Expanding Optometrists’ Scope of Practice to Improve Eye Care Access

Across the U.S., patients face challenges accessing healthcare services, particularly in rural regions where long drives to specialists are common. Eye care shortages, especially ophthalmologists, exacerbate this issue. Many trained optometrists are hindered by laws restricting them from conducting routine and necessary procedures.

In over twelve states, optometrists can perform YAG laser capsulotomy, a simple office procedure for ‘secondary cataracts’ that can cause cloudy vision post-cataract surgery. Over 500,000 elderly Americans undergo this procedure yearly with an excellent safety record, yet most states limit it to ophthalmologists.

Restricting optometrists’ practices impacts patient care. In 2020, the U.S. had thrice as many optometrists as ophthalmologists. Ophthalmologists cluster in urban areas, while nearly all Americans live near a practicing optometrist. Patients often experience lengthy waits and high travel costs to see ophthalmologists for YAG procedures.

Patient safety concerns are understandable, but there is minimal cause for alarm.

Optometrists receive four years of doctoral eye care training, typically including YAG surgery. Additional training or certification is required otherwise. A study of nearly 150,000 laser procedures by optometrists in the U.S. showed only 0.001% negatively affected outcomes, evidencing high safety. Optometrists in the U.K. and New Zealand have safely performed these procedures for years.

A Pacific Legal Foundation policy brief identifies increased procedure utilization where optometrists have expanded practice scope. Medicare recipients in states with scope expansions from 2013 to 2023 received 19% more YAG procedures compared to restrictive states. Earlier expansions yielded even higher rates—almost 42% more.

Expanding optometrists’ practice scope enhances eye care access, allowing patients facing travel burdens, scheduling issues, or specialist scarcity to receive necessary treatment.

Policymakers can learn two key insights:

• Scope-of-practice expansion effects grow over time as eye care markets adapt to regulatory changes.
• The rise in YAG utilization is more significant in non-metropolitan than metropolitan areas, suggesting rural patients face stronger barriers and benefit greatly from optometrists practicing fully.

This reform follows precedents where state laws have expanded non-physician providers’ practice scopes over 20 years, positively affecting access, cost, and healthcare system flexibility.

Despite potential opposition from ophthalmology groups, the focus should remain on patient well-being. With a growing need for eye care and a thinning ophthalmologist workforce, tools to minimize patient delays are crucial.

Kihwan Bae, Ph.D., of West Virginia University’s John Chambers College of Business, and Liam Sigaud, a research analyst, endorse leveraging optometrist capabilities for better patient services.