What kind of impact is optometry making on the nation’s eye health?

May 30, 2024
New study by economists underscores the role of optometry and how scope of practice expansion bodes well for patients and doctors.
Doctor of optometry with African American female patient

Eye health rose in the U.S., commensurate with the state-by-state granting of prescription authority to doctors of optometry starting in the 1970s, three economists write in an article recently published in Contemporary Economic Policy.

In “Seeing is believing: The effect of optometrist scope of practice expansion,” researchers cite three important milestones: prescription authority, for diagnostic purposes in the 1970s and then later therapeutic pharmaceutical agents; the growth in their numbers from 11.06 per 100,000 to 16.11 per 100,000 between 1990 and 2017; and in 1986, when Medicare classified optometrists as medical doctors, making them eligible for reimbursement for their care.

Key takeaways, according to co-authors and West Virginia University economists Kihwan Bae, Ph.D., and Edward Timmons, Ph.D., and University of Minnesota Duluth economist Protik Nandy, Ph.D., are:

  • Health care providers should be permitted to do the work they are trained to perform.
  • Their work suggests that allowing optometrists to treat patients is associated with a decline in vision impairment of 12%.
  • There is evidence of larger declines in vision impairment for non-white patients. As a result, permitting optometrists to treat patients narrowed historical disparities in vision outcomes.

“Vision impairment declined (despite a lag) by 12% on average over a 15‐year period after the policy change,” the researchers write. “The effect was not instant but emerged 6 years after the policy change. Moreover, the policy brought a larger decline in vision impairment among the non‐white population, who might have more limited access to medical care than whites. Also, TPA prescription authority is associated with about a 13% increase in hourly wages among optometrists who are not self‐employed.”

This is especially consequential as the number of ophthalmologists is on the decline.

Study reinforces AOA messages

As more AOA state affiliates pursue scope expansion legislation, this analysis confirms the AOA’s position that doctors of optometry are trained, educated and certified to safely perform these advanced procedures. Recent years have brought historic gains across the country with a growing number of states (12) now permitting doctors of optometry to perform office-based ophthalmic laser procedures.

The study conclusions come as no surprise to doctors of optometry, nevertheless the results underscore the value of the profession and the need for greater scope expansion.

“We are obviously pleased about this study,” says Johndra McNeely, O.D., chair of the AOA State Government Relations Committee. “We are a huge asset to the health care community.”

What might the study say about future modernization efforts?

“Each and every scope advancement in optometry has been a win for the patient, and laser adoption will be no different,” Dr. McNeely says. “Especially looking at the treatment of glaucoma-SLT laser therapy sometimes now considered for some patients.

“First-line treatment of glaucoma adoption of laser privileges will only increase the decrease in disparities (better health outcomes, less vision impairment), especially in Black and Hispanic populations that are at higher risk for glaucoma,” she says.

Say the researchers: “These findings have important implications on ongoing policy debates on scope of practice expansions of optometrists and other health care practitioners to meet the rapidly growing demand for medical services given the limited supply of physicians.”

Expansions in provider scope of practice may help alleviate disparities in health care outcomes for Black and Hispanic individuals, they add.

Attend regional advocacy meetings

The AOA’s State Government Relations Committee (SGRC) Regional Advocacy Meetings are pivotal opportunities for grassroots advocates, affiliate leaders and volunteers to compare playbooks for successful statehouse strategies. Save the date for the 2024 SGRC Regional Advocacy Meetings:

Affiliate advocacy teams are encouraged to join any of the three regional meetings. Visit the event pages above for more information about these highly interactive meetings. 

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