South Dakota secures scope expansion for injections, optometric laser procedures

South Dakota modernizes its optometric scope of practice to include in-office procedures, such as injections and ophthalmic lasers, making it the twelfth state in the nation to authorize these safe, accessible care options for patients. 

Signed into law on March 5 by Gov. Kristi Noem, H.B. 1099 allows doctors of optometry to administer injections around the eye, use local anesthetic for office-based surgical procedures, and perform laser procedures, including selective laser trabeculoplasty (SLT) and posterior capsulotomy with a yttrium aluminum garnet laser (YAG), in accordance with new education and certification requirements. South Dakota becomes the latest state to authorize such in-office procedures, coming on the heels of an ophthalmology workforce report finding ophthalmology unable to meet the increasing demand for age-related eye care in the years ahead. 

"I am so proud of our member doctors for the support they provided in passing this bill,” says Ashley Crabtree, O.D., South Dakota Optometric Society (SDOS) president-elect. “When asked, they responded and met with legislators, texted, called and emailed. Several doctors made the trip to the state Capitol to lobby legislators and testify in committee. 

“Our board also allocated resources to put together a great lobbying team led by our executive director, Deb Mortenson. We also had a robust social media and digital ad campaign to support this effort, and AOA’s State Government Relations Committee (SGRC), specifically Dr. Jeff Michaels, was a key support,” Dr. Crabtree adds. 

Specifically, the law now permits optometrists in South Dakota to provide: 

• Intradermal injection of a paralytic agent 
• Intralesional injection of a steroid to treat a chalazion 
• Local anesthetic in conjunction with the primary removal of a pedunculated skin tag 
• SLT and YAG  
• Intense Pulsed Light therapy for dry eye 

Despite all procedures being taught in every school and college of optometry in the nation since at least 2015, optometrists will be required to complete a three-part “prove up” process to perform any added procedure. This process requires: 

1. Passage of both a national examination on laser and injection procedures (graduates prior to July 1, 2024, will be grandfathered in).
2. Passage of a 32-hour certification course to demonstrate competency on each of the added procedures.
3. Hands-on demonstration of the procedures on at least five human eyes (SLT) and 10 human eyes (YAG) under the direct supervision of an ophthalmologist or authorized optometrist to prove competency in each procedure. 

South Dakota’s scope modernization effort began in earnest over a year ago when the legislation was introduced in the state’s senate, ultimately stalling with the House Health and Human Services committee. Reintroduced in January, the legislation received favorable responses in both chambers before heading to the governor’s desk in late February. 

The law takes effect July 1, 2024, and the SDOS is working with the state optometric licensing board on implementation. 

Optometry qualified, positioned to improve patient access to care 

As optometric scope in a dozen states now authorize doctors to provide in-office laser procedures, such as YAG capsulotomy, a pair of recent studies paint a telling picture of the current eye care situation in the United States. 

In September, a study in the journal Optometry & Vision Science formally assessed the efficacy and safety of YAG laser capsulotomy procedures performed by optometrists, showing 99% of patients reporting subjective improvement in visual acuity post-procedure and 95% of patients showing objective visual improvement that allowed for better quality of life. Importantly, no significant adverse events were noted in any subject. 

Nate Lighthizer, O.D., Northeastern State University Oklahoma College of Optometry associate dean and professor, and study lead author, says doctors of optometry have provided YAG capsulotomies for quite some time and the study results bear out optometry’s efficacy and care, as well as patient satisfaction. 

“Optometry is well qualified to provide YAG laser capsulotomies; it’s a procedure that can be done in office in a matter of minutes so optometry really is improving patient access to this kind of care,” Dr. Lighthizer said. 

⏩ Access AOA’s fact sheet on the YAG capsulotomy study in Optometry & Vision Science. 

Then in December, the journal Ophthalmology published a new workforce study that anticipates a 12% decline in full-time equivalent (FTE) ophthalmologists by 2035 while simultaneously projecting demand to increase by 24%, equating to the second-worst rate of workforce adequacy among all surgical specialties. These findings become far more pronounced as rurality comes into play with ophthalmology’s workforce supply adequacy falling to 26-29% for rural areas by 2035. Despite ophthalmology’s limitations, the study found optometry in a far better position to meet demand—similarly established in the AOA’s own workforce study. 

“Optometry’s essential and expanding role in health care has become well-recognized by the provider community, policymakers, the health care media and the public,” noted AOA President Ronald L. Benner, O.D., in response to the ophthalmology study. “Now, with every indication of an accelerating decline in the ophthalmology workforce outlook, our profession is poised for historic, new opportunities that will allow for the full use of our education, training and skills in caring for our patients.” 

Modernizing optometric scope of practice commensurate with the level of optometric services already provided in a dozen states is a common-sense solution for the remainder of states to address this workforce crisis, noted Rich Castillo, O.D., D.O., co-chair of the AOA’s Contemporary Practice Task Force. 

Dr. Castillo added that it’s vital to recognize optometry as the valuable resource already available to meet projected increases in demand for eye health services. Likewise, optometry’s scope expansion is already addressing geographic disparities noted in ophthalmology’s workforce inadequacy.  

“Optometrists are the primary—and often the only—providers in these underserved areas,” Dr. Castillo said. 

⏩ Learn about the AOA Paraoptometric Micro-Credential: Optometric Surgical Assisting program 

AOA, affiliates committed to advancing optometry 

Launched in 2018, the AOA Future Practice Initiative is an operational partnership alongside affiliates that helps leverage advocacy strengths to challenge historic impediments to full-scope optometric care. That close collaboration continues to not only produce meaningful scope advancements but also keeps in check egregious, anti-competitive and anti-patient vision plan policies, as well as attempts to roll back optometric care. 

As part of these efforts, the AOA’s SGRC Regional Advocacy Meetings prove pivotal opportunities for grassroots advocates, affiliate leaders and volunteers across the nation to compare playbooks for statehouse advocacy strategies. Follow AOA’s Calendar of Events for more information about the AOA SGRC Regional Advocacy Meetings occurring in 2024.