|The bill specifies that ODs must complete post-graduation proctored training for each proposed procedure. Click image to enlarge.
After several years of laborious efforts to pass legislation that would add in-office procedures—such as injections, lesion removal and certain lasers— to optometry’s scope of practice, ODs and advocates in Vermont experienced a devastating setback in 2020. The bill’s halt was provoked by a detailed report from the state's Office of Professional Regulation (OPR), which had been ordered by the General Assembly at the time. At the conclusion of the 40-page document, the OPR stated that it recommended against the scope expansion proposal. It cited that this decision was due to an “inability to confirm that clearly established and appropriately tailored didactic and in vivo education and training in specified procedures is universal to accredited educational programs.”
In response to optometry’s pushback against the report, in 2021 the OPR was tasked with performing a more comprehensive and fact-based study on the proposed procedures. Fast-forward to this September and the Office has released a new report—a whopping 258 pages—in which their stance on the matter has made a complete 180° from that in 2020. Now, the OPR stands in support of the expansion of optometry’s practice scope to include in-office procedures such as specific injections, removal of benign lid lesions, corneal crosslinking and laser procedures including YAG capsulotomy, SLT and LPI (for a full list of all the procedures being proposed, see pg. 37 of the report, which can be found here). The report has been submitted as a bill that will play out in Vermont’s 2024 legislative session, which runs from January to May.
2020: What Went Wrong
The release of the OPR’s initial study on optometric advanced procedures in 2020 sparked an immediate negative reaction from the optometry community due to the document’s inclusion of certain misconstrued claims and data regarding issues such as optometrists’ skills and training.
“It recommended against everything,” says Dean Barcelow, OD, who serves as president, executive director and legislative chair of the Vermont Optometric Association (VOA). “There were arguments against almost every point that we made, and we were really disappointed.” Dr. Barcelow explains that the shortcomings in the report could be attributed to various factors, including understaffing, insufficient evidence collection, ineffective communication with optometry schools and the disruptive effects of a global pandemic in 2020.
The year after the 2020 report was released, Dr. Barcelow and his team at the VOA took their concerns to the Vermont Senate Government Operations Committee. The VOA walked the Committee through each part of the report, pointing out “where the report was factually wrong and where things were misinterpreted,” Dr. Barcelow notes. Following this meeting, the decision was made to send the report back to the OPR for another review. The result of this second review is the document that was released this past September, which has corrected the factual inaccuracies and now favors the proposed scope expansion.
The Road Ahead
While Vermont optometrists and the VOA are thrilled with the OPR’s updated recommendation, certain details in the bill may still need fine-tuning to optimize the practical implementation of the proposed law. One area of concern that remains with the report as it’s currently written, Dr. Barcelow explains, is the strictness of the certification qualifications for the added procedures.
“The Office of Professional Regulation looked around and found the most stringent requirements from every single state bill passed or introduced and put them into their recommendations,” he says. “If this legislation passes as it is, in order to perform any of these procedures in Vermont, we will have to jump through a lot of hoops.” In addition to requiring the completion of a 32-hour course and board certification for injection and laser procedures, he notes that the bill would also mandate proctored surgical experience on live, human patients for each of the 43 surgical procedures being proposed, a number not required in any other state with expanded scope. Additionally, the report specifies that all these requirements would have to be completed post-graduation.
Once the 2024 legislative session kicks off, Dr. Barcelow says that the VOA plans to engage in conversations with the legislature to discuss the proposed training qualifications.
Logistics aside, another upcoming challenge in the bill’s legislative journey will be to neutralize the spurious arguments of the opposition. Anti-optometry groups—primarily ophthalmology and organized medicine—are expected to oppose the bill throughout the upcoming legislative session, as is the case in any state that attempts to modernize optometry’s scope of practice. The most vocal opponent in 2020 was the University of Vermont Medical Center Ophthalmology department, Dr. Barcelow recalls, which will more than likely appear in the committee hearings again this time around.
While Dr. Barcelow recognizes that “there’s going to be a lot of opposition and it’s going to be a lot of work,” he’s also optimistic that optometry will come out victorious in the end.
Come January, hearings on the bill will be scheduled with both the state House and Senate Government Operations. For ODs who wish to show or voice their support for the bill, Dr. Barcelow says that the best way to help is the same as in any other state: “Reach out IN PERSON to your Vermont legislators and let them know this is an important issue to you.” He adds, “Donations to our scope efforts can be sent to our state association treasurer at Vermont Optometric Association ATTN: Dr. Craig Volpe, 61 Highland Rd Underhill, VT 05489.”