As a new graduate optometrist, it is important to understand the level of scope of practice in each individual state.
After spending 4 years of your life dedicated to eyecare, of course, you hope to practice to the fullest extent. However, many new graduates will realize that their state does not allow them to practice full-scope optometry.
This article highlights recent changes in the scope of practice in the US and outlines each state’s privileges.
Overview of optometry scope of practice
Scope of practice is defined as the procedures, actions, and processes that a healthcare practitioner is permitted to perform under their professional license. The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency, such as passing required tests and additional training.1
Changes to the scope of practice occur both on a federal and state level. The American Optometric Association (AOA) is an organization that fights for optometrists rights on a national level. This organization tends to focus on larger policy changes such as higher Medicare reimbursement or minimum base salary for doctors of optometry who work at the Veterans Affairs (VA).
Every year, the AOA and optometry representatives meet with federal legislators on “Capitol Hill” in DC to discuss important bills and changes they would like to see on a national level.2 Within the AOA are state optometric associations, such as the Maryland Optometric Association. Each state has a defined set of laws that dictate the level at which the optometrist can practice.
This is often based on “access to care,” in which states that are more rural with limited access to ophthalmologists and optometrists tend to have a greater range of procedures they can perform, such as laser-assisted in situ keratomileusis (LASIK) and chalazion removals.3
Usually, each state association has an executive director or “point person” who is hired to work with optometrists on the board of their state society to help them fight and maintain scope of practice.
Lobbyists are hired to build relationships with up-and-coming legislators and ask for their vote on bills during the legislative session. The bill is then sent to the committee and then the floor to either be voted into state legislation or not. The governor has the right to veto the bill before it becomes law.3
What is the optometric scope of practice in your state?
To keep up with changes in scope of practice for optometrists, Quy Nguyen, OD, and Matt Geller, OD, developed an infographic illustrating the optometry scope of practice in each state to easily compare the scope in each state and the progress optometry has made!
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What is the optometric scope of practice in your state?
Download the full infographic to visualize the optometry scope of practice in your state!
1. Oral medication authority
As of October 2021, optometrists in all states now have oral medication authority! However, the type of oral medication varies between states.
Further, in all states, optometrists can prescribe certain oral antibiotics and antiviral medications to treat ocular conditions, but only some ODs can treat patients with oral steroids.
2. Glaucoma treatment
As of 2021, optometrists can treat glaucoma topically in all states! This includes all prostaglandins, carbonic anhydrase inhibitors, and beta blockers without co-management from an ophthalmologist.
3. Oral steroid prescription authority
Oral steroids are often used to treat certain eye conditions, such as macular edema, uveitis, and scleritis. The specific use of oral steroids may vary from state to state.
In these states, optometrists cannot prescribe oral steroids:
- Florida
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- New York
- South Carolina
- Washington, D.C.
In these states, optometrists can prescribe oral steroids:
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- Georgia
- Hawaii
- Idaho
- Indiana
- Illinois
- Iowa
- Kansas
- Kentucky
- Louisiana
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
4. Injectables authority
In these states, optometrists can provide injectables to both treat anaphylactic shock (EpiPen) and intradermal injections (anesthesia/steroids) when treating chalazion/hordeola.
States where optometrists can treat anaphylaxis and other needs:
- Alaska
- Arkansas
- California
- Colorado
- Georgia
- Idaho
- Indiana
- Iowa
- Kentucky
- Louisiana
- Mississippi
- Montana
- New Mexico
- North Dakota
- North Carolina
- Oklahoma
- Oregon
- South Dakota
- Tennessee
- Utah
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
States where optometrists can treat anaphylaxis only:
- Alabama
- Arizona
- Connecticut
- Delaware
- Florida
- Hawaii
- Maryland
- Maine
- Minnesota
- Nebraska
- New Hampshire
- New Jersey
- Ohio
- Pennsylvania
- Texas
- Vermont
- Washington
- Washington, D.C.
5. Lasers authority (LPI, SLT, ALT, YAG Capsulotomy)
In these states, optometrists can use lasers to treat ocular conditions, such as post-cataract haze (yttrium aluminum garnet [YAG] capsulotomy), minor glaucoma laser procedures (selective laser trabeculoplasty [SLT] / laser peripheral iridotomy [LPI]), and refractive surgery procedures (photorefractive keratectomy [PRK]).
