I started covering optometry way back in 1991. Then, authors had to mail in their articles on floppy discs and we would send them edits on a new high-tech device called a fax machine. That feels like a prehistoric time compared to now. Also, so much has changed clinically since then that it’s practically a brand-new profession. But one thing hasn’t changed: the way scope of practice expansion efforts play out.
Back in the early 1990s, the drive for TPA laws was still raging. I wrote many news stories that followed a familiar theme. The state optometric association lobbied legislators to allow optometric prescribing rights, citing structural inefficiencies in the system and the subsequent burden placed on patients: delayed care, excessive travel time to ophthalmology offices and disruption of the doctor-patient relationship. Then some MD would fulminate in a newspaper editorial about the imminent harm to patients—from an OD prescribing TobraDex. The state legislators would do some political calculation and then, if the bill failed, everything would start up again the next year. Lather. Rinse. Repeat.
The same pattern played out over and over until we got good or at least decent TPA laws everywhere—except in poor, benighted Massachusetts, where ODs still can’t prescribe glaucoma drugs. There’s another bill up for consideration in the current legislative session there, of course.
Anyway, when news hit that a recent scope of practice expansion bill failed in Arkansas, the local ODs were right to shrug it off. “We have the utmost confidence for eventual scope expansion in the future,” said Belinda Starkey, OD, president of the Arkansas Optometric Association.
The bill would have allowed Arkansas ODs to perform lid lesion removal and minor procedures like SLT. Arkansas, situated between two states that allow laser procedures for optometrists (Oklahoma and Louisiana), does feel like an inevitable win one day. A patient living in a border town could hop in a car, drive west or south and be in the chair of an OD with laser privileges within an hour. Why not in-state, too?
That inconsistent access warps delivery of care. For instance, SLT is increasingly being considered early in the course of glaucoma, sometimes even as a first-line therapy. ODs in non-laser states will have to rely more on medication-based regimens, constraining their ability to provide the best care possible, or they’ll have to refer to a glaucoma surgeon—inconveniencing and confusing the patient in the process.
Expect these ‘lesions and lasers’ bills to dominate the scope expansion conversation for the next decade. And we’ll see both sides run the same legislative playbook from the DPA and TPA eras, with results much the same. Success for optometry in every statehouse isn’t guaranteed, but the forthcoming battles will be more tedious than tense. Many wins are just a matter of time.
Eventually, once the stakeholders make peace with optometric primary eye care, this Groundhog Day loop will finally end and everyone, MDs included, will be better off.