A new bill with bipartisan support in the New Hampshire State Senate would be one of the most dramatic expansions of optometric scope of practice yet. Resistance to the bill is already heating up.
After a 2023 chock full of controversy over the expanding scope of practice of optometrists in the United States, 2024 has started off with a bang in New Hampshire with the proposal of Senate Bill 440 (SB 440).1
In this latest flashpoint in the battle over what procedures optometrists are legally allowed to perform, SB 440 would represent one of the largest-ever single expansions of OD practice in the United States if passed.
Among other changes, the bill would permit optometrists to perform a wide variety of laser and incisional surgeries.
When added to the state’s permission of its optometrists to treat and diagnose glaucoma and prescribe and even dispense a variety of medications, SB440 would give New Hampshire ODs one of the broadest scopes of practice in the country, if not the world.
The bill still has a long journey to becoming law. SB 440 was introduced by a moderately bipartisan (7 Republicans, 2 Democrats) group of legislators, and will face its first public hearing in the New Hampshire Senate on January 17, 2024.
Sweeping changes already meeting local OMD resistance
One of the bill’s defining features is its provision for lifting a blanket ban for ODs on all ophthalmic surgeries and replacing it with a list of specific off-limits procedures.
Text of the proposed Senate Bill 440
The potential implications of defining the scope of practice by negation have already drawn the ire of at least one New Hampshire-based ophthalmologist.
In an opinion piece published on the web-based NH Journal, Dr. Kimberly Licciardi argued against the bill and warned of its consequences for sight in New Hampshire.2
“While SB 440 contains a short list of “prohibited” surgeries, optometrists would be authorized to perform any other eye-related surgery not listed—potentially hundreds of surgical procedures,” Dr. Licciardi wrote.
“All surgical procedures involving the eye and its surrounding regions demand meticulous attention and expertise, as any mistakes can have severe consequences,” she continued.
“[G]ranting optometrists the authority to conduct surgeries with negligible training utilizing surgical tools, such as scalpels, to remove potentially cancerous skin lesions and lasers to perform glaucoma and post-cataract surgery is not the solution New Hampshire citizens need or deserve.”
The eye of the storm over scope of practice
Dr. Licciardi’s comments echo the heart of the debate surrounding optometrists performing procedures under the purview of ophthalmologists. Many OMDs argue that optometrists lack the necessary skills and expertise gained over long years of medical school and residency, and the cost of a mistake is too high.
Optometrists, on the other hand, feel that their degree programs are more than comprehensive enough to cover procedures and treatments they are fighting to access. They further argue that a worldwide shortfall of ophthalmologists necessitates ODs shouldering more of the eye care burden–and that not doing so endangers patient vision.
With each side of the OMD-OD divide presenting their own evidence to make their case, an end to scope-of-practice turf battles is far out of sight.
2023 was a particularly contentious year. Florida optometrists were a Gov. Ron DeSantis veto away from losing their titles as doctors and physicians. Alabama’s HB 349, which would have cleared ODs to perform capsulotomy, trabeculoplasty, skin lesion removal, fluorescein angiography and more, died unceremoniously in its Senate Committee after steamrolling through the House with a 78-9 vote in favor.
There’s no letdown in sight for 2024, either. Similar to New Hampshire, Vermont looks poised to put lasers on the OD menu after a September 2023 revision by the Office of Professional Regulation on the topic. California looks to make a similar move with the introduction of AB 1570, a laser-only version of a bill crushed by a Gov. Gavin Newsom veto in late 2022.
With each state regulating its own certification and scope of practice for optometry, the conditions for a flurry of new legislation are ripe.
References:
- Relative to the board of optometry and the regulation of optometry, SB 440, 168th New Hampshire General Court (2024). https://gencourt.state.nh.us/bill_status/legacy/bs2016/billText.aspx?sy=2024&id=2116&txtFormat=html
- Licciardi, K. (2024, January 14). Licciardi: SB 440 puts Surgical Eye Safety at risk and should be rejected. NH Journal. https://nhjournal.com/licciardi-sb-440-puts-surgical-eye-safety-at-risk-and-should-be-rejected/