Expanding Optometrists’ Role in Eye Care Improves Access

Patients across the United States face challenges accessing health care services, especially in rural areas where long-distance travel to see specialists is common. One critical area suffering from a shortage is eye care. Demand for services is surpassing the supply of ophthalmologists rapidly. At the same time, a large workforce of trained optometrists is constrained by regulations preventing them from performing necessary procedures.

One procedure, a YAG laser capsulotomy, addresses ‘secondary cataracts’ and is performed more than a dozen states by optometrists. This straightforward in-office procedure is crucial for treating cloudy vision that develops post-cataract surgery. While over half a million U.S. seniors receive this procedure yearly with excellent safety outcomes, it is only allowed to be performed by ophthalmologists in most states.

The limitation on optometrists impacts patient care. Data from 2020 shows that there were three times more optometrists than ophthalmologists in the U.S. While ophthalmologists are located mainly in urban areas, almost all Americans have access to optometrists within their own county. Consequently, patients requiring a YAG procedure endure long wait times and high travel costs when being seen by ophthalmologists.

Patient safety remains a concern for all stakeholders. However, optometrists undergo four years of doctoral eye care training in the U.S., often learning YAG surgery during their studies. They must pursue additional training or certification to perform YAG procedures. A review of 150,000 laser procedures by U.S. optometrists found negative outcomes in only 0.001 percent of cases, indicating safety. Such procedures have been safely carried out by optometrists in the U.K. and New Zealand for years.

A new policy brief from the Pacific Legal Foundation reveals that expanding optometrists’ scope to include YAG procedures significantly increases their usage. When comparing Medicare patient data from states that expanded the optometrist scope between 2013 and 2023, results show a 19 percent increase in YAG procedures compared to restrictive states. Those states that expanded scope before 2013 had 42 percent higher rates of YAG surgeries. This trend suggests better access to essential eye care.

Policymakers derive important insights from these findings. Firstly, scope-of-practice expansions lead to progressively greater effects over time, aligning with market adaptation to regulatory changes. States must act now to secure long-term benefits. Secondly, YAG utilization due to scope expansion is particularly pronounced in non-metropolitan areas. Geographically challenged patients significantly benefit when optometrists practice fully.

Such reforms have precedents, as many states have broadened practice laws for non-physician providers like nurse practitioners. These expansions generally lead to improved access, reduced costs, and increased system resilience. Just as other medical specialists have adapted, optometry should follow suit. Despite anticipated opposition from medical groups, the central focus should prioritize patient welfare.

As the U.S. population ages, eye care demands will escalate, intensifying the ophthalmologist shortage. To mitigate care delays, especially in underserved areas, all available resources must be utilized. Allowing optometrists to assume larger roles offers a simple, effective measure to ensure patients receive necessary services.

Kihwan Bae, Ph.D., serves as an assistant professor in the Department of General Business and 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 employed as a research analyst at the Knee Regulatory Research Center at West Virginia University.