Injections and Ophthalmic Lasers: Optometry Scope Broadens in South Dakota

In the latest move in the United States to expand optometry’s scope of practice, South Dakota has now authorized ODs statewide to perform ophthalmic laser treatments and injections. 

Governor Kristi Noem gave optometrists the nod on March 5, with authorization starting July 1 of this year. The newly passed legislation, South Dakota’s House Bill 1099 (HB 1099), brings intradermal injections, selective laser trabeculoplasty (SLT), and ytrium-aluminum-garnett (YAG) laser capsulotomies within the purview of South Dakota’s optometry practice.

The bill also adds educational requirements for optometrists wishing to add these novel procedures to their practice. While surgical and laser procedures have long been part of optometry education, ODs in South Dakota will now face a qualification process to perform them—a national exam, a 32-hour certification course, and supervised hands-on demonstrations of ability.¹ 

South Dakota’s approval of HB 1099 marks a significant shift in optometry practice, granting ODs access to a new echelon of treatment abilities. While proponents argue it addresses a shortage of ophthalmologists and improves access to care, dissenting voices have raised concerns about training adequacy and patient safety.

Bridging eye care gaps

As the state’s optometry community enthusiastically embraces the news, the conversation around OD scope of practice has heated up both locally and nationally. In the leadup to the bill’s passage and its aftermath, ODs and MDs alike have thrown down real talk and traded arguments over the legislation’s impact. 

One common refrain in the optometry community is equitable access to routine care. In a landscape where the demand for eye care is outpacing availability, South Dakota’s optometrists believe that the recent change comes as a strategic response to a shortage of ophthalmologists. 

A commonly cited study in Ophthalmology has revealed the extent of this shortage of OMDs, particularly in the rural areas that predominate in South Dakota.² Another piece of research by the American Optometric Association (AOA) Health Policy Institute (HPI), approximately 8% of the US population (25 million people) have access to an optometrist, but not an ophthalmologist.³

Education, training and controversy

Dissenting ophthalmologists’ most frequent complaint about expanding OD scope of practice revolves around the gulf in the length and rigor of a medical degree compared to its optometric equivalent.

“[HB 1099] would dilute the qualifications needed to operate on your eye,” wrote Dr. Mike Eide, President of the South Dakota Academy of Ophthalmology (SDOA), in a guest column for the Dakota Scout. ⁴

“Optometrists—who are not medical doctors or trained surgeons and lack proper medical and surgical training—would be granted permission to perform delicate eye surgeries with insufficient training.”

OMDs argue that a 32-hour course is a far cry from the thousands of hours of training they must undertake for their medical degrees. For many ophthalmologists, this raises questions about the preparedness and judgment of optometrists performing these procedures as well as concerns over patient safety. 

Optometrists, however, have continued to assert that their education and training are sufficient in the days surrounding the bill’s passing.

Navigating new vistas

South Dakota’s HB 1099 now steers the state’s optometrists into a new era. ODs in the Midwestern state now have access to a spectrum of practices previously reserved for ophthalmologists.

The ramifications for patient safety and the economic dynamics of eye care have generated candid dialogue over access to service, qualifications and patient safety. And with many other counterpart bills currently under debate in legislatures across the United States, the conversation is far from over.

But as South Dakota forges ahead, the conversation remains a dynamic and essential one in reshaping the landscape of eye care.

References:

1. An Act to establish educational standards for the expanded practice of optometry. House Bill 1099. South Dakota 99th Legislative Session. Available at: https://sdlegislature.gov/Session/Bill/24412/266241 Accessed on 9 March 2024. 
2. Berkowitz ST, Finn AP, Parikh R, et al. Ophthalmology workforce projections in the United States, 2020 to 2035. Ophthalmology. 2024;131(2):133-139.
3. American Optometric Association Health Policy Institute. County data demonstrates eye care access nationwide. Available at: https://www.aoa.org/AOA/Documents/Advocacy/HPI/County%20Data%20Demonstrates%20Eye%20Care%20Access%20Nationwide.pdf Accessed on 9 March 2024.
4. Eide, Mike. “VIEWPOINT: No compromises for eye surgery.” The Dakota Scout (South Dakota), 29 January 2024. Available at: https://www.thedakotascout.com/p/viewpoint-no-compromises-for-eye Accessed on 12 March 2024.