Most states with scope expansion legislation in play in 2024 are pushing optometric laser privileges, which will help improve patient access to these necessary procedures for glaucoma and post-cataract surgery care. Click image to enlarge.

We’re not even a full month into 2024, and a lot has happened regarding scope expansion efforts across the US. At least 10 states, as well as Washington D.C., have already introduced or plan to introduce legislation this year advocating for various optometric privileges. Last week, one contender—California—had its laser bill prematurely kicked to the curb, though the state’s optometric association wasted no time in regrouping that same evening to begin charting the next steps.

Several states are still working out the details and language of their scope bills, but at least eight plan to pursue optometric laser privileges. With California out of the running, the remaining seven states with active laser legislation for 2024 include Alabama, Nebraska, New Jersey, Ohio, West Virginia, Utah, Vermont and likely others. Here’s where things stand with some of the bills that have been introduced so far this year.

West Virginia

Coming back from an unsuccessful run last year, optometrists and their advocates in West Virginia have reintroduced their laser bill, HB 4783, which proposes the modernization of the practice scope to encompass all procedures taught in optometry schools today. This includes minor and surgical procedures such as lesion removal, capsulotomy, SLT and LPI. The language of the bill has not changed since its introduction last session.

In positive news, HB 4783 passed the House Health Committee yesterday and will have a second reading today.

Nebraska

This state first introduced LB 216 into the Legislature last year proposing to allow Nebraska optometrists to perform selective laser trabeculoplasty (SLT), a procedure increasingly being recognized as a first-line option to treat glaucoma. The bill will continue into this year’s session, but so far, there hasn’t been any movement; it currently remains under consideration by the Health and Human Services Committee, where a vote has been pending since the hearing last January. While awaiting the verdict, the Nebraska Optometric Association will be continuing its advocacy efforts with Committee members to vote the bill out of Committee during the 2024 legislative session.

Vermont

For the first time since the state’s scope battle loss in 2020, Vermont has introduced a laser bill pursuing the right to perform in-office procedures including certain injections, removal of benign lid lesions, CXL, YAG capsulotomy, SLT and laser peripheral iridotomy (LPI). This year, the bill is backed by the support of the Office of Professional Regulation, which recently recommended the expansion of optometry’s scope to include the above procedures. This position represents a complete 180° from the Regulation’s stance in 2020 when it rejected the same proposal due to insufficient evidence on optometric training and education protocols across states, which has since been reinvestigated.

The bill, S.233, currently awaits a hearing in the state’s Senate Healthcare Committee, which is expected to take place soon.

New Jersey

Last May, New Jersey introduced two identical laser bills, both of which were reintroduced this month (under new bill numbers, now A-920 and S-354) to play out in the state’s 2024 legislative session. The language of the bill has not changed since its introduction and proposes to allow New Jersey ODs to perform three laser procedures—SLT, capsulotomy and LPI—as well as remove styes and skin tags. It also calls for an expansion of vaccine and prescription authority to improve access to needed care for state residents.

“By expanding the scope of practice, optometrists can provide critical eye care when and where it’s needed most and ensure all New Jersey residents have timely access to vision and medical eye care,” says Keira Boertzel-Smith, executive director of the New Jersey Society of Optometric Physicians. “It also lowers costs by eliminating duplication of services and extra co-pays for redundant office visits and reduces patient travel time and missed hours at work,” she adds.

Hearings for both bills will hopefully be scheduled soon. The NJSOP encourages those who wish to learn more about the initiative and its importance to visit njtrustedeyecare.com.

Ohio

For the first time in over 15 years, optometrists in Ohio are gearing up to pass a laser bill in 2024. The legislation—SB 129, which was first introduced to the Senate Health Committee last June before the summer recess—proposes to allow ODs in the state to remove benign lesions, cysts and skin tags, as well as perform three laser procedures: capsulotomy, SLT and LPI. Additionally, the bill also pursues an update to optometrists’ pharmaceutical regulations that would permit the treatment of any eye condition and the use of epinephrine injection for anaphylactic shock. SB 129 would also give authority to the Vision Professionals Board to establish training and infection control standards.

While we await the preliminary scheduling of hearings for the laser bill, other positive news relating to eyecare access in Ohio comes from the 2024 state budget, which will grant $2.5 million to the Ohio Optometric Foundation to expand its in-school eye exam program (iSee) and help further its collaboration with other entities providing pediatric eye care across the state. The immediate past president of the Ohio Optometric Association, Shane Foster, OD, recently took on a new role as president of the Ohio Optometric Foundation and looks forward to witnessing the impact that this project—known as Ohio’s Children’s Vision Initiative—will have on children and families across the state.

Utah

Two years ago, Utah pursued laser legislation that passed the House but unfortunately didn’t make it out of the Senate. Now, scope expansion efforts in the state are again ramping up thanks to a critical report released earlier this month by the newly formed Office of Professional Licensure Review (OPLR). Weston Barney, OD, legislative chair of the Utah Optometric Association (UOA), explains that the OPLR’s report contains a favorable recommendation for optometrists to perform YAG capsulotomy and SLT.

“We have great support in the House, where the bill passed two years ago, and have been actively lobbying the Senate to get it done this year,” says Dr. Barney. He reports that the bill is currently in legislative research and will be assigned a bill number in the next few weeks.

While the UOA works tirelessly over the next few months to see this bill through, Dr. Barney points out that one troublesome piece of legislation—HB 189—will make this an especially busy year for optometrists and advocates in Utah.

“The UOA has been closely monitoring Rep. Jordan Teuscher's HB 189 Contact Lens Purchasing Amendments bill since its introduction three years ago,” the Association wrote in a recent press release. Essentially, this bill would prohibit prescribing doctors from selling contact lenses to their patients, encroaching upon the doctor-patient relationship. The current language of this bill also “mandates by law that a contact lens prescriber MUST write a prescription for any and all contact lenses requested by the patient, completely disregarding the doctor's expertise and medical advice,” the UOA explained.

In addition to the state’s ongoing battle to defeat HB 189, which will be competing with the laser bill for the focus of defensive efforts this year, Dr. Barney also shared that the American Optometric Association FPI Committee has continually denied the state’s funding requests, which he says is disappointing “especially when the majority of state associations attempting scope expansion have been granted financial assistance.” Nonetheless, Dr. Barney is confident that “Utah optometrists are undeterred and will pass our scope bill through our own efforts, merits and support.”

As these various efforts for scope expansion unfold across states, optometrists should remember to support and reach out to your respective state’s optometric association to learn how you can help fight the good fight for your profession and the well-being of your patients.