To wrap up an eventful run this legislative session, Washington’s Substitute Senate Bill 5389—proposing to add various practice rights and procedures to optometry’s scope—recently passed both the Senate (46-2) and the House (81-15) with strong bipartisan support. The document landed on Governor Jay Inslee’s desk on April 21 and is expected to be signed into law within the next 20 days.  

“For the first time in two decades, the bill will update Washington’s scope of practice to more fully reflect the education and training of optometrists and move the state more in line with what is increasingly becoming the standard of care in optometry,” says Michael Sirott, OD, president of the Optometric Physicians of Washington (OPW). “It is an important step forward for our members.”

The bill has been altered rather significantly since its introduction back in January. The original version proposed that optometrists be allowed to perform laser procedures, which is included in the practice scope of 10 states and counting. But, after multiple negotiations to assuage the concerns voiced by the opposition, the current and final version of the bill excludes lasers, as well as suturing. The final document would still grant optometrists the authority to perform numerous advanced procedures and prescribe more pharmaceutical agents. Some of the expanded privileges proposed in SSB 5389 include:

• Incision and excision of chalazion
• Injections (subconjunctival, subcutaneous and intramuscular (epinephrine))
• Eyelid surgery (excluding cosmetic surgery or those requiring the use of general anesthesia)
• Use of topical and injectable anesthesia
• Prescribe oral steroids

A bill awaiting Washington Gov. Jay Inslee’s signature would authorize the state's ODs to perform several non-laser advanced procedures, such as lesion removal and injections, as well as expand prescribing authority to include oral steroids and topical or injectable anesthesia.  Click image to enlarge.

The legislation also grants authority to the Washington Board of Optometry regarding the rulemaking necessary to implement the physician training and certification outlined in the new law, which is something Dr. Sirott says the OPW pushed for throughout the session to remain on the bill. Once the document is signed, it’s expected to take the Board about two years to implement the provisions of the new law. 

So, what will optometrists have to do to perform the added procedures once SSB 5389 is signed and the Board’s rulemaking process is complete? Dr. Sirott says that the legislation “creates a licensing endorsement structure that will clearly demonstrate which optometrists are endorsed by the Board of Optometry to perform advanced procedures. It spells out specific pathways for optometrists to earn the endorsement, including completion of required training in an accredited school of optometry or through robust, accredited continuing education courses, similar to the continuing education requirements that physicians meet when they learn new procedures,” he explains.

Other training requirements outlined in the bill to perform the advanced procedures include live patient experience during clinical training, as well as successful completion of a nationally standardized examination, such as the National Board of Examiners in Optometry procedure examination. 

Speaking on the bill’s negotiated amendments, including the exclusion of laser procedures, Dr. Sirott remarks that “the road to legislation always has a few curves along the way. We accepted some compromises to align the bill more closely with the findings and recommendations of the Department of Health’s ‘sunrise review’ of the bill,” he notes. “Our opponents battled every step of the way, including proposing some ‘poison pill’ amendments with the intention of making the bill something OPW couldn’t accept. Fortunately, we were able to work with legislative leaders to get those problematic provisions removed and keep the bill something we could strongly support.”

The OPW credits the progress of the bill thus far to its numerous supporters and advocates, especially the organization’s members. “It took a lot of work to get to this point,” Dr. Sirott reiterates. “We had a core group of volunteers who put in untold hours working on the substance of the bill and coordinating our advocacy efforts. We organized a series of meetings and demonstrations with legislators from around the state in preparation for this session. As the bill moved through Olympia, we had a number of calls to action for our members to contact their legislators or sign in supporting the bill during committee hearings, and they responded.”

Dr. Sirott shares numerous arguments cited by proponents of the bill during hearings that helped communicate its safety and importance:

• The bill aligned closely with the Department of Health findings and recommendations. The Department concluded that “ODs are taught these procedures in school, are prepared to safely provide this care to patients and are already doing so in other states, including our neighbors in Oregon,” said Dr. Sirott.
• The bill would help patients receive more timely care by removing the need to wait months for an appointment with an ophthalmologist that accepts their insurance (especially Medicaid).
• A study commissioned by the OPW found that “patients most likely to benefit from expanded access to care were rural residents, the elderly and low-income families that rely on the state’s Medicaid system,” notes Dr. Sirott.
• The bill would reduce patient costs by eliminating unnecessary duplicate office visits and exams and reducing the time and expense of travel to and from appointments.

“Some of the most powerful testimony came in the form of personal stories from optometrists holding dual licensure in multiple states who could perform the procedures elsewhere but not in Washington,” Dr. Sirott points out.

Thanks to the strong advocacy efforts of the OPW and optometrists across the state, in just a few weeks, the expanded practice rights may be signed into law.

“While this was an important victory for optometry in Washington, we didn’t get everything we wanted in the bill, such as laser procedures, so we will be developing plans for when and how to reapproach the Legislature on that issue in the future,” says Dr. Sirott. 

With numerous states fighting for optometric laser authority and four that have succeeded just since 2021, evidence continues to mount on the safety and qualification of optometrists performing laser procedures. The OPW plans to gather more data and work alongside the Department of Health over the next few years to prepare for the ensuing legislative battle for laser privileges.