I am an optometrist originally from Northampton, MA who fell in love with Vermont as a child. I went to UMass-Amherst for my undergraduate degree and UC Berkeley for my doctorate in optometry, where I graduated in 2020. I went to work in Colorado after graduation and while I was in Colorado, it became clear to me that the future of optometry was evolving. I decided to go to Oklahoma to do a residency in laser and advanced surgical procedures at the Oklahoma College of Optometry and for the Cherokee Nation in Tahlequah, OK, where I am currently.
The reason I decided to go back and do a residency was to become more proficient in the surgical procedures that are now becoming ubiquitous across the profession of optometry. I trained in laser procedures and other surgical procedures in school, but not to the level that is now being taught in optometry schools across the country in the five short years since I graduated.
The future of optometry is clear. To provide the best care to our patients, optometrists must be able to perform additional procedures than what was considered standard of care in the past. Optometrists are the primary care providers for all eye care in the US. Optometry now manages all first-line treatment of ocular disease, dry eye, and refractive error. In the treatment and management of glaucoma, all the recent studies confirm that, for the vast majority of glaucoma patients, Selective Laser Trabeculoplasty (SLT) should be the first line of treatment. SLT is a repeatable procedure that is generally painless with little to no side effects. It is a procedure that costs significantly less than the current first-line treatment which is using pressure-lowering eye drops that a patient will have to remember to take every day for the rest of their lives. These drops come with notable side effects to the patient. SLT is generally a low-priority procedure in the world of ophthalmology that may take months of waiting to do, for the simple fact that glaucoma drops can be used to treat any immediate risks over glaucomatous damage while a patient waits for an SLT to be performed. This can be easily justified by the fact that other surgeries take precedence in an ophthalmologist’s schedule, such as surgeries to repair a retinal detachment, remove a cataract, or insert implants for end-stage glaucoma, because there is no alternative to those procedures and no one is better qualified than an ophthalmologist to provide them. The introduction of glaucoma drops can take care of the immediate problems associated with glaucoma but does little to take into account the patient’s quality of life. Once drops are introduced they are seldom taken away, even after an SLT is performed and that becomes a lifelong burden upon the patient that doesn’t need to occur in states that have already passed scope of practice laws.
Anterior segment laser surgeries which include SLT, Yag Capsulotomy, and Laser Peripheral Iridotomy are all procedures based on skills that optometrists have been trained on for decades: slit-lamp proficiency and gonioscopy. Every optometrist has four years of experience in these procedures by the time they graduate from optometry school. As someone who personally trains students in how to perform these procedures, I can testify to the fact that they are safe and that these procedures take little additional training to manage and perform for an optometrist. The competence and success of optometrists performing anterior segment laser procedures are well documented in peer-reviewed studies.
In the past 10 years, I’ve watched the number of states with expanded scope grow from 3 to 12 nationally. In 5 more years the number is expected to grow to more than 30, in 10 years it will include all states but an outlier or two. Progress can often start very slowly until it starts to move very quickly when it becomes clear that no one wants to be the last one living in the past. I would love to see Vermont become the first state in New England to follow the example being set in the rest of the country. This may happen this year or later, but I doubt that Vermont will allow itself to be satisfied living in the past. I look forward to whenever that day comes. Until then, I will continue to practice where I can to the level of my training and help others be prepared for the ever-changing profession of optometry.
Daniel Phillips, OD