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 Administration.
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” that 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 optometry scope of practice in your state?
To communicate this, we’ve developed an infographic showing the optometry scope of practice in each state to easily compare the scope in each state and the progress optometry has made!
1. Oral medication authority optometry scope of practice
As of October 2021, optometrists in all states now have oral medication authority! However, the type of oral medication varies between states. All states can prescribe certain oral antibiotics and antiviral medications to treat ocular conditions but only some can treat with oral steroids.
2. Glaucoma treatment optometry scope of practice
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 optometry scope of practice
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
- Michigan
- Minnesota
- New York
- South Carolina
- Washington, DC
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
- Maryland
- Massachusetts
- 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 optometry scope of practice
In these states, optometrists can provide injectables to both treat anaphylactic shock (EpiPen) and intradermal injections (anesthesia/steroids) when treating chalazion/hordeolums.
States where optometrists can treat anaphylaxis and other needs:
- Alaska
- Arkansas
- California
- Colorado
- Georgia
- Idaho
- Illinois
- Indiana
- Iowa
- Kentucky
- Louisiana
- Minnesota
- Mississippi
- Montana
- New Hampshire
- New Jersey
- 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
- Maine
- Maryland
- Nebraska
- Ohio
- Pennsylvania
- Texas
- Vermont
- Washington, DC
5. Lasers authority (LPI, SLT, ALT, YAG capsulotomy) optometry scope of practice
In these states, optometrists can use lasers to treat ocular conditions such as post-cataract haze (YAG), minor glaucoma laser procedures (SLT/LPI), and refractive surgery procedures (photorefractive keratectomy [PRK]).
States where optometrists have varying laser authority:
- Alaska: YAG Capsulotomy / ALT / SLT / LPI
- Arkansas: YAG Capsulotomy / ALT / SLT
- Colorado: YAG Capsulotomy/ ALT / SLT / LPI
- Indiana: YAG Capsulotomy / ALT / SLT / LPI
- Kansas: YAG Capsulotomy / ALT / SLT / LPI
- Kentucky: YAG Capsulotomy / ALT / SLT / LPI
- Louisiana: YAG Capsulotomy / ALT / SLT / LPI
- Montana: anterior segment laser surgical procedures (types of procedures not explicitly specified)
- Mississippi: YAG Capsulotomy
- Oklahoma: YAG Capsulotomy / ALT / SLT / LPI / PRK
- South Dakota: YAG capsulotomy/ SLT
- Tennessee: YAG Capsulotomy / SLT / LPI
- Virginia: YAG Capsulotomy / SLT / LPI
- West Virginia: YAG Capsulotomy / SLT / LPI
- Wisconsin: State laws grant licensed optometrists laser privileges based on the clinician’s education, training, and expertise. No specific procedures are specified.
- Wyoming: YAG Capsulotomy / SLT / LPI
6. Lumps and bumps optometry scope of practice
Optometrists can perform small excision surgery on chalazia/hordeolums:
- 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!
2025 optometry scope of practice expansions
Montana
On April 16, 2025, Gov. Greg Gianforte signed HB 218 into law, with an effective date on July 1, 2025, officially expanding optometric scope in Montana.
The bill authorizes optometrists to perform laser surgical procedures limited to the anterior chamber of the eye and the adnexa. This bill brings laser procedures like YAG posterior capsulotomy, selective laser trabeculoplasty (SLT), and laser peripheral iridotomy (LPI) into optometric practice.5
But it’s not just about lasers! This bill loosens the restriction of medications, moving away from rigid formulary towards a broader authority for diagnosing and evaluating ocular conditions.5
With this bill, Montana joins as one of the 16 states nationwide, as of today, that permits optometrists to perform ophthalmic laser procedures, marking another step forward to optometric scope expansion and expanded access to eye care.
West Virginia
On May 1, 2025, Senate Bill 565 (SB 565) officially became law in West Virginia that took effect on July 9, 2025.6 So, what’s actually in it? West Virginia gets a level up.
Laser surgical procedures including posterior capsulotomy, peripheral iridotomy, and selective laser trabeculoplasty are now permitted! Unlike HB 218 in Montana, this bill does not have blanket rules of restriction to specific anatomic structures, rather it specifies which procedures are permitted.
What’s the plus side? The new bill opens room for scope expansion if it meets two major criterions: (1) FDA approval for treatment of ocular conditions and (2) if it's widely accepted in clinical practice with appropriate training.7
Moving forward, this marks West Virginia as the 14th state in 2025 to receive laser procedures!
Optometry scope of practice abatement in 2024 to 2025
Florida
During the 2025 legislative session, Florida House Bill 449 (HB 449) died in rules, meaning the bill was not formally voted down and rather it was not scheduled for final consideration. Unfortunately, this house bill did not advance through the Senate Rules process to reach a floor vote.8
What’s the importance of HB 449? This bill would have allowed optometrists to:9
- Perform laser procedures such as selective laser trabeculoplasty and YAG posterior capsulotomy.
- Conduct minor surgical procedures limited to external eyelid and periocular procedures such as chalazion incisions and removal of benign eyelid lesions.
- Expand medication rights allowing optometrists to prescribe oral medications for certain ocular disease management.
