Advocates for optometry in every state are constantly lobbying to expand the licensure of the profession to better match that of the education clinicians receive. And, while some of those efforts surface in state assembly, house, or senate bills, only a few make it to a governor’s desk and are signed into law. In 2021, 5 such pieces of legislation were passed, in California, New York, Massachusetts, Mississippi, and Wyoming.
By no means do these 5 bills represent the complete picture of the American Optometric Association’s (AOA) or optometry’s achievements for the year. Indeed, challenges in court have been faced down and new therapeutic options continue to redefine the discipline. The fact that optometry practices were able to continue to practice safely at all through the ongoing pandemic is a success.
But scope-of-practice advancements have a special place on optometry’s mantle. Here, Optometry Advisor provides a summation of these new authorizations.
In 2004, Vermont became the 49th state to permit optometrists to prescribe topical drops for glaucoma treatments.1 Massachusetts stood as the last hold out for 17 years. In the AOA’s first big win of 2021, Gov. Charlie Baker signed into law Senate Bill 2984 on New Year’s Day.2
The legislation gives optometrists authority to “use and prescribe topical and oral therapeutic pharmaceutical agents…used in the practice of optometry, including those placed in schedules III, IV, V and VI…for the purpose of diagnosing, preventing, correcting, managing or treating glaucoma and other ocular abnormalities,” the bill says.2
Optometric educators consider this a boon for the state’s clinicians. New England College of Optometry’s Gary Chu, OD, MPH, FAAO, says that his institution has noted “graduates were leaving Massachusetts to practice elsewhere because they are unable to fully practice the scope of optometry. This law will change this trajectory and many more graduates will choose to practice in Massachusetts,” Dr Chu explains. “For over 3 decades we have been training the optometrists of every other state, who are authorized to treat glaucoma and use other oral pharmaceutical agents to treat systemic related eye diseases as described in the new law.”
This indication was couched in a larger bill that aimed to expand telemedicine access for patients.2
“This law will provide the citizens of Massachusetts not only with access to cost-effective, high-quality eye care but will also encourage newly trained and talented providers to establish their professional practices in the Commonwealth,” Dr Chu says. “In chronic diseases, such as glaucoma, the savings are cumulative over the lifetime of these patients.”
Optometrists in Massachusetts were also restricted in prescribing oral medications until this bill was signed into law.2
In October, New York’s Gov. Kathy Hochul signed into law Senate Bill 1519, finally giving optometrists in the Empire State the ability to prescribe oral medications. New York was the only remaining state prohibiting oral prescribing authority to optometrists.3,4
The law, set to go into effect January 1, 2023, will give New York’s optometrists the authority to prescribe oral therapeutic pharmaceuticals, including antibiotics, antivirals, and antiglaucoma agents.3,4
“New York’s scope of practice enhancement now means every state legally recognizes optometry’s ability to prescribe oral medications for the treatment of eye diseases, a hard-fought achievement for the profession that began 44 years ago,” said the AOA in a press release.4
While the Northeastern states on this list overcame similar obstacles, prescribing legislation is not representative of the latest scope-of-practice barriers optometry faces. Today, advocates are supporting rules to permit in-office lid lesion treatment and growth removal as well as permit some laser procedures.5
Mississippi’s House Bill 1302, encompasses both. This legislation grants optometric physicians the ability to utilize local anesthetics and remove noncancerous lesions. They may also prescribe certain pharmaceuticals as part of their treatment regimen.5
The bill does not grant them the authority to perform surgeries or other intraocular procedures, but it does allow certain laser applications, such as the use of the yttrium aluminum garnet (YAG) laser for capsulotomies, provided they have met board certification requirements.5
However, the new indications do take aim at the troubling trends in the state’s eye health, with its projected prevalence of visual impairment and blindness in adults expected to have the highest per capita prevalence of blindness by 2050.6
“We are excited to finally be able to take care of our patients with conditions that we previously had to refer out. Mississippi optometrists have been doing an excellent job of taking care of their patients for years, and now we can do so further at the highest level of our education,” says Roya Attar, OD, an educator and Director of Optometric Services with The University of Mississippi’s Medical Center. “Mississippi has many rural areas with limited access to ophthalmology. Patients in these areas can now receive treatment from their trusted optometrist, whether it is for a condition that requires treatment with certain drug prescriptions or a YAG capsulotomy.”
And, Mississippi can also benefit from the potential for drawing recent optometry graduates, which Dr Attar says, will “ultimately reduce vision-related health disparities in the state with patients having increased access to primary eye care providers.”
