If passed, California's scope bill would permit the states' ODs to perform a number of advanced procedures.

If passed, California's scope bill would permit the states' ODs to perform a number of advanced procedures. Click image to enlarge.

Optometrists and their advocates across the country have been working tirelessly to pass legislation that will expand the profession’s scope of practice to align with current optometric training and education. Efforts have paid off in several states over the last few years, the most recent win being in Colorado just last month when the state became the tenth to allow ODs to perform certain laser procedures and other office-based minor surgeries. This spring, Virginia also passed such a law.

This scope expansion wave is far from over; another state—the third largest in the country with the highest number of employed optometrists—is aiming to make its way onto the list: California.

The Golden State’s scope bill, AB 2236, would allow its nearly 7,000 optometrists with the proper certification to perform the following:

  • Three types of laser procedures, including therapeutic lasers appropriate for the treatment of glaucoma, peripheral iridotomy for the prophylactic treatment of angle-closure glaucoma and posterior capsulotomy secondary to cataract surgery.

  • Lesion removal: skin tabs, cysts and other lesions that are non-cancerous.

  • Injections to treat eye conditions (subcutaneous, intramuscular, subconjunctival and intralesional injections).

  • Corneal crosslinking.

On June 27, the bill passed the Senate Business and Professions Committee with a nine-to-one vote. Next up: on August 1, it will be heard in Senate Appropriations and then go to the full Senate for a vote.

Kristine Shultz, executive director of the California Optometric Association, says, “All optometric colleges say their curricula currently cover the teaching of ophthalmic procedures and their graduates are trained to perform these therapies.” ODs who graduated before these procedures were included in the curriculum will have to complete several certification requirements before taking advantage of practice privileges under the new law—but they’re not the only ones. Newer graduates will also require further training.

“This bill adds additional training that includes procedures on live humans in an attempt to address the opposition’s concerns,” Mrs. Shultz explains. “The proposed training required for this certification includes a three-step process,” as follows:

  • Completion of a 32-hour course that requires a specified amount of practice in performing the procedures on simulated eyes.

  • Passage of the national board’s Laser and Surgical Procedure Examination.

  • Completion of additional training to include direct experience with “as many live human patients as needed to ensure competency,” Mrs. Shultz says. “This could be done via clinical rotations or a preceptorship administered by an accredited optometry college.” At minimum, the bill requires each optometrist to complete a total of 29 procedures combined on live humans before they can become certified.

Amanda Dexter, OD, president of the California Optometric Association, says, “This legislation is needed so that patients will have increased access to quality eye care. In some California counties, Medicaid patients must wait months to get in with an ophthalmologist,” she points out. “Optometrists already provide 81% of the eye care under California’s Medicaid program. Optometrists are located in almost every county in California and are well situated to bridge the provider gap for these eye conditions that are becoming more common as our population ages.”

Texas, Florida and Pennsylvania follow California in the list of US states with the most optometrists; still, when weighed against any one of these individually, the state of California employs more than two times as many ODs. If voted into law, California’s scope bill would act as an influential precedent for the safety and value of optometric scope expansion in other US states.