Across the United States, many patients struggle to access health care services. This issue is especially pronounced in rural areas where long trips to see a specialist are common. Eye care is one area suffering from acute shortages, with demand for services outstripping the supply of available ophthalmologists.
A significant untapped resource exists in the large number of optometrists trained and ready to perform necessary procedures, hindered by laws restricting practice capabilities. More than a dozen states allow optometrists to perform a procedure known as YAG laser capsulotomy. This simple procedure treats ‘secondary cataracts,’ a common post-cataract surgery condition leading to cloudy vision. Each year, over half a million elderly Americans undergo this procedure with a remarkable safety record. Yet, in most states, only ophthalmologists can perform it.
Limits on what optometrists can do impact patients. In 2020, the U.S. had about three times as many optometrists as ophthalmologists. Optometrists practice in nearly every U.S. county while ophthalmologists are mainly in urban areas. This leads to long wait times and costly travels for patients requiring YAG procedures.
Concerns over patient safety arise, but these fears lack substantial foundation. Optometrists receive four years of doctoral training in eye care, including YAG surgery within their curriculum. Additional training or certification is required if not part of their formal education. Data from the U.S. shows only 0.001 percent of nearly 150,000 laser procedures by optometrists result in negative outcomes, demonstrating high safety levels. Countries like the U.K. and New Zealand have a record of safe optometrist-performed procedures.
A policy brief from the Pacific Legal Foundation found that where optometrists’ scope of practice includes YAG procedures, usage significantly rises. States that permitted more optometrist involvement saw 19 percent more YAG procedures within Medicare populations between 2013 and 2023 compared to restrictive states.
Moreover, states adopting these expansions before 2013 showed a 42 percent increase over restrictive states. These patterns indicate that expanding optometrists’ capabilities enhances access to critical eye care. Patients previously challenged by travel, scheduling, or accessibility hurdles obtain necessary care.
Policymakers glean additional insights: benefits of expanded scope-of-practice grow over time. Therefore, long-term advantages require immediate action. Additionally, data shows non-metropolitan areas gain more from these expansions, aiding those with severe access barriers the most.
Such reforms mirror broader trends seen over two decades. Many states have extended practice scopes for non-physician providers like nurse practitioners and physician assistants, improving access, reducing costs, and adding healthcare system flexibility.
Optometry should follow this path, despite expected opposition from professional ophthalmology groups guarding procedural turf. However, the focus must remain on patient benefit. With an aging population increasing eye care needs, deepening ophthalmologist shortages loom. To cut care delays in underserved communities, utilizing optometrists’ full capabilities is a simple, effective strategy.
Authors Kihwan Bae, Ph.D., assistant professor at West Virginia University, and Liam Sigaud, research analyst at the university, emphasize the pressing need for such reforms.
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