Similarly, Wyoming’s House Bill 39, signed into law April 2, 2021 by Gov. Mark Gordon, allows optometrists to perform some laser procedures, including YAG, selective laser trabeculoplasty (SLT), and iridotomy.7 It does not grant them any globe penetrating surgeries, such as cataract removal or retinal surgeries. SLT offers a particular benefit in its ability to delay the need for glaucoma drops, in some cases for several years.
Wyoming’s drug prescribing authority has been expanded by the bill as well.8 Wyoming is the country’s least populous state, making access to an eye care facility difficult, especially since it is also the nation’s 10th largest state by land area. The bill was initially introduced in 2018. But the Wyoming Optometric Association (WOA) has not just been waiting around for 3 years. While the bill was reviewed, the WOA partnered with Northeastern State University’s College of Optometry to bring laser education and training to clinicians across the state, demonstrating optometry’s ability to deliver this care.8,9
Finally, the Golden State passed 2 bills, both on October 8, 2021, that broadened optometry’s ability to treat patients. The primary bill, AB 407, authorizes the treatment of all noncancerous anterior segment conditions, with some limitations, as well as all kinds of inflammation in adult patients. Importantly, it permits optometrists to use a scalpel to remove foreign bodies, and to employ intense pulsed light (IPL) therapies. It also removes previous requirements for optometrists to obtain a referral to offer allergy drugs. It authorizes optometrists to use antiviral and antifungal drugs, and allows for CLIA-waived testing for systemic conditions and COVID-19 testing.10
A secondary bill, AB 691, gives the state’s optometrists permission to administer COVID-19 vaccines and perform CLIA-waived COVID-19 testing.11
An Eye on the Future
Not every recent attempt to expand the scope of licensure for optometry professionals has been successful. A similar bill allowing laser procedures and the authority to prescribe certain opioids and painkillers failed to pass in Florida earlier this year, dying in the Senate Health & Human Services Committee in late April.12
Despite this setback, the trend for 2021 appeared to tend toward the expansion of the scope of licensure for optometrists in many states.
“More and more states are moving toward full recognition of optometry and our essential and expanding role in health care,” said former AOA President William T. Reynolds, OD, in a press release. “Together, our AOA and state associations are a nationwide force working to expand patient access to the full range of care that highly trained doctors of optometry are ready, willing, and able to provide.”
- Byrne J. Practice scopes expanded in Vermont, Virginia. Primary Care Optometry. https://www.healio.com/news/optometry/20120225/practice-scopes-expanded-in-vermont-virginia. Updated July 1, 2004. Accessed December 20, 2021.
- An act promoting a resilient health care system that puts patients first. Commonwealth of Massachusetts. S 2984. Updated December 23, 2020. Accessed December 20, 2021.
- Bailey J. An act to amend the education law, in relation to the use of oral medications by optometrists. New York State Senate. Updated January 12, 2021. Accessed December 21, 2021.
- New York gains oral medication prescribing authority. American Optometric Association. https://www.aoa.org/news/advocacy/state-advocacy/new-york-gains-oral-medication-prescribing-authority?sso=y. Updated October 27, 2021. Accessed December 20, 2021.
- An act to amend section 73-19-1, Mississippi code of 1972, to define the practice of optometry. HB 1302. Updated November 9, 2021. Accessed December 20, 2021.
- Varma R, Vajaranant T, Burkemper B, et al. Visual impairment and blindness in adults in the United States. JAMA Ophthalmol. 2016;134(7):802. doi:10.1001/jamaophthalmol.2016.1284
- Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. The Lancet. 2019;393(10180):1505-1516. doi:10.1016/S0140-6736(18)32213-X.
- Optometrist practice act amendments. Wyoming State Legislature. HB 39. Updated April 2, 2021. Accessed December 20, 2021.
- The scope of success. American Optometric Association. https://www.aoa.org/news/advocacy/state-advocacy/the-scope-of-success?sso=y. Updated August 9, 2021. Accessed December 20, 2021.
- Optometry: assistants and scope of practice. AB 407. California Legislative Information. Updated October 11, 2021. Accessed December 20, 2021.
- Optometry: SARS-CoV-2 vaccinations: SARS-CoV-2 clinical laboratory tests or examinations. AB-691. California Legislative Information. Updated October 11, 2021. Accessed December 20, 2021.
- Optometry. Florida Senate. CS/HB 631. https://www.flsenate.gov/Session/Bill/2021/631. Updated July 1, 2021. Accessed December 20, 2021.