At the start of 2024, a record number of states—more than a dozen—were advocating for the expansion of their optometric scope, 10 of which were proposing the use of optometric lasers. We’re nearly halfway through the year and just three bills remain in pursuit in New Jersey, Ohio and Washington D.C.

So far this year, the only state to witness the passage of its scope bill has been South Dakota, which brought the tally of optometric laser states up to 12. Under the new law, which was enacted in March and goes into effect on July 1, optometrists in the state with the proper certifications will be permitted to perform SLT, YAG capsulotomy, certain injections and intense pulsed light.

Several other states pursuing scope expansion this year were met with a less favorable outcome. California, Utah, Kansas, West Virginia, Vermont, Nebraska, Minnesota, Missouri and, most recently, New Hampshire, all had their scope bills voted against or postponed since January. Additionally, a laser bill in Alabama failed to make it out of negotiations in time to play out in this year’s legislative session.

Wins and losses aside, let’s take a look at where things stand with the three active scope battles that remain.

Optometrists across the country continue to advocate for the right to practice to the full extent of their education by bringing in numerous advanced procedures. The always contentious issue has seen its share of both wins and losses this year. Click image to enlarge.

New Jersey

Last year, this state introduced two identical laser bills (A-920 and S-354) proposing three laser procedures—SLT, capsulotomy and LPI—as well as the removal of styes and skin tags and an expansion of vaccine and prescription authority. The legislation’s progress has since been slow but steady; most recently, on March 14, the Assembly Regulated Professions Committee voted unanimously to release A-920 with only minor amendments.

“The bill language was tightened up so the New Jersey State Board of Optometrists has less authority to identify procedures that are not specified in the bill,” explains Keira Boertzel-Smith, Executive Director of the New Jersey Society of Optometric Physicians. The Assembly bill is now on second reading in the Committee.

Meanwhile, S-354 is still pending in the Senate Commerce Committee. Feeling optimistic, Ms. Smith comments, “We are continuing to build support for the bill and hope the bill will receive further action later in the spring.”

Ohio

Looking to update their 17-year-old scope bill, optometrists and advocates in this state introduced Senate Bill 129 last June, which proposes to allow Ohio ODs to remove benign lesions, cysts and skin tags, as well as use lasers for YAG capsulotomy, SLT and LPI. It also seeks to broaden ODs’ pharmaceutical authority and permit epinephrine injections. Additionally, the bill advocates increasing the authority of the Vision Professionals Board to establish training guidelines.

SB 129 hasn’t seen much movement in the past year since its introduction. It currently resides in the state’s Senate Health Committee, which heard the proponent testimony last month on April 24. Opponent testimony will follow, though no date has been scheduled at this time.

D.C.

It’s been 25 years since this jurisdiction last updated its optometric scope of practice, but that could change as soon as next week. On June 3, the mayor of D.C., Muriel Bowser, is due to respond to Bill 25-0545, which seeks to update the practice scope for numerous allied health professionals, including optometrists.

If passed, the bill would allow ODs in D.C. to prescribe and administer controlled substances for ocular conditions—a right that’s been granted to optometrists nearly everywhere else in the country, with the exception of Hawaii, Maryland and New York.

The Ones that Got Away

The constraint of time prevented several states’ scope bills from moving further along this year, though it’s likely most will be reintroduced in the next legislative session. Here’s what went down in a few states whose scope bills were recently put on pause.

New Hampshire. Introduced at the start of the year, Senate Bill 400 proposed to authorize ODs in New Hampshire to perform YAG capsulotomy, SLT and other minor surgical procedures that fall within the profession’s education. The legislation also intended to increase the authority of the state’s optometry board, which would allow it to have “more ability to approve certain things as new training and technology comes along without having to go back for legislation every time,” explains Angelique Sawyer, OD, of the New Hampshire Optometric Association.

The state’s Senate passed SB 400 in early February, and on May 13 the New Hampshire House Executive Departments and Administration Committee passed the legislation with a vote of 14-6. That same day, the House recommended the bill be referred for interim study to gather more data on the safety and necessity of the proposed law before it would be heard by the full chamber.

Unfortunately, in order to allow time for the interim study, the New Hampshire House voted to table the bill on May 23; essentially, this means that the legislation may be considered at a later date.

Missouri. This state had two identical laser bills in the running this year–SB 956 and HB 1963–both of which gained a favorable vote in their respective committees in late April. Unfortunately, the bills didn’t have a chance to be voted on by their full chambers before the state’s legislative session adjourned earlier this month. Hopefully, optometrists and their advocates in Missouri will be able to pick up where they left off next January with their efforts to update the state’s practice scope and add its name to the growing list that allow optometrists to perform laser procedures.

Nebraska. Last year, Nebraska introduced LB 216, legislation proposing to add a single laser procedure—SLT—to optometrists’ legal practice scope. The bill was heard by the Health and Human Services Committee last January and carried over into this year’s legislative session. Unfortunately, the document didn’t make it out of the Committee before the session adjourned last month. At the time of this writing, the Nebraska Optometric Association (NOA) says it cannot yet report on the bill’s future endeavors.

Looking ahead, the NOA is redirecting its focus on helping to enhance the state’s Credentialing Review Program, which may require statutory changes (requiring legislation), as well as regulatory and administrative process changes and could have implications for optometrists’ scope of practice in the state. The process will involve the Nebraska Department of Health and Human Services, the Nebraska Board of Health and allied health organizations. Filed in the state’s Health and Human Services Committee as Legislative Resolution 397, the document describes that its purpose is “to examine the structure and processes of the credentialing review process known as the ‘407 process.’ The 407 process reviews a health profession's proposal for licensure or change in scope of practice. This study shall include, but not be limited to, a review of: (1) the scope of practice criteria; (2) the role of the technical review committee; (3) application requirements; (4) funding mechanisms; and (5) the coverage of health professions.”

The Nebraska Board of Health appointed a subcommittee to develop recommendations for the Program, and an interim study is underway now. Keep an eye on our News Feed for updates.

Minnesota. While not pursuing laser authority for its ODs, Minnesota introduced several scope bills last year proposing to allow optometrists there to administer drugs by injection around the eyelid and prescribe oral carbonic anhydrase inhibitors, oral antiviral medication and oral steroids. Additionally, the legislation proposes allowing the state’s Board of Optometry to establish the scope of practice guidelines.

The state wrapped up the 2024 legislative session earlier this month without granting a final verdict on any of the proposed bills, though hopefully they’ll be considered again next year.

Vermont. This state’s laser bill (S.233) spent the duration of the 2024 legislative session awaiting a hearing in the state’s Senate Healthcare Committee that, similar to in Missouri and Nebraska, didn’t have a chance to occur before the session adjourned earlier this month. The Vermont Optometric Association is currently mapping out its next steps to try and push the legislation further along in 2025.

Alabama. Following an unsuccessful pursuit of laser authority in 2023, the Alabama Optometric Association and fellow scope expansion advocates in the state have been working alongside legislators to introduce a similar bill. For the entirety of this year’s legislative session, which wrapped up on May 7, Alabama’s laser bill remained in negotiations, a process that will continue in the 2025 legislative session.

Howard Day, OD, president of the Alabama Optometric Association, is hopeful that by next January, they will be able to reach a compromise with organized medicine and ophthalmology, who aggressively pushed back against the bill during its last legal run.