2023 Legislative Victories Boost Optometry’s Credibility, More Changes Looming

After months of uncertainty, courtesy of a lingering Florida bill threatening to strip optometrists of their ‘physician’ title, a few 2023 legislative victories have given optometrists a reason to celebrate. The ‘not a doctor’ legislation, which the American Optometric Association (AOA) claims sought to “block growing momentum in state legislatures to further expand optometry’s role in the delivery of essential health care services,” was vetoed by Governor Ron Desantis on June 2.^1,2 However, Florida is not the only state to deliver a victory for optometry this year, and the governors of Washington and New Hampshire have signed legislation into law expanding the profession’s scope of practice.^3,4 More scope of practice expansions allowing optometrists to perform minor laser procedures, remove styes and skin tags, and expand their vaccination and prescribing authority may also be on the horizon with bills floating their way through the New Jersey and Ohio state legislatures.  

Allowing Optometrists To Do What They’re Trained To Do

Washington Senate Bill 5389, which was signed into law by Governor Jay Inslee on May 9, is expanding the scope of practice for optometrists within the state. While this bill stops short of allowing optometrists to perform laser procedures, it does allow them to excise chalazia, administer subconjunctival injections, deliver topical or injectable anesthesia, and prescribe oral steroids.³ While opponents of this and similar legislation may question optometrists’ ability to perform these procedures, they are taught in every optometry school and have been performed successfully by optometrists in 10 states. To date, no adverse events for optometry-performed procedures have been reported in the literature.⁵  

“When you look at a place like Oklahoma that’s been doing this for 20 years, you can see that this is not the tip of the spear,” according to Dale Tosland, OD, President of the Optometric Physicians of Washington. “The optometrists coming out of school today are very well-trained — they’ve all had exposure to this. The states that are not legislating, advocating, and passing these laws are not going to be attractive to these new graduates and they’re going to end up with a short supply of optometrists going forward.”     

As ophthalmologists lament shortages in their profession, an exodus of optometrists may only exacerbate the issue of limited access to eye care. Since 1990, the number of ophthalmologists has remained relatively stable.⁶ The population of individuals aged 65 years and older, however, has not, with 42% and 83% increases expected in this population by 2030 and 2050, respectively.⁶ Not only is the US population getting older, ophthalmologists are getting older — 50% are older than 50 years and are likely closer to retirement than their residency training.⁶

Dr Tosland states that optometrists in his state are ready, willing, and able to step up and address the voids that will likely result from this shortage, and they can prove even more useful if granted the authority to perform laser procedures. 

“With the advancements in glaucoma treatment around lasers and the automation of some of these machines that make everything so easy, and you buoy that against the shortage of ophthalmologists, it makes sense that optometry should be on the forefront of these laser procedures and advanced scope of practice procedures as they’re taught now in the schools of optometry,” he said. 

Other Expansions Cementing Optometrists’ Role as Health Care Professionals

A pharmacy or a family doctor’s office may be popular places to receive vaccines, but an overwhelming influx of patients may create a need to divert some of them to other health care specialists — a reality recently highlighted by the COVID-19 pandemic. As the push to administer hundreds of millions of vaccines intensified, a total of 8 states, which included California, Utah, Colorado, Ohio, Virginia, West Virginia, New Jersey, and South Carolina, allowed optometrists to administer COVID-19 vaccines.⁷ 

Included in the list of 2023 legislative victories is a bill that grants optometrists in New Hampshire similar vaccination authority and allows them to administer influenza, shingles, and COVID-19 vaccines beginning October 3.⁴ While there may be no current pandemic to shutter businesses and disrupt everyday life, the COVID-19 era showed that such changes can occur suddenly. Since 90% of Medicare beneficiaries — individuals who are particularly at risk for disease complications — live within 15 minutes of an optometrist, they may be ideal professionals to include on the front lines against any future disease outbreaks.⁷ 

Pending Legislation May Give Optometrists More Reasons to Celebrate

Bills floating through the New Jersey and Ohio state legislatures may soon be added to the list of 2023 legislative victories and expand optometry’s scope of practice to include laser treatments. Identical senate and assembly bills (SB3841 and AB5445, respectively) in New Jersey and SB 129 in Ohio have the 2 states jockeying for position as the 11th state to allow laser procedures and call for scope of practice expansions to include benign lesion, skin tag and cyst removal, subcutaneous injections, and more vaccine and prescription authority.^8-10

Some optometric associations from other states have successfully lobbied for optometric scope of practice expansions, convincing legislators that their low population density limited patients’ access to care. New Jersey and Ohio, the states with the highest and tenth highest population densities, respectively, may not be able to make a similar case.¹¹ 

Jesús L. Barrios, OD, President of the New Jersey Society of Optometric Physicians, says that the Garden State’s high population density does not ensure equal access to eye care for all. 

“It’s important to note that access to care issues for underserved populations is not limited to geographic location. Accepted insurance, transportation, costs, duplication of services, appointment wait time, and a growing need for eye care come into play as well. While we may have a smaller rural population, we have large underserved populations,” he said.  

However, Dr Barrios acknowledges that convincing New Jersey’s legislators that the state’s high population density will not improve access to care isn’t the only hurdle optometry lobbying groups need to clear. “Unfortunately, as is often the case, it can come down to money and the power of lobbying,” he said. 

Since optometry advocacy groups are unlikely to outspend medical advocacy groups — the American Medical Association (AMA) spent 19.27 million dollars on lobbying in 2022 alone, making them the seventh largest lobbying spender in the US last year — optometrists must rely on their ability to educate others and discuss the importance of retaining optometrists who want to practice in the state.¹² 

“Optometrists must educate legislators and the general public about these procedures and the need for this legislation,” according to Dr Barrios. “Aside from the needs of patients, we also want to highlight what passage of this legislation means in terms of attracting and retaining a skilled workforce to our state. If we want optometrists to move to and remain in New Jersey, we need to make it attractive to practice here. That means allowing optometrists to practice to the full extent of their education, training and certification.” 

The Scorecard Shows Optometry Is Ahead

While 2 bills with the potential to expand optometry’s scope of practice have failed to see their way through the South Dakota and Idaho legislatures for the time being, the profession has experienced tremendous strides in allowing optometrists to practice to their full potential.^{13, 14} During the past 2 years, California, New York, Massachusetts, Mississippi, Wyoming, Virginia, and Utah have enacted laws expanding optometry’s scope of practice.^15-21 As more states pass laws allowing optometrists to perform procedures traditionally reserved for ophthalmologists, optometrists may have an opportunity to add to their 2023 legislative victories. If newly enacted legislation permits them to showcase their skills, medical professionals may even grow to appreciate the burden that optometry has lifted from their shoulders.