Washington D.C. is one of four areas in the country where optometrists are not permitted to prescribe controlled substances to treat conditions of the eye and adnexa. Photo: Getty Images.

In October 2023, Washington D.C. introduced Council Bill 25-0545, which proposed an update to the District of Columbia Health Occupations Revision Act of 1985 intended to modernize the practice scope of numerous allied health professionals in the jurisdiction, including optometrists, podiatrists and pharmacists. The original document stated that if the proposed changes were granted, “the scope of optometry will authorize optometrists to prescribe controlled substances which are rational to the diagnosis and treatment of diseases of the human eye and its adjacent structures,” which also would have given ODs in D.C. the right to diagnose and treat glaucoma.

After several months of litigation, the bill was handed off to D.C. Mayor Muriel Bowser, who approved the new legislation earlier this month. However, unfortunately for optometry the language cited above that would have authorized ODs in D.C. to prescribe controlled substances was stripped during amendments and excluded from the enacted document.

“This decision was influenced by a range of factors, including expert testimonies, research findings and concerns regarding patient safety and public health,” stated the recent report from the D.C. Committee on Health. “The Committee received live or written testimony from over 20 public witnesses, primarily ophthalmologists, strongly opposing the expanded scope of practice for optometrists,” it continued. One point of contention raised by the opposing side, the Committee explained, “was the disparity in training and education between optometrists and ophthalmologists,” an argument that organized medicine banks on time and time again in similar scope battles across the nation. 

Opponents of the bill also expressed concern regarding the inclusion of controlled substance pain medication in non-surgical cases (arguing that OTC drugs are sufficient) as well as the removal of the requirement for ODs to consult an ophthalmologist before initiating glaucoma treatment. In addition, OMDs testified that access to board-certified ophthalmologists is readily available within even the most underserved areas in D.C., implying that giving ODs these additional privileges would have a negligible effect on patient access to timely care.

A plethora of evidence threatens the strength of this case against ODs. Washington D.C. is one of the few remaining areas in the country where optometrists are prohibited from prescribing controlled substances, accompanied only by Hawaii, Maryland and New York. In the remaining 47 states, optometrists have consistently exemplified the safety and necessity of these expanded pharmaceutical privileges for their patients.

“The Committee received written testimony from numerous optometrists as well as a letter from the Association of Regulatory Boards of Optometry citing the necessity for optometrists to prescribe pain medication and advocating for the removal of consultation requirements before treating chronic open-angle glaucoma,” the Committee wrote in its report. “D.C. Health referenced similar actions in other states without reported issues.”

A spokesperson for the D.C. Department of Health also told Review of Optometry that the proposed bill failed to flesh out guidelines regarding telehealth, such as licensing requirements for out-of-state practitioners delivering virtual care to patients in D.C. In the coming months, the D.C. Board of Optometry will work on developing these policies and rules in preparation for the next legal endeavor to expand the practice scope for D.C. optometrists.

Remaining Active Scope Battles

Despite starting the year with more than a dozen pieces of legislation advocating increased practice privileges for optometrists, just two remain on the docket for 2024.

Ohio’s scope expansion bill, Senate Bill 129, has been moving at a slow but steady pace since its introduction last June. The legislation, currently residing in the state’s Senate Health Committee, aims to add the state’s name to the current list of 12 where optometrists can perform laser procedures, including YAG capsulotomy, SLT and LPI. Additionally, it would give ODs in Ohio the authority to remove benign lesions, cysts and skin tags, broaden pharmaceutical privileges and permit epinephrine injections. The legislation also advocates increasing the authority of the Vision Professionals Board to establish training guidelines.

The Ohio Senate Health Committee heard proponent testimony in late April, followed by opponent testimony earlier this month. The state’s legislature is now in summer recess, meaning there won’t be any new updates on the bill until autumn.

Like Ohio, New Jersey’s legislature also recently entered its summer recess. This state has two identical laser bills in the running—A-920 and S-354—proposing many of the same privileges as the bill in Ohio, including YAG capsulotomy, SLT, LPI, removal of styes and skin tags as well as an expansion of vaccine and prescription authority. Once the legislative session resumes in the fall, the New Jersey Society of Optometric Physicians is hopeful that the bills will continue moving forward in their respective committees. As of now, A-920 is on second reading in the Assembly Regulated Professions Committee, while S-354 rests in the hands of the Senate Commerce Committee.