States where optometrists have varying laser authority:
- Alaska: YAG capsulotomy / ALT / SLT / LPI / PRK
- Arkansas: YAG capsulotomy / ALT / SLT
- Colorado: YAG capsulotomy/ ALT / SLT / LPI
- Indiana: YAG capsulotomy / ALT / SLT / LPI
- Kentucky: YAG capsulotomy / ALT / SLT / LPI
- Louisiana: YAG capsulotomy / ALT / SLT / LPI
- Mississippi: YAG capsulotomy
- Oklahoma: YAG capsulotomy / ALT / SLT / LPI / PRK
- South Dakota: YAG capsulotomy/SLT
- Virginia: YAG capsulotomy / ALT / SLT / LPI
- Wyoming: YAG capsulotomy / ALT / SLT / LPI
6. Lumps and bumps surgery
Below are states where optometrists can perform small excision surgery on chalazia/hordeola:
- Alaska
- Arkansas
- Colorado
- Georgia
- Idaho
- Indiana
- Kentucky
- Louisiana
- Mississippi
- New Mexico
- Oklahoma
- Oregon
- South Dakota
- Tennessee
- Utah
- Virginia
- West Virginia
- Washington
- Wyoming
This list is a work in progress and we will continue to update this as new changes are made in our ever-so-dynamic profession. See a mistake? Let us know, and we will update it.
We are always working with state associations to keep this as up-to-date as possible! Thank you!
2023 optometric scope of practice expansions
Florida
Floridian ophthalmologists pushed to pass Bill SB230 which would ban the use of “optometric physicians” for optometrists in Florida. However, with support from optometrists, both on the state and national level, Governor Ron DeSantis opted to veto the bill on June 2, 2023.4
Washington
On May 9th, 2022, Gov. Jay Inslee signed into law a bill that authorizes optometrists in Washington state to excise chalazia (small lumps and bumps procedures), administer subconjunctival injections, and deliver topical or injectable anesthesia. Furthermore, they are now allowed to prescribe oral steroids.5
Texas
House Bill 1696 was signed into law on June 16, 2023, and took effect on September 1st, 2023. This bill is “groundbreaking legislation” with “first-in-the-nation” reforms.
After years of dealing with anti-competitive, anti-patient policies and requirements set by major health insurers and vision plans, this law limits insurance plans’ infringement on doctors’ independent judgment and patient choice caused by the lack of competition and absurdly low fee schedules through vertical integration and market consolidation.6
Specifically, the H.B. 1696 prevents:
- Patient Steering: Plans cannot encourage or incentivize patients to seek services at any particular in-network provider, or at locations, retailers, or e-commerce sites that the plan owns or affiliates with.
- Doctor Tiering: Plans cannot tier in-network providers based on noncovered service discounts, amount doctors spend on products or brands, etc.
- Practice Control: Plans cannot offer different fee schedules based on doctors’ practice or business decisions, such as lab or supplier choice or affiliations.
- Chargebacks: Plans cannot utilize chargebacks when the plan isn’t paying for the cost of goods to be delivered.
- Covered Services: Plans cannot call a product or service “covered” when there is no reimbursement from the plan to the doctor, nor can plans require doctors to provide a covered service or product at a loss.
- Requiring Unrelated Information on Claims: Plans cannot require reporting of unrelated or unneeded patient information to file a claim or receive reimbursement, e.g., prescription information or facial measurements.
- Extrapolation in Audits: Vision plans cannot use extrapolation as a technique to complete an audit.
Additionally, the Texas law requires plans to provide transparency about in- and out-of-network coverage for both patients and doctors, as well as a 90-day notice for contract changes. The law also empowers doctors to call out violations directly to the state.6
Optometry scope of practice abatement in 2023
California
California’s laser bill, A.B. 2236, which would have allowed optometrists to use therapeutic lasers, remove lesions, perform corneal crosslinking, and other advanced surgical procedures, was ultimately vetoed in September 2022 by Gov. Gavin Newsom.
Later, in February 2023, state legislation introduced bill A.B. 1570, which was the second attempt to pass identical legislation with some expanded stipulations. This bill is different from A.B. 2236 in that it requires California-practicing ODs to become certified in order to perform advanced procedures such as:7
- Glaucoma laser procedures (i.e., SLT / LPI)
- YAG laser for post-cataract surgery
- Lesion removals, including skin tags, cysts, and other non-cancerous growths
- Injections to treat various eye conditions in the subcutaneous, intramuscular, subconjunctival, and intralesional spaces
- Corneal collagen cross-linking (CXL) to treat keratoconus and other similar diseases
Unfortunately, following the bill’s passing by the California Assembly Business and Professions Committee, A.B. 1570 was later “held on submission” by the state’s Assembly Appropriations Committee Suspense File. This means there was no vote and no official reason provided.7
2024 changes in optometry scope of practice
South Dakota
On March 5th, 2024, Gov. Kristi Noem signed into law bill H.B. 1099, which will go into effect on July 1st, 2024.
