Why you should fight for scope expansion

Excerpted from page 44 of the Winter 2024 edition of AOA Focus 

Optometry education and training has broadened significantly in the past two decades to include injections, lasers and minor surgical procedures. However, in many states, the laws have not been updated to allow optometrists to expand the scope of their practices to reflect this. 

“It’s been the case for a long time that our training has exceeded what we are legally allowed to do in many states, but it benefits us and our patients to be able to fully utilize our education,” says Heather Gitchell, O.D., a Colorado Optometric Association and AOA member. 

2 reasons scope expansion is important

1) It improves access to care

Paul Barney, O.D., AOA Trustee and chair of the Legislative Committee for the Alaska Optometry Association, points out that in states like his, where roads are sparse, patients’ ability to find care can be limited. Allowing optometrists to use their education to the fullest provides patients with more options. 

“We’ve been able to save patients a lot of indirect costs, travel costs, lost time from work and so forth, by expanding our scope,” says Dr. Barney, who was instrumental in passing H.B.103 in 2017, a statute that gave the Alaska Board of Examiners in Optometry the autonomy and the authority to write regulations for anything that is taught at an accredited school or college of optometry. “By not having legislation like this, we’re denying the public better access to care and better competition within eye care.” 

In Dr. Gitchell’s home state of Colorado, optometrists are in many more counties than ophthalmologists. 

“There are a number of Colorado residents who would choose not to seek care because the trip would be too expensive, too long, too inconvenient for them,” she says. “Being able to provide that needed care in smaller communities or to our patients in general, even in metro areas, has been a huge change and a good change.” 

In fact, a study published in Clinical and Experimental Optometry in July 2024 concluded that “the global shortage in ophthalmology services, the increasing prevalence of ocular conditions with an aging population, and the increasing need for access to timely eye care services highlight the urgent need for educational programs to expand the optometric scope of practice.” 

2) It results in quality care

“Clinical evidence shows that when optometrists perform these procedures, the results are similar to the outcomes that are achieved by ophthalmologists. And with the greater access to care that optometric scope expansion provides, patients receive excellent quality of care in a more timely and cost-effective manner,” Dr. Barney says. 

A study published in a 2023 issue of Optometry and Vision Science looked at the outcomes of YAG laser capsulotomy procedures performed by optometrists and concluded, “Based on the outcomes of this study, YAG laser capsulotomies are effective treatments to improve patient vision that can be safely and effectively performed by optometrists.” 

Comparing results of all the debated procedures when done by ophthalmologists and optometrists, Clinical and Experimental Optometry found “these metrics outline the effectiveness of these procedures performed by optometrists and show strong support for future optometric scope expansion.” 

Join the fight for scope expansion 

If your state still prevents you from using your education and training to the fullest, you can take action now. Here’s how to start. 

Make sure you’re up to speed 

Practitioners who have been out of school for several years should go back to school to refresh their skills.  

“Once the bill is passed, there’s usually educational requirements that everybody has to take to be given the authority to do the procedures,” explains Dr. Barney. He adds that in Alaska, they passed what’s referred to as a board autonomy bill, which gives the board of optometry the authority to expand scope of practice as long as it is taught at an Accredited School of Optometry. “That’s unique. It’s the only bill in the country that gives the board of optometry that authority.” 

Educate legislators on optometric education 

“It can’t happen the year of the bill dropping. It has to be an ongoing process where a legislator gets to know the optometrist and trusts them as the source they would go to for any eye-related issue that may come through the legislature,” Dr. Gitchell says. 

And it can’t just be one legislator here or there.  

“In Colorado, we have an optometrist assigned to every legislator, and this relationship-building happens over years. You may think you have one champion, but if you don’t have multiple legislators on board, it’s going to become much more of a fight,” she adds. 

Remember, another state’s success helps other states succeed. Whatever happens in a particular state can set a precedent for the next states that are going for scope expansion. 

“I know when we were going through ours, we were very careful not to do anything that could be damaging to the next state trying to go for scope expansion. And by damaging, I mean you never want to negotiate out something just to gain something else,” Dr. Gitchell says. “There is going to be a physician shortage, especially in ophthalmology. Ophthalmology has become much more specialized; that leaves these procedures that we’re talking about to PAs or midlevel practitioners. Optometrists, who have already been trained to do these procedures, are the ones who should be doing them. We have a doctoral-level profession with specific training for the eye and for these procedures.”