U.S. Army Staff Sgt. Juan Gonzalez served his country for 11 years until combat-sustained injuries sidelined him while serving overseas in Afghanistan.
Gonzalez’s dreams of a full military career climbing the ranks vanquished when he was diagnosed with traumatic brain injury, post-traumatic stress disorder and permanent injury to his lower back, rendering him unable to physically serve. These days he fights a different kind of war, the kind that only stay-at-home dads understand.
View a photo album from Erica R. Alvarez, MD.
Raising our two sons brings fulfillment and joy along with challenges. He is my right hand, with boots on the ground, handling these “enemy combatants” — all while maintaining the mantra in our house that “we do not negotiate with terrorists.” Most battles are won after a much-needed nap, bottle or box of animal crackers and mutually agreed-upon Disney movie.
Growing up in El Paso, Texas, home of the Fort Bliss military base (the largest Army installation in the U.S. Army Command) has given me a visible awareness of our military and appreciation for what they do. My medical education was richly enhanced by the wide range of patient experiences and teaching I received, most importantly at Veteran Affairs (VA) hospitals and medical clinics.
It was one such VA rotation during my residency program that not only allowed me to hone my surgical skills performing cataract surgery, but also brought us together serendipitously. One month before I started my rotation in the VA ophthalmology clinic, my future husband also found himself as a medical support assistant in the eye clinic. Through access to VA-sponsored vocational rehab, he was taking college courses in the medical field and was also given the opportunity to complete a work-study program at the VA.
I have watched from the passenger seat as he navigates the VA medical system as a patient and the challenges he experiences. Although the VA system in the past has received a bad rap for poor quality of care, many things have changed to dramatically improve these deficiencies. That’s why I was shocked to learn about the VA’s plan to revise its national standards of practice. Also called the Federal Supremacy Project, these changes would effectively remove language regarding safety concerns and opens the doors for optometrists to perform eye surgery.
Why is this worrisome? Optometrists lack the adequate background medical training, the years of necessary supervision performing eye surgeries and the experience to handle complications that may arise — not to mention the lack of oversight or accountability when reporting possible complications.
As an ocular oncologist, I’m burdened by the concern that an optometrist without surgical training could pick up a scalpel and remove an ocular tumor, when they:
- Lack the years of knowledge needed to understand how to excise such a lesion correctly in order to prevent tumor seeding
- Lack sufficient expertise on recommendations for metastatic imaging scans and appropriate next steps like adjuvant chemotherapy, immunotherapy and/or radiation therapy
- Lack a full understanding of how these gaps in knowledge and expertise could lead to fatal complications
I urge you as physicians to remember your own veterans, the patients you have met who have trusted you to be part of their care. Be their advocates and their voice. As surgeons we know the rigors that go into surgical training and the great responsibility we must bear as we operate and perform procedures that could alter the quality of life for our patients. We have a unique perspective, and often our legislators need input from someone with the medical background or insight we have.
Being an advocate starts locally at the state level. By staying informed on the issues at hand, getting to know your local representatives and, most importantly, joining your state ophthalmology society. Being connected allows you to show up when given the opportunity to share your experiences and professional opinion. We have a critical opportunity to educate the public and make them aware of the harm that could arise from allowing nonsurgeons to perform laser procedures, injections, and even scalpel surgery on our veterans. Our service members deserve the highest quality of care possible, and we can help advocate for that.
About the author: Erica R. Alvarez, MD, is an ocular oncologist and retina specialist in El Paso, Texas. She joined the Academy’s YO Advocacy subcommittee in 2023.
Erica R. Alvarez's Reason for Advocacy