Alabama's recent scope bill made it through the Senate, but not the House. Photo: Carol M. Highsmith/Library of Congress.

It’s been 27 years since Alabama has expanded the state’s optometric scope of practice—and things will stay that way for now after the defeat of a recent bill. Optometrists in 21 states are currently allowed to do more than those who practice in Alabama, including perform various types of ocular surgeries, lesion removal and administer injections. Eager to update the law to match the current education and training of optometrists, which has greatly evolved since the state’s last scope bill passed in 1995, the Alabama Optometric Association (ALOA), along with the State Government Relations Committee and the American Optometric Association, has been working for five years to try and pass a bill that better reflects the capabilities of today’s ODs.

In March, SB 120 passed the Senate with a vote of 17 to 12. The bill would allow optometrists with the proper training to perform several advanced procedures: YAG capsulotomy, laser peripheral iridotomy, selective laser trabeculoplasty (SLT), removal of chalazia or other skin lesions around the eyelid, corneal crosslinking and injections near the eye or within the most superficial layers. For residents of the 31 counties in Alabama where optometrists are the only eyecare providers, the bill would make these services more accessible and reduce the need for patients to travel to receive potentially visionsaving treatment.

Unfortunately, after moving forward to a public hearing before the House Health Committee, the bill did not pass. “The session ended, and we didn’t get a vote in the House because we ran out of time, which ultimately is because of the power of our opposition,” explains Caleb Gardner, OD, president of the ALOA. “There was opposition from medicine, ophthalmology and the medical association of the state of Alabama, who all fought really hard against this bill.”

Dr. Gardner says that although ODs and scope expansion advocates in the state have been making an increasing level of effort to advocate for SB 120, the momentum must continue to build to push for change before the bill is again put before the Senate.

“I think optometry just really woke up in Alabama toward the end of February when we decided that if we’re going to get this done, it was going to take our own boots on the ground; we can’t just farm this out to third parties like lobbyists, although they are an important part and we thank them for the work that they do,” says Dr. Gardner. “But, optometrists in Alabama have to get out, shake hands, make donations, work in campaigns and build relationships with their legislators if we're ever going to get this done.”

Dr. Gardner says he is optimistic about the future of the bill, especially since several US states have recently been successful passing similar laws.

“Even though we lost this year, which did feel like a punch in the gut after all the work we put into it, we learned some lessons the hard way, and now we’re in a place where we’re communicating with each other and are really working hard and focused on getting this done,” he says. “We’d love to get it done next year, but we know that it could be a long battle. After this recent loss, I think there’s a lot of optometrists in Alabama who are in this fight for the long haul, which is great.”

The ALOA created a task force earlier this year for scope expansion that will continue to discuss and potentially make amendments to the bill before it’s reintroduced to the Senate in 2023. “Optometry in Alabama is now awake,” says Dr. Gardner. “We know that this is what’s best for access to care for our patients, and we are committed to seeing this through whether it takes one year or 10. We’ll keep learning lessons and coming back. We’ll lean on our friends who have done it to gain wisdom from them as we try to go forward and make next year better than this year was.”

Despite this recent setback for AL, other states are continuing to push their own legislative battles forward. The Nebraska Optometric Association (NOA) introduced an initial request to the Department of Health and Human Services that would allow ODs in the state to perform SLT to treat glaucoma. The state formed a technical review committee to oversee the request, which held its first hearing on April 7th and plans to hold a second on June 7th. Presentations were heard from both the NOA and the opposition, and both answered questions from the committee. Janet Seelhoff, executive director of the NOA, says they anticipate having the bill ready to introduce in January 2023.

“We really hope that this goes favorably for our members and so that Nebraskans can receive SLT treatment for glaucoma,” says Mrs. Seelhoff. “There’s definitely a need for it, and this will be a great opportunity to enhance the scope of practice. It’s all about access to care and services, and this future bill would help a lot.”