

America has trusted the eyes of its soldiers to pilot warplanes and spot enemy tanks on the horizon. However, one proposal the Trump administration is reportedly considering could lead to significant changes to the Veteran Administration's hospitals. Reports suggest the VA’s provision of integrated eye care for veterans in a bid to save money could be at risk.

“Our veterans deserve better than this, they deserve to have their eyes examined by those operating under the highest standards of care,” says Jaime Membreno, a Florida ophthalmologist and an air force veteran.

Currently, roughly a third of the VA’s services are privatized, and Shulkin has said that “hard choices” had to be made regarding further privatizations. In an interview with the New York Times, he hinted that optometry services might be one of the areas for possible closures.

“We make eyeglasses for our veterans. Last time I checked, every shopping mall in America has a place where you can get glasses in an hour. I do not care about making eyeglasses.” Shulkin allegedly made similar comments to a closed-door meeting of VA directors.

While eyeglass services might be a convenient target, the VA’s eye-care is a carefully integrated system. The removal of one service – even the provision of eyeglasses – could impact other services such as optometry and ophthalmology.

Shulkin may have shelved further privatization for now but, the Trump Administration remains keen on making cuts to the VA's budget. The Trump administration backed away from cutting a $460 million program that targets veterans with chronic illness in December as it reconsiders where to cut.

Optometry services are among the busiest in the VA System. Thus, they offer a tempting target for those looking to cut costs. The VA Optometry's service provided primary eye care for military veterans with 1.8 million eye care visits in 2016.

The Veteran’s Administration has its own standards for eye care which are often more stringent than that found in some jurisdictions. For example, some states such as Oklahoma, Louisiana, Kentucky allow optometrists to perform certain laser surgeries on the eye. While in the VA only ophthalmologists, who are medical physicians, can perform this operation.

This VA policy is the result of some unfortunate recent history.

In 2009 the ophthalmology service at the VA hospital in Palo Alto received a patient who was in trouble. The veteran had been receiving treatment for glaucoma at the hospital since at least 2005 but, by the time ophthalmologists saw him it was too late, even with surgical procedures to save his vision intact. 

The case prompted legal action and a three-month internal review of 381 patients - some of whom had received laser surgery to treat eye conditions.

“Some patients got treated with lasers that should have never been treated with lasers, and that’s abhorrent the vets, and the military doesn't deserve that,” said Jaime Membreno. “The Palo Alto incident shows that internal standards were not being clearly enforced and since then the VA has ensured that veterans received specialized care by ophthalmologists, retina specialists or whatever the appropriate medical physician.”

The VA internal review ultimately determined that 23 veterans suffering from glaucoma have experienced “progressive visual loss” as a result of their treatment at the hands of the hospital’s optometry department. One 87-year old veteran received a $250,000 settlement from the federal government due to his injuries.

“In response to this incident, two VA Palo Alto Health Care System employees were removed from clinical duties -- both no longer work at VA,” said Curt Cashour a press secretary Department of Veterans of Affairs in a written statement to the author.

As a 2015 VA Directive document notes, multiple veterans were harmed by the optometry departments not referring their cases to ophthalmology.

However, the unfortunate incidents in Palo Alto had a lasting impact.  The incident resulted in new policies including further close collaboration between the VA’s optometry and ophthalmology services.

“Current VA policy permits only VA ophthalmologists to perform therapeutic laser eye procedures,”Cashour told the author, “Dependent upon state law, optometrists having the required education and certification may be permitted to perform select ophthalmic surgical procedures by the State Board of Optometry.”

A recent study of patient outcomes in Oklahoma published in the Journal of the American Medical Association found that patients who received laser surgery from optometrist were twice as likely to need additional laser surgery than when the same operation was performed by an ophthalmologist.

A VA spokesperson contacted last year declined to comment if further privatizations of eye-care were being planned. Instead, he referred to the New York Times article cited in this article. The Society of Military Ophthalmologists declined to comment on this story.

Still, if the Trump Administration is eager to find waste within the VA, there is waste to be had. Information released by Sen. Chuck Grassley, (R-Iowa) last year revealed the VA had spent some $20 million artworks across the nation. Something that the senator found to be a waste of the taxpayer's money.

Exhibit A? Some $670,000 had been spent on artwork at the facility for blind veterans in Palo Alto.

Joseph Hammond is a senior contributor with the American Media Institute. As a former Cairo correspondent for Radio Free Europe during the 2011 Arab uprisings, he has also reported from four continents on issues ranging from stability in Somalia to the M23 rebellion in the Eastern Congo.