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Learn more about expanding the scope of optometry in Vermont
S.64, introduced this week, has been moved from the Senate committee on Health and Welfare to the Senate committee on Government Operations. Testimony will begin next week.
A companion bill, H.241, will be introduced in the Vermont House on Feb. 18, 2025.
Frequently Asked Questions
What procedures would optometrists perform under an expanded scope, and are they safe to perform in the office?
With an expanded scope, optometrists would be able to offer laser surgery for post-cataract haze, prevention of glaucoma, and early glaucoma treatment.
They would also be able to remove small lid lumps and bumps by drainage or excision, give therapeutic injections for local anesthesia to treat anaphylactic shock, and treat keratoconus with corneal cross-linking.
Although no surgery is simple, these straightforward procedures are completely safe to be performed in the office, as they are in most ophthalmology practices. These procedures do not require general anesthesia or sedation, are typically several minutes in duration and are well tolerated by patients.
What sort of education do up-and-coming optometrists receive in order to perform procedures requested in this scope expansion?
Current graduates from programs offering a Doctor of Optometry (O.D.) complete degrees with the prerequisite education to perform these procedures outlined within the scope expansion bill.
This is demonstrated by the state boards of Louisiana and Kentucky, which required signed affidavits to their education in 2014 and 2012, respectively. During their schooling, optometrists receive 10,000 hours of classroom instruction and at least 2000 patient encounters.
The Vermont Office of Professional Regulation (OPR), in its capacity to protect the public and through extensive research, has determined that there is uniform education for these procedures in all programs from 2019 onward. As a result they have placed a requirement for all graduates prior to 2019 to obtain additional education to match what is offered in optometry schools today.
In addition to classroom instruction and clinical experience, optometrists are required to perform these procedures on patients under a licensed preceptor’s watchful eye prior to obtaining this specialty license.
How many years of schooling do optometrists receive?
Optometric education starts with typically four years of undergraduate education on a pre-med track in the sciences.
Upon graduation, those wishing to pursue eye health care attend an additional four years of graduate education, eventually earning a Doctorate of Optometry.
These years focus on primary eye care which includes anatomy and physiology, pharmacology, histology, biochemistry, optics, neuroanatomy, pathology, research, disease diagnosis and management and pre- and post-operative care.
Optometry school includes clinical experience throughout their four years of schooling. During their fourth year, they usually rotate through a combination of private practice, community health centers, group practices and hospitals.
Similar to ophthalmology fellowships, some graduates pursue residencies focused on disease, pediatrics, contact lenses, primary care, refractive and ocular surgery, brain injury, low vision or neuro-optometry.
When they graduate, they are able to prescribe glasses and contacts AND manage and treat many eye conditions, such as glaucoma, diabetic retinopathy, and macular degeneration. They can remove foreign bodies and treat dry eye by inserting punctal plugs, as well as screen and monitor for retinal detachments and suspicious ocular lesions.
Why do optometrists want to do these procedures and how will this affect patients?
Optometrists want to be able to use their education and skills to help their patients get more timely and cost-effective care.
There are about 162 licensed optometrists and about 37 active licensed ophthalmologists (data from Vermont Department of Health).
Ophthalmology is heavily concentrated in the Burlington area, and not all ophthalmologists perform all procedures. For instance, a retinal specialist would not help a patient with post-cataract haze or treat their sty.
Currently, when a patient sees an optometrist and needs a consultation for a procedure with an ophthalmologist, there is typically a 2-4 month wait (sometimes more) for a non-urgent issue.
In many cases, the patient will need to return a second time after their initial visit with the ophthalmologist to have the procedure performed. Because there are a third fewer
ophthalmologists in Vermont than optometrists, these patients will often have to travel an hour or more for care, at least twice but likely more with post-op visits.
Allowing optometrists to perform these procedures would cut down on the number of necessary visits because an extra consultation visit would not be needed. Reducing the number of visits will also mean less travel required in general because there are more optometrists in the state.
Optometric Scope Expansion can help reduce these time and travel burdens. Increasing optometrists’ scope can also decrease healthcare costs in the system. The cost of care is typically higher when performed in a hospital setting or when an ophthalmology practice is owned by the hospital, and while some optometrists practice within a hospital, most optometrists do not. This leads to lower costs billed out to the healthcare system, and eventually to the patient.
Who is opposing this bill, what are the opposition’s concerns, and what are your rebuttals?
The opposition is primarily ophthalmology and the American Medical Association. They have a longstanding history of opposing any and all scope changes for any profession regardless of merit, location, or benefit. The American Medical Association has a standing resolution that opposes any change in scope for any non-MD profession.
We firmly believe that the American Medical Association and Organized Ophthalmology should have no hand in our regulatory process. They have not attended schools or colleges of optometry and lack an awareness of our profession, training and ability.
A concern that does not have legs is the idea that optometrists are not educated enough to perform these procedures.
As the bill is written, doctors wanting to perform these procedures will have to attend additional classroom education, complete a clinical preceptorship under someone licensed to perform these procedures, take two additional national board certification tests, and attend additional continuing education to maintain their license. This bill will have some of the most stringent requirements across the country. There is an excellent track record spanning hundreds of thousands of procedures in the 12 other states that allow full optometric scope with far fewer requirements to perform optometric procedures.
Another concern that does not have legs is that there will be a medical emergency during these procedures.
Optometrists are qualified to perform these procedures and care for the patient, including during an adverse reaction. There is always a risk when performing medical procedures. Fortunately, these events are very rare and optometry has the training to manage emergencies like anaphylaxis, hypoglycemic crisis and syncope.
The opposition also does not believe this will increase access for patients.
As stated previously, optometry has far more coverage than ophthalmology within the state of Vermont. Plus, there will likely be a reduction of at lease one visit for each patient who would have been referred, which means a shorter waiting time to get treatment.
How many other states are practicing at the same scope of practice as is being requested in the bill currently?
There are currently 12 states that allow Optometrists to practice at the level requested from the legislature by the Vermont Optometric Association and the Office of Professional Regulation.
Alaska
Arkansas
Colorado
Indiana
Kentucky
Louisiana
Mississippi
Oklahoma
South Dakota
Virginia
Wisconsin
Wyoming
There are currently 14 states that allow some, but not all, of the procedures requested from the legislature by the Vermont Optometric Association and the Office of Professional Regulation.
California
North Carolina
Georgia
North Dakota
Idaho
Oregon
Iowa
Tennessee
Kansas
Utah
Montana
Washington
New Mexico
West Virginia
An up-to-date list of changes in optometric scope can be found here: www.reviewofoptometry.com/article/optometric-scope-breaking-down-barriers