Optometry’s role in eyecare is constantly evolving, most notably in the United States but a growing number of regions around the world are also embracing the profession’s use of lasers and other advanced procedures, such as injections and lesion removal. The United Kingdom and New Zealand have both granted ODs these practice privileges, as have 12 US states. Some optometrists, such as those in Oklahoma, have practiced under an expanded scope for more than three decades; yet, limited data exists on the frequency and outcomes of OD-performed procedures and misinformation abounds when the topic is discussed by opponents of scope expansion.

The incredibly low rate of negative outcomes from optometric lasers reported in this study validates the argument that US optometrists possess the proper skills and education to competently and safely perform these procedures. Click image to enlarge.

To provide objective data, a group of researchers from the US and Australia recently assessed the delivery of post-graduate education on advanced optometric skills and evaluated the safety of laser procedures performed by optometrists by analyzing the rate of complications in regions with an expanded practice scope.

Post-graduate programs and requirements for advanced procedures vary widely from state to state, explains Nate Lighthizer, OD, a prominent leader in optometric laser education and lead author of the present study. While states such as Oklahoma and Louisiana require only the completion of a 32-hour course, others oblige ODs to perform several proctored procedures to gain certification, South Dakota being one example.

Despite these regional differences in training, this study found the number of complications reported from OD-performed procedures to be next to none across the board. The table below summarizes the number of laser procedures performed and negative outcomes reported across different time periods in 10 US states where optometrists practice under an expanded scope. Data was obtained from various reputable sources, according to the paper, published recently in Clinical and Experimental Optometry.

“The outcomes of over 146,403 laser procedures performed by optometrists across the US have shown only two negative outcomes, equating to 0.001%,” the researchers reported in their paper on the study. “These metrics outline the effectiveness of these procedures performed by optometrists and show strong support for future optometric scope expansion,” they added.

It's important to note that this number isn't reflective of the total quantity of laser procedures ODs have performed in the US since Oklahoma passed the first laser law in 1988. For example, that state stopped requiring the reporting of procedures after 1998 but has maintained a volume of at least 5,000 procedures per year ever since, Dr. Lighthizer estimates. "And I think that would be a conservative estimate, since we are doing way more laser procedures in the past 10 years (2014-2024) than we did back in 1988-1998,” he points out. 

Dr. Lighthizer comments that while those who oppose scope expansion often lean on the argument that optometrists are inadequately trained to use lasers and perform minor surgery, this simply isn’t true. “Optometrists don’t just get a 32-hour course on performing advanced procedures,” he explains. “They spent four years in optometry school and are already trained at numerous procedures like eyelid lesions, foreign body removal, punctal plugs and gonioscopy—the essential skill for performing a selective laser trabeculoplasty. Optometrists have already built a tremendous foundation of education, and this is just adding the last piece,” he explains.

Dr. Lighthizer draws a parallel to ophthalmologists, making the point that those who “graduated in 1980 or 1990 can do LASIK even though it came about after that, and the same goes for intravitreal injections,” given that the required post-graduate training has been completed. In other words, “they built upon their foundation and added a new skill, and optometrists are doing the same thing,” he argues.

This study represents the first published data—spanning multiple decades and numerous states—highlighting the competency and safety of ODs performing advanced procedures. “I envision this will be used in nearly every state [scope expansion battle] going forward,” Dr. Lighthizer says. “This report shows people the trend happening in optometry schools, the training that happens post-graduation, the states that are doing this and, finally, the outcomes and their metrics, which show a very, very strong track record.”