Proposed Legislation May Continue to Expand Optometry’s Scope of Licensure in 2 States

Last year, optometry saw 5 states implement expansions in the optometric scope of practice. California, New York, Massachusetts, Mississippi, and Wyoming each enacted legislation to permit optometrists to perform certain laser procedures or prescribe topical and oral medications.^1-5 Virginia and Utah are now following suit as bills permitting some laser treatments make their way through state legislatures. 

Utah

On February 15, the Utah House of Representatives voted (48-23) to advance HB 224 to the Senate.⁶ If the bill passes, optometrists will be able to perform YAG capsulotomy treatments, trabeculoplasty, and peripheral iridotomies in the state. Optometric training has adequately prepared optometrists to perform such procedures, insists Weston Barney, OD, president of the Utah Optometric Association. “These are 3 common procedures taught to optometrists, even in optometry school. Every school teaches them,” he says. Detractors to optometry expansion bills have raised the potential for increased complications associated with laser procedures.⁷ But research shows that these complications are rare, whether performed by an optometrist or an ophthalmologist.⁸ In fact, as Dr Barney explains, optometrists are often the ones who manage complications of these procedures. 

“I work in an ophthalmology setting and I deal with these procedures day in and day out,” he says. “They are quick, safe, and side effects are rare.” 

If the bill makes it to the governor’s desk, Utah will join the ranks of states such as Kentucky, Oklahoma, and Louisiana; all of which have permitted optometrists to perform laser procedures for years. Dr Barney reports that several states have allowed optometrists to administer these treatments for quite some time and “no negative complications have been noted by any regulatory board.”

State Representative Ashlee Matthews argues that this bill could reduce healthcare disparities, citing that “this could potentially move some barriers for lower-income, underinsured people, to access this care” during an open-floor discussion at a House Business and Labor Committee meeting.⁷ 

Virginia

Old Dominion’s version of the bill is currently sitting on Governor Glenn Youngkin’s desk, awaiting his signature. SB 375, which calls for almost identical provisions as Utah’s HB224 passed overwhelmingly in the Virginia Senate by a 33-3 vote.⁹ Like in Utah, the bill allows optometrists to perform laser procedures “consisting of peripheral iridotomy, selective laser trabeculoplasty, and YAG capsulotomy for the medically appropriate and recognized treatment of the human eye through revision, destruction, or other structural alteration of the tissue of the eye using laser technology.” 

All optometrists who plan on performing such procedures must be certified to perform them by the VA Board of Optometry, complete appropriate didactic and clinical training, and register annually with the board. All disciplinary action, malpractice settlements, and malpractice judgements must be reported to the board.⁹

The house’s version of the bill also advanced, moving forward with 84 voting in favor of the legislation and 10 voting against. 

The Virginia Optometric Association’s website indicates a full endorsement of the proposed measures: “Every optometry school in the USA trains Doctors of Optometry to perform in-office eye laser procedures and Doctors of Optometry in Virginia have been certified to perform in- office laser procedures since the 1990s. In other states, these glaucoma and after- cataract in-office eye laser procedures are provided by optometrists.”¹⁰ 

Optometry’s Future 

Debate over this kind of proposed legislation can lead to political and inter-speciality conflict. But Richard E. Castillo, OD, DO of Oklahoma (a state that has allowed optometrists to use laser treatments for years), is able to offer insight. He believes optometrists are well-qualified to perform these procedures. Through a video posted on the Virginia Optometry Association’s website, he states, “Optometric physicians excel at primary eye care and are uniquely qualified to provide the services they do. And yes, primary optometric eye care in an ever expanding number of states includes specific laser… procedures.” ¹¹

So what can optometrists expect from the profession going forward? Dr Barney says optometrists are not looking to begin using scalpels or perform globe-penetrating procedures, such as cataract surgery. Nor does he endorse the idea that they should. He says that he is not looking to perform advanced surgical procedures exclusively entrusted to ophthalmologists, only “minor, in-office procedures that [optometrists have] been trained to do.”

References 

1. Optometry: assistants and scope of practice. AB 407. California Legislative Information. Updated October 11, 2021. Accessed February 18, 2022.
2. 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 February 18, 2022.
3. An act promoting a resilient health care system that puts patients first. Commonwealth of Massachusetts. S 2984. Updated December 23, 2020. Accessed February 18, 2022. 
4. 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 February 18, 2022.
5. 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 February 18, 2022.
6. Optometrist practice amendments. State of Utah. HB 224. Updated February 17, 2022. Accessed February 18, 2022.
7. Imlay A. Should non medical doctors perform laser eye surgery? Bill would expand scope of optometrists. KSL.com. Posted February 8, 2022. https://www.ksl.com/article/50343602/should-nonmedical-doctors-perform-laser-eye-surgery-bill-would-expand-scope-of-optometrists. Accessed February 23, 2022. 
8. Fingeret M. Laser trabeculoplasty use patterns among optometrists and ophthalmologists in Oklahoma. JAMA Ophthalmol. 2016;134(10):1101-1102. doi:10.1001/jamaophthalmol.2016.2567
9. Optometrists; allowed to perform laser surgery if certified by Board of Optometry. SB 375. Updated February 21, 2022. Accessed February 22, 2022. 
10. Virginia Optometric Association. Proven success, doctors of optometry already perform in-office eye laser procedures. Virginia Optometric Association website. https://trustedeyecare.com. Accessed February 22, 2022.
11.  Virginia Optometric Association. A professor of both ophthalmology and optometry’s perspective. Virginia Optometric Association website. https://trustedeyecare.com. Accessed February 22, 2022.