VA rescinds laser policy, opens path to full recognition of optometric care

Elimination of a restrictive Department of Veterans Affairs’ (VA) policy on laser eye procedures represents progress toward affording the nation’s veterans with the same level of access to optometric care enjoyed by other Americans.

In an update to the Veterans Health Administration’s (VHA’s) Eye and Vision Care policy on Aug. 18, the administration rescinded a previous directive that effectively limited veteran access to therapeutic laser eye procedures at VA medical facilities and, in turn, issued a new directive that emphasizes the use of interdisciplinary care. This recent VA action is one in a series of access-focused efforts, including an April 2020 policy underscoring that veterans are best served when all VA doctors of optometry and other essential care providers deliver care with full practice authority.

“As leading advocates for veteran access to high-quality eye health and vision care, the AOA commends the VA for taking important steps to continue to modernize care and its delivery in VA facilities,” says William T. Reynolds, O.D., AOA president. “Doctors of optometry, who deliver more than 80% of primary eye health care in America, are trained and qualified to safely provide the full breadth of eye care services, including therapeutic laser eye procedures, and our veterans have earned and deserve access to that care.”

Optometry’s advocates have long emphasized the profession’s accessibility in providing Americans’ primary eye health care, considering doctors of optometry practice in counties that make up 99% of the U.S. population. As a growing number of states recognize that therapeutic laser eye procedures, such as selective laser trabeculoplasty and YAG laser capsulotomy, can safely and effectively be provided by local doctors of optometry, Americans—including those with coverage provided by major health insurers, Medicare, Medicaid, the Indian Health Service and other payers—are gaining access to essential care once limited to them.

The VA’s new policy change eliminates a May 5, 2020, directive that limited laser procedures only to ophthalmologists due to safety concerns and updates the VA’s Eye Care Handbook to include a new definition of laser eye procedures that specifically notes “therapeutic laser eye procedures in VHA are currently performed by only ophthalmologists and ophthalmology residents.” Additionally, the handbook outlines how ophthalmologists become qualified to provide these procedures within VA.

Seeking full recognition of optometric care

These changes to the VA Eye Care Handbook represent a significant pathway to seek full recognition of care for doctors of optometry who are licensed and trained to provide this level of care—and an opportunity that has been over a decade in the making.

“For 15 years, VA doctors of optometry have been expressly prohibited from performing laser eye procedures within the VA nationwide. This was due to a directive that was created by ophthalmology, under the guise of patient safety in order to restrict VA Optometry’s clinical practice,” says Lindsay Wright, O.D., Armed Forces Optometric Society (AFOS) executive director.

“From the start, the AOA and AFOS have fought to have this unfounded policy rescinded. The removal of the restrictive policy, along with the language that attacked optometry, is a step in the right direction and an incremental but very significant win.”

Although these changes don’t effectively change the scope for VA doctors of optometry, Dr. Wright notes the absence of any express prohibition on care, coupled with the removal of any patient safety concerns, opens the door for potential inclusion in the future. What’s more, the abrupt reversal by the VA is recognition that “patient safety” was never an issue for limiting these procedures.

“This restrictive language and directive can no longer be used as a weapon to hurt affiliates pursuing scope expansion in their states,” Dr. Wright says.

The AOA and AFOS continue to advance access to safe and effective care for veterans, fighting to ensure all veterans receive the comprehensive vision and eye health standard of care recognized nationwide. In that effort, the AOA and AFOS are proud to work alongside many Veterans Service Organizations, such as AMVETS and other veteran-focused groups, to remove the barriers veterans face to care provided by the nearly 1,000 VA doctors of optometry.

“On behalf of America’s more than 20 million veterans and their families, AMVETS is proud of and applauds the VA for its recent and decisive move toward ensuring that more of our veterans have access to the full range of eye care services, including laser eye procedures, that doctors of optometry are ready, willing and fully able to provide,” says Joe Chenelly, AMVETS national director. “AMVETS is committed to ensuring that our veterans have access to the care they need, where and when they need it—and we’re happy that the VA is increasingly joining us in that mission.”

Learn more about how the AOA and AFOS are advocating for veterans’ eye health and vision care.