It’s only a quarter of the way through the year and numerous states have already introduced legislation to expand practice privileges for their optometrists. While some states have more positive progress to report than others, lessons can still be drawn from the losses that may help in fighting future scope battles. Here’s an update on a few states with bills in play.

A bill expected to be heard by Washington’s House in the coming weeks would authorize ODs in the state to perform lesion removal, administer injections around the eye and prescribe oral steroids.  Click image to enlarge.

Washington

One scope expansion bill working its way to the House floor is Washington Senate Bill 5389, which passed the state’s Senate on March 6th. As it stands, the legislation proposes that authority be granted to ODs with the proper training to remove lumps and bumps from the eyelid, administer injections around the eye and prescribe oral steroids. The bill also states that it would allow the Washington Board of Optometry to decide on the education and training requirements needed to permit optometrists to perform the added procedures.

While the original bill also included in-office laser procedures such as YAG capsulotomy and SLT, the therapeutic use of lasers has since been removed from the proposed legislation as part of a negotiation. 

During the bill’s second executive session with the House Committee on Health Care and Wellness on March 29th, several amendments to the document were discussed. The hearing concluded with a majority vote by the committee to pass the bill with the amendments, the specifics of which cannot be reported on at this time.

“Making sure that optometrists and other eyecare providers have the ability to provide the care necessary is key, and this bill delivers that,” remarked Washington State Representative Monica Jurade Steiner during the recent hearing.

Michael Sirott, OD, president of the Optometric Physicians of Washington, reports that because of the amendments, the state’s Senate will have to vote on the bill a second time. SB 5389 will expectedly head next to the House Rules Committee and then will be heard by the House within a few weeks.

South Dakota

On the final day of February, South Dakota’s House Health and Human Services Committee voted to defer the state’s laser bill, SB 87, to the 41st legislative day with a 7-6 vote, ending the bill’s run in this legislative session. The bill had proposed that optometrists in the state be permitted to perform several procedures included in their education and training, such as certain injections, chalazion and lid lesion removal, foreign body removal, YAG capsulotomy, peripheral iridotomy, SLT and corneal crosslinking. The legislation would have also expanded pharmaceutical privileges and authorized the state’s ODs to use local anesthesia.

In addition to citing differences in training for ODs vs. MDs, a few members of the opposition also testified during the hearing that there isn’t a need for the bill at this time, claiming that there are enough ophthalmologists across South Dakota to perform the proposed procedures. Several optometrists and advocates took the stand to explain why they believed otherwise.

“There are full-time optometrists in 38 of our 66 counties,” said Representative Rocky Blare of the South Dakota legislature. “Ophthalmologists are in limited areas of the state, and in some areas, only provide their services one day a month.”

Population aging is another threat to eyecare access cited repeatedly by proponents of the bill. “The limited laser procedures allowed by SB 87 are key treatment options for managing glaucoma and addressing post-surgery secondary cataracts,” explained Craig Dockter, OD, who has been practicing in Mobridge, SD, since 1992. “Glaucoma and cataracts are eye diseases that are associated with aging. The number of patients over the age of 65 in the nation is estimated to increase by 42% by 2030 and will increase to 83% by 2050. The number of ophthalmologists has remained stable since 1990, and over 50% of current ophthalmologists are over 50 years old,” said Dr. Dockter. “These numbers indicate that as our population ages, there will be a greater need for access to these procedures across the state.”

The last change to optometry’s scope of practice in South Dakota happened nearly 30 years ago, highlighting the need for a bill like SB 87 to soon be passed—hopefully in 2024—to better align the language of the law with the current skills and training of optometrists.

Idaho

Optometrists and advocates in Idaho also recently hit a roadblock in their efforts to pass scope expansion legislation. SB 1052, introduced on February 7th to the Senate Health and Welfare committee, had proposed that optometrists in the state who received the proper training in university be authorized to perform three distinct laser procedures: YAG capsulotomy, peripheral iridotomy and SLT. The bill had strong support in the Senate, passing the Health and Welfare Committee 6-1 and the Senate floor 23-11. However, following the document’s first reading in the House on March 13th, the bill was referred to the Ways and Means Committee, effectively—and unfortunately—killing it for this legislative session.

Opposers of the bill—which includes the American Medical Association—argued that optometrists, unlike ophthalmologists, aren’t equipped with the proper skills and training to perform the surgical procedures being proposed, despite factual evidence that suggests otherwise. In 10 other states, for example, ODs are safely and effectively using lasers to treat glaucoma and cataract patients. Since Oklahoma became the first state to authorize the therapeutic use of lasers by optometrists 25 years ago, more than 100,000 of these procedures have been performed by ODs without an increase in any disciplinary actions against these doctors.

To further address these safety concerns, SB 1052 had also stipulated that to take advantage of the new laser privileges, licensed optometrists in Idaho must have completed training on laser capsulotomy, LPI and SLT as part of their optometry schooling, as well as have passed the national board of examiners in optometry laser examination.

“The public needs to be educated on how many hours of schooling optometrists have focused just on the eye,” notes Lisa White, executive director of the Idaho Optometric Physicians (IOP), whose staff and members have been working tirelessly to advocate for the bill.

The last legal—and ultimately unsuccessful—endeavor to expand the optometric practice scope in Idaho occurred in 2020. The former bill had a wider focus than SB 1052, proposing various changes to the language used to define the practice of optometry in Idaho, which hasn’t seen an update since the 1970s. “A lot of the terminology was outdated, so we were trying to update the language to better represent the current times, as well as include some of the laser surgeries in the scope,” says Mrs. White about the 2020 bill.

Given the experienced difficulty of pushing too many language modifications at once, Mrs. White says that in this year’s bill, the proposed changes to the practice scope were intentionally much more straightforward. “We just added in one line: ‘The practice of optometry does not include laser procedures, except laser capsulotomy, peripheral iridotomy and laser trabeculoplasty,’” she explains.

Despite last month’s setback, the IOP and other scope expansion advocates in Idaho are not yielding in their efforts to push the legislation forward, Mrs. White assures. “Optometry and ophthalmology will be meeting with the Speaker of the House over the next year to try and come to an agreement on the education and training aspects of the bill,” she says. By educating the public and lawmakers on the safety and necessity of the bill, the IOP feels optimistic that it may be reintroduced in the next legislative session.