AOA FOCUS logo

Study: ‘Unprecedented’ optometry scope of practice expansion benefits patients

May 7, 2025

The gains were strongest for Medicare beneficiaries and rural patients.

Tag(s): Advocacy, State Advocacy

Doctor of optometry with older, female patient


Key Takeaways

  • New research recognizes optometry scope expansion as “unprecedented.” 
  • The findings reinforce that expanding scope of practice for doctors of optometry fills a gap in eye care, given the shortage of ophthalmologists, especially in rural areas. 
  • The AOA State Government Relations Center (SGRC) is a group of seasoned volunteers and staff supporting all state advocacy efforts. 
  • The AOA’s Future Practice Initiative is one tool in the SGRC arsenal for supporting state scope initiatives that include lasers. States considering scope efforts should consult with SGRC for more information.

Optometrists have secured the most significant expansion of their clinical responsibilities in U.S. medical history—allowing them to perform specialty procedures on a broader scale than psychologists, pharmacists and dental hygienists. According to new research from West Virginia University, this scope of practice (SOP) expansion has increased patient access to critical eye care, with patients on Medicare and those in rural communities experiencing the greatest benefits. 

“This paper shows that we are accomplishing our goal to allow doctors of optometry to practice safely at the level we are trained,” says John Whitlow, O.D., chair of AOA’s State Government Relations Center (SGRC). “This opens up access to more obtainable and convenient care, especially for patients in underserved and rural communities. Bottom line: better care for our patients. Hopefully, this will encourage other states in their fight for scope enhancements.” 

The AOA and its affiliates have played a key role in helping doctors of optometry win SOP expansion, including the use of laser surgery, in over a dozen states and counting: Alaska, Arkansas, Colorado, Indiana, Kentucky, Louisiana, Mississippi, Oklahoma, South Dakota, Virginia, West Virginia, Wisconsin, Wyoming

“This is an unprecedented SOP expansion,” write the study’s authors, Kihwan Bae and Liam Sigaud. “The optometrist SOP expansion to laser surgical authority could have profound implications as a case study to inform SOP policies [for other types of healthcare providers.]” 

Key findings from the research include: 

  • The number of Medicare beneficiaries receiving secondary cataract procedures (YAG laser posterior capsulotomy) increased in states with SOP expansion. According to the study’s analysis of 2022 data, states with early SOP reform— Oklahoma and Kentucky—saw an 18.5% increase in these procedures among Medicare beneficiaries. Later SOP reform was also associated with an increase but on a smaller level that was not statistically significant. (Overall, states with early SOP reform experienced greater benefits, indicating that “it takes time for practitioners to adapt and for states to fully benefit from the policies.”) 
  • In states with SOP reform, optometrists gradually replaced ophthalmologists in the increasingly competitive market for laser surgeries.
  • Evidence suggested that the impacts of optometrist SOP expansion were larger in rural areas than urban environments, indicating that populations with access issues would benefit most. Other findings suggested that optometrist SOP expansion would also benefit “elderly, low-income, or marginalized populations, who may have more limited access to vision care than the general population.” 

In conclusion, the authors wrote: “These findings suggest that expanding optometrist SOP fills a gap in eye care, given the shortage of ophthalmologists, especially in rural areas.” 

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 with the AOA’s State Government Relations Committee (SGRC) 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 

“The future of optometry and access to critical patient eye health and vision care lies in the ability for doctors of optometry to adapt and expand the profession’s scope of practice, which has long been a key priority for the AOA and affiliates across the country,” says AOA President Steven T. Reed, O.D. “The AOA is committed to supporting the fight for this important progress across the country.”  

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. 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.    

Registration will open soon, and additional details will come.