Ophthalmologists Win Eye Surgery Scope of Practice Battle

California optometrists lost their latest bid to expand their scope of practice when the state’s governor recently vetoed a bill that would have allowed them to perform laser and scalpel eye surgeries, long the domain of ophthalmologists.

Assembly Bill 2236 sought to permit optometrists who treat glaucoma to perform advanced procedures, including excision and drainage of small lesions, corneal crosslinking, administering injections for blocked glands in the eyelid, and using therapeutic lasers.

The California Optometric Association said the expanded scope of practice would improve access to eye care services, especially for Medi-Cal enrollees where rural ophthalmologist shortages have “created major bottlenecks in care for one in three Californians,” many of whom are people of color.

Opponents of the legislation — including the American Medical Association, California Medical Association, California Academy of Eye Physicians and Surgeons, and American Society of Retina Specialists — expressed concerns about scope creep (expanding scope of practice for non-physician healthcare professionals), patient safety, and unforeseen surgical complications.  

While the bill outlined additional training requirements, including 32 hours of continuing education and completion of 43 surgical procedures on live human patients, its passage  would have reduced the educational and training requirements to perform eye surgery in California.

To obtain an optometry license in California, an individual must complete a 4-year college degree and attend a 4-year optometry program. Ophthalmologists require a 4-year undergraduate degree, 4 years of medical school, and at least 3 years of residency.

California Gov. Gavin Newsom cited the difference in educational requirements in his decision to veto the bill. 

“I am not convinced that the education and training required is sufficient to prepare optometrists to perform the surgical procedures identified,” Newsom said in a press release. “This bill would allow optometrists to perform advanced surgical procedures with less than one year of training. In comparison, physicians who perform these procedures must complete at least a three-year residency program.”

In a statement released before the veto, another opponent of the bill, the American Academy of Ophthalmology, said that “Californians deserve far better than the substandard training and potentially dangerous care that would be allowed under AB 2236.”

More States Revising Optometrists’ Scope of Practice

The scope of practice for optometrists varies by state. Most states permit optometrists to prescribe oral steroids and administer injectables, though the latter is limited to treating anaphylaxis in 20 states.

This year, new laws in Virginia, Mississippi, and Colorado now allow optometrists to use lasers to treat ocular conditions, bringing the number of states with this expanded scope of practice to 10. Similar legislation has passed the state House in Utah and is pending review in the state Senate.

According to the National Conference of State Legislatures database, optometrists in California are limited to:

• performing procedures related to foreign body removal and the examination, evaluation, diagnosis, and treatment of the human eye;

• administering vaccines and all pharmaceutical agents for the diagnosis and treatment of eye diseases, including oral steroids and epinephrine auto-injections to counter anaphylaxis; and

• prescribing Schedule III-V controlled substances and Schedule II hydrocodone or hydrocodone combination medications.

Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.

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