Destination: Scope expansion

Excerpted from page 30 of the Winter 2024 edition of AOA Focus. 

When the Colorado Optometric Association (COA) drove its scope law across the finish line two years ago, it overcame intense opposition from ophthalmology and organized medicine. 

The COA did the heavy lifting of marshaling members and resources and leveraging legislative relationships for the extended fight. And while affiliates are in the driver’s seat in these scope fights, the AOA State Government Relations team, buoyed by the Future Practice Initiative (FPI), has been riding shotgun. 

“The AOA team was helpful in a number of ways,” says Deanna Alexander, O.D., former chair of the COA’s Legislative Committee. “Obviously, money helps in a legislative effort, but before we ever had a discussion about money, the guidance provided by the FPI Committee was invaluable as an internal navigator of what needed to be done and how we were progressing. The support helped us build our roadmap for legislative success, really for any legislation, and enabled us to take an honest look at where we stood. We applied for and received FPI money toward the end of our process, which was used to hire additional lobbyists.” 

Colorado’s law was signed in June 2022 and turned over to its state board for rulemaking. Doctors of optometry began performing laser and other in-office surgical procedures in January 2023 and, in the first year, more than 1,500 procedures were performed by doctors of optometry in the state. 

Since the AOA’s increased focus on supporting affiliates and the inception of the FPI, more states have been able to reach their destinations. Bolstered by their preparedness, aided by the AOA’s solid strategic counsel and a shared ambition to extend patient access to care, the AOA and affiliates are driving change. 

FPI: A vehicle for advocacy 

The FPI was announced in 2018, the brainchild of former AOA President Samuel D. Pierce, O.D., and the AOA Board of Trustees in close partnership with the association’s affiliates mobilizing for scope expansion. The initiative aims to: 

• Bolster state efforts to address outdated state practice acts that limit the practice of optometry. 
• Expand the scope of practice to ensure doctors of optometry are able to practice to the full extent of their education, training and certifications to ultimately expand patient access to care, which includes in-office optometric surgical procedures, specifically laser procedures. 
• Share and arm state affiliates with strategic resources, the benefit of experience of battle-tested advocates, funding and training. 

“I have been around long enough to have been part of Alabama getting therapeutic privileges,” Dr. Pierce observes. “One of the things I learned was that any time a milestone was accomplished in a state or a few states, typically within 20 years, all states are onboard—for the most part.” 

The AOA and affiliates are seeking to continue making progress—bringing the fight to organized medicine state by state—to create a critical mass that will tip passage of laser authorization in the remaining states. That is how it has been historically. Momentum matters. 

Mapping a powerhouse strategy 

Why not pursue laser authority? 

Laser procedures are regarded as safe and effective and well within the education, training and certification of doctors of optometry. A safety study, published in the July 24 issue of Clinical and Experimental Optometry, reported that out of 146,403 optometric laser procedures performed by U.S. doctors of optometry in authorized states, there were only two (0.001%) reported with “negative outcomes” or complications. 

Authorizing doctors of optometry to perform laser procedures also increases patient access to care. A 2023 survey conducted by the AOA Research & Information Committee found expanded scope afforded patients greater convenience, shorter wait times and continuity of care. Doctors of optometry practice in 77% of U.S. county equivalents, compared to ophthalmologists at 44%. Here is how laser authority currently stands in states: 

• Over a 20-year span from 1998-2018, prior to the AOA’s increased support and the development of the FPI, four states achieved scope expansion through their practice acts, allowing doctors of optometry to perform laser procedures. 
• From 2019-2024, a period of only five years after FPI was first announced, six additional states passed scope expansion legislation that includes the authority for doctors of optometry to perform in-office laser procedures. 

Active with the State Government Relations Committee (SGRC) and the FPI since its inception, AOA President-elect Jacquie M. Bowen, O.D., says she has been “thrilled” with the success of the partnership between affiliates and AOA. 

“The initiative continues to evolve as we reinvent our strategies and as the opposition is waking up to the powerhouse behind optometric advancement,” she says. “They are mobilizing more, but usually with the same old tricks.” 

By contrast, the FPI and affiliates are adjusting to road conditions and evolving strategy and resources. 

“FPI does not replace the necessities of advanced preparedness, hard work and financial contributions required in each state,” Dr. Bowen says. “FPI does help get bills across the finish line with counseling and funding based on each state’s needs. The true gold mine lies in engaging with the SGRC years ahead of bill introduction and working the strategy as thoroughly as possible.” 

Steering success 

AOA leaders are quick to credit the association’s affiliates in those 10 successful state legislative wins. Well-organized affiliates rallied members and battled misinformation by larger, well-funded opponents, including organized medicine. The lift can be all-consuming and last over a period of years. 

The AOA has the affiliates’ backs. In the past several years, for instance, the FPI has provided hands-on guidance and planning and advocacy resources that meet each individual state’s needs, based on learnings from other successes and each state’s unique landscape. 

