Expanding Optometrists’ Scope to Improve Eye Care Access

Across the United States, many patients face challenges in accessing healthcare services, especially those in rural areas. Here, traveling long distances for specialized care is increasingly common. Eye care is a particular area of concern, where the demand for services exceeds the supply of ophthalmologists. Despite this, a substantial workforce of optometrists remains restricted by laws that limit their ability to perform routine and necessary procedures.

For example, over a dozen states allow optometrists to perform YAG laser capsulotomy. This is a straightforward, in-office procedure for treating “secondary cataracts,” which often occur after cataract surgery, resulting in cloudy vision. This procedure is performed over half a million times annually in the U.S. It has an excellent safety record. Nevertheless, in most states, only ophthalmologists are authorized to perform it.

This restriction on optometrists impacts patients significantly. In 2020, there were about three times as many optometrists as ophthalmologists in the U.S. Ophthalmologists mostly work in cities, while over 99% of Americans have access to a practicing optometrist close by. Consequently, patients needing a YAG laser capsulotomy often wait long periods and incur high travel expenses to see an ophthalmologist.

Concerns about patient safety are understandable, yet generally unwarranted in this scenario. Optometrists undergo four years of doctoral training in eye care in the U.S. This training includes YAG surgery or requires additional certification for the procedure. A study of nearly 150,000 laser procedures by optometrists found only 0.001% had negative outcomes, demonstrating high safety levels. In the UK and New Zealand, optometrists have safely conducted such procedures for years.

A policy brief from the Pacific Legal Foundation shows that expanding optometrists’ scope of practice to include YAG procedures leads to a noticeable rise in their use. Adjusted for population, Medicare patients in states with expanded optometrist roles between 2013 and 2023 had 19% more YAG procedures than those in states with restrictive practices. Notably, those states expanding such practices before 2013 had 42% higher rates of YAG surgeries.

This trend implies better access to essential eye care when optometrists are allowed to use their full training. Patients otherwise untreated due to travel difficulties, scheduling delays, or lack of specialist availability receive necessary treatment.

Policymakers can learn two vital lessons from these findings. First, the benefits of expanding scope-of-practice regulations appear to increase over time as the eye care market adjusts. States should act promptly for maximum long-term advantages. Second, the rise in YAG procedures is particularly notable in non-metropolitan areas, where access issues are more severe.

This type of reform is not new. Over the last two decades, many states have broadened scope-of-practice for non-physician providers, like nurse practitioners and physician assistants. The positive evidence from these expansions is clear: access improves, costs decrease, and the healthcare system adapts better. Optometry should follow suit.

Opposition from organized ophthalmology groups is expected. These professional boundary disputes have long existed in medicine. The focus should be on patient outcomes, not procedural control. As the U.S. population grows older, and the demand for eye care increases, the ophthalmologist shortage will worsen. To reduce delays in care, especially in neglected areas, every resource must be used. Allowing optometrists greater scope is an efficient and effective measure to ensure patients receive necessary care.

Kihwan Bae, Ph.D., serves as an assistant professor in the Department of General Business and as a research fellow at the Knee Regulatory Research Center in the John Chambers College of Business and Economics at West Virginia University. Liam Sigaud is a research analyst at the Knee Regulatory Research Center at West Virginia University.