Optometrists and their advocates in South Dakota, Nebraska and Washington are all currently fighting to pass scope expansion bills that would allow ODs to perform certain advanced ocular procedures, including SLT (pictured here). Photo: Nate Lighthizer, OD. Click image to enlarge.

Things are heating up in several scope expansion battles. On January 26th, Nebraska’s scope expansion bill, LB 216, was heard by the Health and Human Services Committee and currently awaits the committee’s vote. The bill would allow trained optometrists to perform selective laser trabeculoplasty (SLT) for the treatment of glaucoma. What’s even more exciting is that Nebraska isn’t the only state where legislative efforts for scope expansion are underway. Two other states are advancing even more expansive legislation.

The prospect of expanded practice rights also draws nearer for optometrists in South Dakota following the state Senate’s 26-9 vote in favor of SB 87 last week. The bill, introduced last month by Senator Sydney Davis, proposes an update to optometry’s practice scope in the state that would include various in-office procedures being taught in optometry schools today. This includes several forms of laser surgery, such as capsulotomy, peripheral iridotomy, SLT and corneal crosslinking. The legislation would also allow ODs in South Dakota to administer injections around the eye, remove chalazia and lid lesions, use a local anesthetic for lesion removal, remove superficial foreign bodies from the eye and prescribe pharmaceutical agents.

According to the bill text, if SB 87 is voted into law, optometrists in South Dakota will have to apply for authorization from the state’s Board of Optometry before performing the procedures outlined. This authority will be granted by the Board if the optometrist fulfills one of two requirements:

(1) received a passing score on the laser and surgical procedures examination offered by the National Board of Examiners in Optometry or

(2) satisfactorily completed a training session approved by the board and proctored by an optometrist or an ophthalmologist authorized to perform the procedure in any state.

Now that SB 87 has passed the Senate, the bill has been referred to the South Dakota House Health and Human Services where it awaits review.

Another state where advocates are pushing scope expansion legislation is Washington, where such laws for optometry haven’t been updated since 2003. The proposed bill, substitute SB 5389, would allow ODs with the proper training to remove lumps and bumps from the eyelids, prescribe oral steroids, administer injections around the eye and perform in-office laser procedures such as YAG capsulotomy and SLT. It would also give authority to the state’s Board of Optometry to engage in rulemaking regarding the education and testing requirements that optometrists would have to meet to perform these procedures, as well as to determine whether new technologies designed to replace these procedures and treat the same conditions are allowed.

One organization actively advocating for the bill is the Optometric Physicians of Washington (OPW). “We have worked hard to develop a solid proposal and build awareness among lawmakers,” said OPW president Michael Sirott, who practices in Omak, WA. “It’s a disservice to my patients to have to refer them to other providers located hours away for care that I am trained to provide. Our message is very patient-centric, emphasizing the lower costs and improved access to timely care that will result from an expansion of our scope.”

Given that inadequate training is a common argument from the opposition, it’s important that advocates of scope expansion take the time to educate legislators—in addition to patients and the community—about the safety of optometrists performing these advanced procedures. Dr. Sirott said that in the months leading up to the January start of the legislative session, OPW did just that. During that time, “OPW members held approximately 20 local events with small groups of legislators at which they discussed the benefits of the proposed legislation and performed demonstrations of the proposed laser procedures.”

The Washington State Department of Health recently reviewed the proposal and determined that today’s schools of optometry are teaching the procedures outlined in the bill. Additionally, Dr. Sirott added that the department “acknowledged that optometrists in other states are already safely performing these procedures with patient outcomes that align with those of ophthalmology.”

If SB 5389 becomes law, it will help improve eyecare access for communities across the state. A study commissioned by OPW confirmed that patients in Washington who would benefit most from an increase in optometry's scope of practice are more likely to be low income, of color and rurally located, Dr. Sirott pointed out.

The legislation is being opposed by the Washington Academy of Eye Physicians and Surgeons, who argue the difference in education and training standards for optometrists vs. ophthalmologists.

Washington’s legislative session runs through late April. The bill received a hearing January 31 with the Senate Health & Long Term Care Committee and awaits a full vote of the committee. If approved, it would head to the House Rules Committee before reaching the Senate floor for a vote.