What now? Since the bill died in session, it would need to be reintroduced in a future legislative session, typically with revisions and renewed sponsorship support.
New Mexico
On March 22, 2025, House Bill 36 (HB 36) was vetoed by Governor Grisham even though the bill passed in both chambers, house and senate. Why? Governor Grisham argued there was insufficient evidence that the bill’s expanded scope would improve access to quality eye care.10
Well, what was the bill expanding on? If HB 36 passed, optometrists would have been allowed to perform:11
- Laser procedures such as LPI, SLT and YAG posterior capsulotomy
- Minor surgical procedures that are limited to the periocular region such as removal of superficial eyelid lesions
Although the bill was vetoed by the governor, it gained strong momentum by passing both chambers, highlighting the need to rebuild support and address opposition concerns in future efforts to move the bill forward.
2025 to 2026 changes in optometry scope of practice
Kansas
On March 12th, 2026, Governor Laura Kelly signed into law Kansas House Bill 2223 (HB 2223), which expanded optometric scope of practice in Kansas following its continuation from the 2025 legislative session.12
This bill allows optometrists to perform expanded ophthalmic procedures, including:12
- Ophthalmic laser procedures such as SLT, YAG posterior capsulotomy, and laser peripheral iridotomy.
- Limited minor eyelid and external ocular procedures within defined training parameters.
- Use of local anesthesia and periocular therapeutic interventions in office-based care.
Furthermore, optometrists will have expanded authority in medical management of ocular disease, including updated prescribing capabilities for conditions such as glaucoma and post-operative care.
Tennessee
In March 2026, Tennessee’s optometry scope expansion legislation officially became law (HB1952), marking a significant advancement in the state’s optometric practice act.13
What does this change include? This bill allows optometrists to perform:
- Laser surgical procedures including SLT and YAG posterior capsulotomy with appropriate training and certification.
- External eyelid and periocular procedures under defined training and safety requirements.14
Moving forward, this marks Tennessee as the 16th state as of 2026 to adopt laser-based optometric surgical authority, further expanding access to in-office eye care services.
Vermont
In June 18, 2026, Vermont became the 17th state to authorize optometric laser procedures and the third state in 2026 to modernize optometric practice, creating an Advanced Therapeutic Procedures Specialty License.15
Beginning July 1, 2028, qualified Vermont optometrists who complete the required specialty license will be authorized to perform specific laser procedures, injections, and minor surgical procedures.15
Current optometry scope of practice proposals
New Hampshire
During the 2026 legislative cycle, New Hampshire House Bill 349 (HB 349) successfully passed the legislature but was ultimately vetoed by the governor, meaning it did not become law despite advancing through both chambers. The bill generated significant momentum but did not move forward into implementation.16
What’s the importance of HB 349? This bill would have allowed optometrists to:
- Perform ophthalmic laser procedures such as selective laser trabeculoplasty, YAG posterior capsulotomy, and other board-defined anterior segment laser procedures.
- Conduct limited minor ophthalmic procedures under defined training and certification requirements, focused on external and periocular care.
What now? Since the bill was vetoed, it did not become law and optometric scope in New Hampshire remains unchanged. Any future advancement would require reintroduction of revised legislation with additional stakeholder support to address concerns raised during the veto process.
Maine
The Maine Legislative Document 1803 (LD 1803) was first introduced to expand the scope of practice for optometrists, allowing for laser surgical procedures and minor surgical procedures. However, the legislative document ultimately failed to pass due to disagreement between the House and Senate.
The bill reached late-stage consideration, but on April 13, 2026, it “died between houses,” meaning it did not become law despite significant progress.17 Since the House and Senate could not agree on final amendments, the bill is considered dead for the session, meaning optometric scope in Maine remains unchanged
Ohio
After the expiration of Senate Bill 129 (SB 129), Ohio lawmakers reintroduced the legislation in 2025 as Senate Bill 36 (SB 36), reigniting the long-standing debate over optometric scope expansion such as laser procedures.
The bill is currently awaiting further action in the Ohio Senate Health Committee, where it remains under review as stakeholders in optometry continue to advocate for their positions in 2026.18,19
New Jersey
Following the failure of prior scope expansion efforts, New Jersey lawmakers reintroduced the initiative in 2026 as Senate Bill 178 (S178) and its companion Assembly Bill A1696, renewing efforts to expand optometric scope of practice such as laser procedures including selective laser trabeculoplasty, capsulotomy, and iridotomy and minor surgical procedures including excision of skin tags and treatments of chalazions.19,20
The legislation is currently awaiting further action in their respective committees, where they remain under review as stakeholders in optometry continue to advocate for expanded procedural authority heading into 2026.
South Carolina
On April 15, 2026, South Carolina House Bill 4103 (HB 4103) was sent back to the House Labor, Commerce and Industry Committee, effectively stalling its momentum for the session and signaling that more revisions are needed before it can move forward.21 Had HB 4103 passed, it would have significantly expanded optometrists’ scope of practice, including the ability to perform certain laser procedures and broaden prescribing authority.
For now, South Carolina law remains unchanged—but the conversation is far from over. Any future push to expand optometric scope will likely return in a revised form, with lawmakers working to address concerns raised in committee and build enough support to carry it across the finish line.
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.22