This bill will allow optometrists to administer injections around the eyes as well as use local anesthetic for office-based surgical procedures including:8
- Intradermal injection of a paralytic agent
- Intralesional injection of steroid to treat a chalazion
- Local anesthetic in conjunction with primary removal of pedunculated skin tag
Furthermore, optometrists will be able to perform minor laser procedures, including YAG capsulotomy and SLT.
Optometrists will need to have proper education and training, including:
- Passage of a national examination on laser and injection procedures (graduates prior to July 1, 2024 will be grandfathered in).
- Passage of a 32-hour certification course to demonstrate competency.
- 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.
West Virginia
On April 3, 2024, bill H.B. 4783 bill was signed into law by Gov. Jim Justice, which would allow optometrists to perform minor and surgical procedures, including removal, biopsy, and treatment of non-malignant growths of the ocular adnexa. The state is still waiting to obtain approval for minor optometric laser procedures, including YAG, SLT, LPI, etc.9
Current optometry scope of practice proposals
Nebraska
Nebraska introduced bill L.B. 216 in 2023, which would allow optometrists to perform minor glaucoma procedures (SLT). There are no updates as of yet.9
Vermont
Senate Bill 233 received a first reading on January 9, 2024. This would allow optometrists to perform certain injection, removal of benign lid lesions, CXL, YAG capsulotomy, SLT, and LPI.
Strict qualifications such as a 32-hour course and board certification for injection and laser procedures as well as mandated surgical experience of living, human patients will have to be completed by any optometrist wishing to perform these procedures. The Office of Professional Regulations is currently in support of the bill.9
New Jersey
Two identical laser bills were introduced in May 2023 and failed to pass. As of January 2024, these two bills were reintroduced as bills A-920 and S-354.
The bills have not changed language since their initial introduction in 2023, which would allow optometrists to perform three laser procedures—SLT, YAG, and LPI—as well as remove styes/chalazia/skin tags.9
Ohio
S.B. 129 was first introduced to the Senate Health Committee June 2023 before summer recess. This year Ohio is gearing up again to pass this bill which would allow optometrists to remove benign lesions, cysts and skin tags, and perform minor laser procedures such as YAG, SLT, and LPI.
Furthermore, this bill seeks an update to optometrists’ pharmaceutical regulations that would permit the treatment of any eye condition as well as the use of epinephrine injection for anaphylactic shock.9
Utah
Of note, 2 years ago, laser bill S.B. 210 did not pass in the Senate. This year, Ohio is ramping up again to reintroduce a laser bill, H.B. 224, in which optometrists could perform YAG and SLT procedures.
Furthermore, Utah is working hard to defeat bill H.B. 189, which was introduced a few years ago and would prohibit prescribing doctors from selling contact lenses to their patients and must write a prescription for any and all contact lenses requested by the patient. This bill would also prevent specialty contact lens wearers from receiving their lenses within Utah.9
Washington, D.C.
Bill 25-0545 was introduced on December 6, 2023, which would permit and administer controlled substances related to the eye profession. The only US states besides DC that cannot prescribe controlled substances include Hawaii, Maryland, and New York. There have been no updates yet as of this year.10
Tennessee
Bill S.B. 1720 was introduced in the Tennessee Senate on January 11, 2024, which would be an amendment known as the Healthcare Provider Advertising Law.
This amendment would put conditions on the contents of a doctor’s printed, electronic, or oral advertisements to the general public, and add certain activities to and exempting certain activities from the definition of the practice of medicine.11
On a more positive note, H.B. 1295 was filed in January 2024 in the House, which would allow optometrists to advertise and use the verbage “optometric physician” or “doctor of optometry.”11
In closing
If you feel the scope of practice in your state would benefit by being expanded, consider getting involved with your state’s optometric association.
The AOA is dedicated to ensuring doctors of optometry can practice to the highest level of medical eyecare. They are always looking for new optometrists to help advocate and fight for the expansion of the scope of practice and even maintain our current laws.
It can be overwhelming for optometrists to navigate the legislative system and many don’t know where to begin. The first step is to join your local state optometric organization to learn how you can get involved.
To this end, the AOA has created an advocacy toolkit that helps optometrists understand the process of advocating for legislation and the ins and outs of political advocacy.12
