This publication, founded in 1891, has advocated for scope of practice expansion literally since before the profession had settled on the name optometry for itself. Back when practitioners still called themselves opticians and only performed refraction and vision correction, the earliest incarnation of Review of Optometry began educating its readers on diagnostic screening. We were also at the front of the pack pushing for the DPA and TPA laws that re-engineered optometry into a primary eye care profession.
The next wave, of course, is surgery. Optometrists need to approach that vast sphere of eye care with caution and humility. Invasive intraocular surgery would be a bridge too far. Procedures that involve sterile ORs, sedation/anesthesia, systemic vital sign monitoring and access to emergency care all belong to the physicians trained for such responsibilities. But there are plenty of simple, low-risk procedures that patients need—and ophthalmologists aren’t always going to be available for in a timely fashion.
That’s why we’re kicking off our annual surgery issue with an article on the minor surgical procedures some ODs already perform and the rest seem destined to. We’re saying, in effect, “this is optometry now.” Not a special case to be reserved for unique circumstances, not something to be apologetic about around your MD colleagues—just plain old mainstream optometry. Of course, it comes with a huge caveat about the need to have the requisite skills, certifications and state licensing. But any OD familiar with scope of practice expansion knows how to navigate that terrain. Be smart, heed your mentors and don’t rush or overreach.
The case for expansion just got an unexpected endorsement from the Trump administration, as a federal report on the need for increased healthcare competition explicitly advocated for it. “Even well-intentioned regulations may impose unnecessary restrictions on provider supply and, therefore, competition,” the report notes. “When state regulators impose excessive entry barriers and undue restrictions,” the report goes on, “they often are not responding to legitimate consumer protection concerns.” Instead, “healthcare professionals with overlapping skill sets” push back against scope of practice expansion “as an easy, state-sanctioned opportunity to insulate themselves from competition.”
In other words, medical lobby: quit pushing the ‘patients at risk’ canard about the work of non-MDs. The solid track record of ODs who do have expanded privileges shows the fallacy of that fear-mongering.
Still, the American Academy of Ophthalmology tried to spin the report as consistent with its own messaging about the risks of ODs performing procedures. “Nation’s eye physicians and surgeons support executive branch’s emphasis on patient safety,” reads its statement. Of course everyone prioritizes safety—including the optometrists who perform these procedures. Absent any evidence of higher complication rates, organized medicine’s tired old narrative is played out. Optometry’s, meanwhile, is finally getting heard.