The  recent policy change brings ODs in the VA system to parity with the rest of their in-state colleagues. Photo: US Department of Veterans Affairs.

Optometrists employed by the US Department of Veterans Affairs must comply with the organization’s national standard of practice guidelines, which previously denied ODs the ability to perform invasive ocular procedures, even if permissible in their state of licensure. However, thanks to a recent update to the language in these guidelines, VA optometrists—rather than exclusively ophthalmologists—are allowed to perform various advanced ocular procedures, including laser and other types of eye surgery, injections and lesion removal based on the scope of practice of each provider’s state of licensure.

The change comes following persistent advocacy from the American Optometric Association (AOA), the Armed Forces Optometric Society (AFOS), the Mississippi Optometric Association (MOA) and members of Congress, after one recent circumstance brought attention to the need for VA guidelines to be modified to reflect the current scope of practice.

“In March 2022, a Mississippi doctor of optometry providing routine care to a veteran in the community was denied coverage by the local VA system to diagnose and treat trichiasis with entropion due to the former language in the Eye Comprehensive Standardized Episode of Care,” noted a story on the AOA’s website about the win.¹ “The VA reportedly suggested that the doctor refer the veteran to an ophthalmologist nearly 60 miles away for needed epilation.”

In response to concerns from vets, lawmakers and organizations including the MOA, AOA and AFOS, the VA changed the language of these guidelines to state “an ophthalmologist or optometrist can perform invasive procedures, including injections, lasers and eye surgery.” 

In 2021, Mississippi lawmakers expanded the state’s scope of practice for ODs to include injections, excision and removal of non-cancerous lid lesions and chalazion, YAG capsulotomy and greater prescribing authority. Several other states have added advanced procedures to their optometric scope of practice in the last several years, including Alaska (2017), Arkansas (2019), Wyoming (2021) and just this year, Virginia and Colorado. Now, ODs with the VA in any of these states will be able to take advantage of the new practice rights and offer a higher level of care to veterans, which Kris May, OD, legislative chair of the Mississippi Optometric Association, notes is the most important factor.

“Many states have expanded their scope of practice for optometrists, recognizing their training and abilities can provide expanded access and excellent care for their residents,” says Dr. May. “It is encouraging to see the Veterans Administration decide to do the same. My hope is that this model carries forward into the VA's national standard of practice guidelines and nationally expanded scope of practice for VA optometrists so our veterans continue to have access to the care they deserve.”

Stacie Moore, OD, MOA president, adds that because of the language change, “veterans now have an expanded list of licensed optometrists for services allowing for time-efficient, quality eye care.” Dr. Moore also notes that “the language change builds momentum for a national expanded scope of practice for VA optometrists. Veterans should have access to eyecare services nationally based on each provider’s state licensure.”

Marc Myers, OD, who has worked with the VA for over 15 years, agrees that “ultimately, the primary benefactor, both locally and nationally, is veterans who benefit from improved access to quality eye care.”

A recent article on American Academy of Ophthalmology’s website pushing back on the VA’s decision states that “ophthalmology department chairs of several leading medical schools are concerned that a recent change to the Veteran’ Health Administration’s Community Care Program guidelines will put veterans’ eye care in significant jeopardy,” adding that 10 letters were received so far.² The article cites differences in surgical training standards for optometrists vs. ophthalmologists as the primary reason for opposing the change.

The VA has been working towards establishing a national standard of practice that would allow any licensed OD within the VA system to perform procedures the agency designates, superceding individual state scope regulations. The Federal Supremacy Project, as it’s called, will set scope parameters for at least 50 different healthcare professions that provide care within the VA network. Optometry’s standards are expected to be released within the first few months of 2023, with a decision expected closer to the end of next year.