The FPI also offers the benefit of optometry leaders and staff who previously have been through a scope battle or two—such as William T. Reynolds, O.D., a past AOA president who was instrumental in Kentucky’s scope battle. Dr. Reynolds is the AOA Advocacy chair and leads the efforts to support affiliate scope expansion. 

“The FPI was a 10-year commitment by AOA to help state affiliates logistically and financially pass scope legislation,” he says, noting the AOA Board of Trustees recognized that, given the strength of the opposition, they needed “additional firepower to continue momentum.” 

“The future of the profession is in contemporary optometry and we very, very much believe that,” he adds. “That includes practicing at your highest scope, which includes laser procedures, being reimbursed at the highest level, utilizing your staff and technicians, and providing top care to your patients. That is our future.” 

Fueling resources and preparation 

Affiliates give the FPI high marks, emboldening their efforts based on the aid FPI provides for their preparation. 

Participating in the FPI process helped Wyoming move its scope expansion “across the finish line,” says Kari Cline, executive director of the Wyoming Optometric Association. 

“The SGRC and the resources that AOA provided were timely and effective,” Cline says. “Not only did we get funding for additional lobbying and public awareness, but the Wyoming-specific maps, talking points and policy expertise were invaluable.” 

The finish line 

The Virginia Optometric Association’s (VOA’s) push to expand the state’s scope of practice for optometrists got underway in 2017. Once partnered, Lisa Gontarek, O.D., past VOA president, says the FPI “showed us that we were on the right track and forced us to make sure that we left nothing to chance.” 

“We had a preliminary call with the FPI Committee in late summer and the official call in December before we introduced our bill,” Dr. Gontarek says. “That call was gratifying. We had put in a ton of work, and it showed.” 

The FPI provided a needed infusion of funds to support the VOA, says Bo Keeney, VOA executive director, adding that the VOA developed and followed a strong strategic plan to advance its legislative initiative, and the FPI monies were used to hire additional lobbyists that helped the association finalize its legislative plan. 

“The FPI Committee and toolkit served as an invaluable resource to keep the VOA, its volunteers and legislative priorities on track during our scope expansion efforts,” Keeney says. 

Ryan Wally, O.D., president of the Mississippi Optometric Association, was legislative chair when Mississippi Gov. Tate Reeves passed the law to expand laser authority to optometrists on March 17, 2021. 

“The FPI was crucial in the final stages of our successful scope legislation in 2021, allowing us to secure additional lobbying power at the state Capitol,” Dr. Wally says. 

“Not only were the funds themselves highly appreciated, but the FPI process also was invaluable, helping to make sure we were fully prepared and properly invested for the battle ahead,” says Matthew Jones, O.D., Arkansas Optometric Association: “We are truly grateful for everything the AOA did to work through the entire process with us, and the State Government Relations Committee staff was extremely helpful.” 

Scope expansion can take years of planning and execution. In Colorado, they began planning in 2015. In the intervening years before the passage of scope expansion, Colorado optometrists passed vision plan legislation. 

A key provision of the state’s revised Optometric Practice Act is the expansion of services, procedures and treatments that certified doctors of optometry in Colorado can now perform. Those new interventions include: 

• Injections for treating conditions or diseases of the eye or eyelid (excluding intraocular injections penetrating the globe). 
• Use of a local anesthetic in conjunction with the primary treatment of an eyelid lesion. 
• Removal and biopsy of eyelid lesions without characteristics or obvious signs of malignancy, excluding lesions involving the eyelid margin or larger than 5 millimeters in size. 
• Incision and curettage of a chalazion. 
• Simple repair of an eyelid laceration no larger than 2.5 centimeters and no deeper than the orbicularis muscle and not involving the eyelid margin or lacrimal drainage structures. 
• Corneal cross-linking. 
• Laser capsulotomy, laser peripheral iridotomy and laser trabeculoplasty. 

Part of the preparation was building up a grassroots network and educating members and legislators alike, say current Legislative Co-Chairs Jon Pederson, O.D., and Heather Gitchell, O.D. Another part was reading the climate at the Capitol and knowing the right time to introduce their bill. 

“Since the implementation of our law, patients have been pleased to have procedures performed by their own local doctors of optometry,” Dr. Pederson says. “Prior to this legislation, patients would have had to wait months or travel long distances to obtain care.” 

“Doctors have been excited to be able to utilize their full education and training,” adds Dr. Gitchell, “to provide further care to their patients in their own communities.” 

Save the date!  

If AOA state affiliates are interested in elevating advocacy in their states, save these dates for the AOA State Government Relations Center (SGRC) Regional Advocacy Meetings in 2025.  

• Aug 15-16 in Chicago, Illinois 
• Oct. 24-25 in Phoenix, Arizona  

Registration will open soon, and additional details will come.