Snapshots of the “hands-on” optometry that continues to gain steam, as expansive new laws bring more procedures to ODs in two large states. Click image to enlarge.

Optometrists in California will no longer be hamstrung with limited prescribing and treatment authorities, thanks to a twin set of expanded scope of practice bills that were recently signed by Governor Gavin Newsom. The new law also grants ODs permanent privileges to administer COVID-19 vaccines, effective immediately.

The first bill, AB 407, revises the Optometric Practice Act to eliminate the restrictive list of allowed drugs and conditions, and instead authorizes treatment of all non-cancerous anterior segment conditions, with some limitations, according to the California Optometric Association (COA).¹ The updates will also mandate new rules for optometric and medical assistants, including a prohibition of subjective refraction done by assistants via telemedicine.¹ This bill will take effect January 1, 2022.

The other bill, AB 691, gives optometrists permanent authority to administer COVID-19 vaccines and perform clinical laboratory improvement amendment (CLIA)-waived COVID-19 testing, according to the COA.¹ Optometrists see patients more frequently than other providers, and each visit to the optometrist is an opportunity to vaccinate, the COA said in a recent press release.¹ In addition to the ongoing need for booster shots, optometry clinics can play a big role in improving public health, the COA suggests.¹

“Previously, we were under emergency use to administer the COVID-19 vaccine, but now it is part of our scope, and it’s effective immediately, so there isn’t any more tiptoeing around and asking for permission to do immunizations,” says optometrist Mark Nakano, associate dean for clinics at Southern California College of Optometry. “This is a game-changer for optometrists who have been certified to administer vaccinations, as they can be part of the frontline. If optometrists haven’t been certified yet, they can be now and should be welcomed and accepted with open arms.”

Dr. Nakano, who is part of the COA legislative team and helped negotiate the bills, says the new law clears up several points of ambiguity and some misunderstandings regarding specific optometric privileges. For example, if one went by the letter of the previous scope of practice law, ODs weren’t authorized to treat blepharitis.

“We tried to go for a broader-based bill that is closer to what is taught. Most optometrists are trained far beyond what we are able to practice, especially in California, so this is closer as far as disease processes that we can treat and medications we can use,” Dr. Nakano explains.

The previous law, which Dr. Nakano describes as being very “prescriptive,” only allowed ODs to treat limited types of inflammation in individuals over 18 and prescribe a small amount of antiviral medications.

“Now we can treat almost every type of viral infection a patient may be experiencing, and we’re not limited to certain medications, so this really opens up the door for optometrists,” Dr. Nakano says.

The new scope law will also allow ODs to perform tests for systemic conditions not limited to the eye that may be related to an ocular problem, he adds.

“It’s important that ODs in California can now order any tests, imaging or cultures, as we were restricted before,” Dr. Nakano says.

Specifically, the new scope expansion law includes the following:²

• Eliminates the lists of allowed drugs and conditions in statute, and instead authorizes treatment of all non-cancerous anterior segment conditions, with some limitations, as well as all kinds of inflammation in adults and some in children.

• Permits the use of antivirals and antifungals and eliminates a referral requirement for anti-allergy agents.

• Allows ODs to order more medical tests, including CLIA-waived testing for systemic conditions and COVID-19 testing.

• Permits optometrists the use of a scalpel to remove foreign bodies, as well as intense pulsed light and low-level light therapy.

The new law also outlines rules for medical and optometric assistants performing subjective refractions, requiring direct and on-site supervision and 45 hours of documented training, and precludes their ability to write prescriptions.²

The COA also advocated for two other bills that were signed into law earlier this year.¹ AB 1534 prohibits retail optical companies from interfering in an optometrist’s professional judgement, and SB 509 allows optometry school graduates to temporarily practice under supervision if they are unable to take Part III of the NBEO due to COVID-19.¹

NY ODs Gain Oral Med Rx Rights

On the heels of California’s news, the state of New York recently passed an expanded scope of practice bill that will allow its ODs to prescribe a formulary of oral therapeutic pharmaceutical agents for the treatment of eye diseases. The bill, S. 1519 / A. 1921, was passed on October 25.

New York optometrists have had the ability to use diagnostic topical drugs since the mid-1980s and therapeutic topical drugs since the mid-1990s. However, they were unable to prescribe oral medications for the treatment of eye disease until now, explains Thomas J. Coté, MBA, CAE, executive director of the New York State Optometric Association (NYSOA).

Specifically, the new law permits optometrists to use oral therapeutic pharmaceutical agents, including antibiotics, antivirals and antiglaucoma agents, according to the American Optometric Association (AOA). Additionally, ODs need to be certified to prescribe oral medications for the treatment of glaucoma and ocular hypertension and must complete an oral therapeutic drug certification course and an exam unless they graduated from an accredited college of optometry and passed board examinations after the law takes effect on January 1, 2023, the AOA says.

The bill’s passage is significant for many reasons, the NYSOA suggests, including improved patient care and enhanced access to health care, especially since New York ODs are the primary eye care providers in much of the state, especially in rural and low-income urban areas.

Additionally, ODs are highly qualified caregivers, with robust training and experience, and the new law mirrors the oral med prescribing privileges that are available to ODs in almost every other state, the NYSOA cites.

With its new bill, New York now joins 48 other states and the District of Columbia in permitting their optometrists to prescribe oral medications, according to the NYSOA. A total of 32 states granted oral prescription authority to ODs more than a decade ago, and North Carolina adopted its statue in 1977. Massachusetts remains the only state that doesn’t grant ODs this oral med prescribing right, according to the NYSOA.

Also of note: ODs in other states that have granted prescribing privileges haven’t experienced an increase in malpractice or professional misconduct based on oral authority, nor has any state ever repealed the authorization or limited the right of ODs to prescribe oral medications, the NYSOA says.

Additionally, at least 18 states allow ODs to prescribe oral medications without restrictions of any kind, the NYSOA explains.

1. California Optometric Association sponsored legislation signed into law. California Optometric Association. Press Release. October 8, 2021. 2. California amends optometry’s approved treatments, medications and testing. American Optometric Association. October 13, 2021. www.aoa.org/news/advocacy/state-advocacy/california-amends-optometrys-approved-treatments-medications-and-testing?sso=y. Accessed October 19, 2021.