Concerned that a recent change to the Veteran’ Health Administration’s Community Care Program guidelines lowers the standard of eye care for the nation’s veterans, a group of U.S. House of Representatives members and a senator has sent a letter to the agency demanding answers.

The letter was led by Rep. Mariannette Miller-Meeks, MD, R-Iowa, an ophthalmologist and a veteran, and signed by four other physician members of Congress. It was delivered to the VA Under Secretary for Health Shereef Elnahal, MD, MBA, on Oct. 18, 2022.

Their action comes after the VA’s action to remove language from the Community Care “Standardized Episode of Care: Eye Care Comprehensive” guideline that has historically provided that “only ophthalmologists can perform invasive procedures, including injections, lasers and eye surgery.”

The Academy shares lawmakers’ concern that “by removing this standard, even if the VA intends to defer to state licensure and scope of practice law, the VA is creating confusion by implying that someone other than an ophthalmologist — e.g., an optometrist — can perform invasive eye surgery.”

In their letter, the members of Congress are asking the VA for answers to specific questions so the lawmakers can “better understand the steps the VA is taking to prevent poor outcomes for veterans.”

Dr. Miller-Meeks was joined on the letter by Sen. Roger Marshall, MD, R-Kan., and Reps. Larry Bucshon, MD, R-Ind., Andy Harris, MD, R-Md., and Greg Murphy, MD, R-N.C.

The Academy shares their concerns. By removing the clause limiting surgery to ophthalmologists, the VA is implicitly authorizing optometrists to perform ophthalmic surgery on veterans that are referred under this program, where permitted by state licensure laws. We are concerned about the implications the community care policy change could have for the national standards that the VA is developing for optometry