It sure took long enough. The push for optometric prescribing rights in glaucoma spanned 45 years, from West Virginia’s ground-breaking 1976 law to Massachusetts’ better-late-than-never authorization in 2021. But that isn’t the only reason optometry’s uptake of glaucoma responsibilities has been so unevenly distributed throughout the profession compared to other prescribing rights.
The cost of the necessary equipment and difficulties in billing medical insurance plans are the top two setbacks to fully embracing glaucoma care, optometrists told us in a 2020 reader survey. When you combine those logistical impediments with the time-consuming nature of glaucoma services and a generalized anxiety about making the wrong clinical call on a vision-threatening disease, it’s easy to see why a sizable number of optometrists decide to concentrate on other aspects of eyecare.
Trouble is, optometry is already moving on to the next level of glaucoma management: performing laser procedures like SLT and, to a lesser extent, LPI. The routine, day-to-day work of glaucoma care—performing tonometry, optic nerve evaluation, OCT and visual fields, then managing the patient medically—was once aspirational for many optometrists. Now, those are the table stakes.
The rising stature of SLT as a first-line therapy in glaucoma management dovetails nicely with the legislative gains that are now making it available to optometrists. The profession has an opportunity to transform itself, and the care glaucoma patients receive, in one fell swoop.
All the experts who teach SLT to ODs stress that it’s well within your skill set. Laser trabeculoplasty can delay the need for filtering surgery or other advanced aspects of care. If optometry embraces this new tool, patients can remain in their care for longer before comanagement or referral to ophthalmology is needed.
And the opportunity is poised to explode. Colorado’s recent success in passing a laser law brings the number of states with such privileges to 10. These laws currently give more than 5,000 US optometrists the right to perform laser procedures, or a bit over 10% of the country’s OD workforce.
But it won’t stay that way for long. California alone has just about the same number of practicing optometrists as the 10 current laser states combined—and it’s in play for a laser law too. In late June, a bill authorizing California ODs to perform laser and other minor surgical procedures cleared a key legislative hurdle.
If California gets a laser law this year, well, that’s the ballgame. Laser procedures would instantly vault into mainstream optometry and other states would have an even stronger case to make in their own scope expansion efforts. This would, of course, be welcome. But especially in glaucoma, not everyone’s ready to level up yet.
I encourage anyone who wishes they could do more to read this month’s cover story, “Taking the Lead on Glaucoma,” for advice from optometric experts in the disease. Whether you need to master the core components or are ready to make the jump to lasers, these pros can show you the path forward. Good luck!