This month’s cover story lays out in detail the status of optometric scope expansion in the US, highlighting the many gains earned in recent years and the vigorous efforts presently underway in at least a dozen states. There’s a lot to be excited about right now. But if you’ll load that page and look at the chart detailing the range of optometric scope state by state, you’ll see a dizzying amount of variation.

In researching the legal status of 10 different advanced responsibilities—laser procedures, oral meds, injections, minor surgeries and the like—we found that not a single category has been uniformly rolled out yet in the US. Instead, all 50 states plus the District of Columbia each present to their communities a slightly (sometimes radically) different conception of optometry than their neighbors. It’s confusing, frustrating and just plain exhausting.

It’s also here to stay. The prospects for enacting a nationwide optometry law, settling once and for all the legal status of the profession uniformly, are dim. Any effort of that sort would need the vigorous support of numerous optometric institutions that may not have the time or resources to put in the work on such a Herculean task. So, we’re left with the image of optometry as the biggest Baskin Robbins freezer case you could ever imagine.

This certainly doesn’t help optometry integrate into the broader healthcare delivery system. When the capabilities of practitioners diverge so widely across state lines, it makes it easier for insurers, policymakers and doctors from other corners of healthcare to just wash their hands of it and favor ophthalmology, the known quantity in eye care.

But there are a few encouraging developments that might ease the path to legal parity for optometrists across states.

First, if optometry’s advocates are able to craft “as-taught” legislation, which allows practitioners to perform any procedure they trained on, it will cut down on the number of scope bills and battles. It recently came to light that ODs in Wisconsin have been quietly—and successfully—performing a variety of advanced procedures under such a philosophy instead of formally seeking legal action on every specific new responsibility (see news story). Naturally, opponents are already crying foul. If the Wisconsin model survives challenges from ophthalmology, it can be emulated elsewhere.

Second, the case being made for scope expansion is evolving. The long-standing argument that it would expand access to care in rural areas does still have merit, of course, but we’re approaching a time when we’ll no longer need that crutch. California got a laser bill to the one-yard line in 2022 and New Jersey, the most densely populated US state, has one in session now. Everyone benefits from optometric scope expansion (psst, including ophthalmologists, if they could ever abandon their blinkered view of things). 

Third, a rising tide lifts all boats. Every successful expansion bill makes the next one that much easier to pass, as advocates have more precedents to point to.

Lastly, of course, surging demand for eye care and a declining supply of ophthalmologists pretty much make it a foregone conclusion. Whether it’ll take years or decades, the endgame of scope expansion is obvious.

Until then, enjoy your time in the ice cream parlor. I hear Pralines & Cream is nice.