Vermont committee hears split testimony on S.64 to expand optometrists' surgical scope

The Senate Committee on Government Operations heard more than two hours of testimony Feb. 26 on S.64, a bill that would amend optometry scope-of-practice law to allow qualified optometrists to perform specified laser and minor ocular procedures.

Supporters of the bill, including optometry educators and a current optometry resident, told the committee that modern optometry education and supervised clinical training prepare graduates to perform the procedures safely and that expanding scope would improve access to care. Opponents — including the chair of the Vermont Board of Medical Practice and representatives of specialty medical boards — said there is insufficient evidence that expansion improves access or lowers costs and argued the proposed training, supervision and assessment provisions in S.64 are inadequate to protect patient safety.

Why it matters: The dispute centers on whether the incremental surgical and laser procedures in S.64 can be learned and practiced safely with the training and oversight the bill specifies, and whether expansion would meaningfully increase access to care in rural Vermont. Committee members pressed witnesses on evidence, case-volume thresholds, continuing-assessment requirements, and differences between optometry and ophthalmology training paths.

Rick Hildebrandt, chair of the Vermont Board of Medical Practice, told the committee the board “unanimously voted against supporting the expansion of optometry scope of practice” in October 2023 and again expressed no support after a January review because “no new evidence had emerged.” He cited three core concerns from the board: the Office of Professional Regulation (OPR) report’s finding of insufficient evidence that scope expansion improves access or lowers cost, and the board’s judgment that optometrists receive significantly less surgical training than ophthalmologists, which could pose patient-safety risks.

Hildebrandt told senators that Vermont shows no demonstrated shortage of ophthalmologic surgical services: a 2020 Green Mountain Care Board review denied an Eye Surgery Center’s certificate-of-need request on the basis that the board found no shortage of surgical ophthalmology services in the state. He also pointed to data in the Vermont Department of Health’s 2022 optometrist report showing 102 active optometrists (about 81.2 FTEs), uneven geographic distribution (16–18 FTEs per 100,000 residents in Chittenden, Washington and Windsor counties; five counties under 10 FTEs per 100,000; Essex and Grand Isle with none) and an anecdotal example of a 10-month wait for routine optometric care in Rutland.

Charlie Sheffield, vice president for government affairs at the American Board of Medical Specialties, said S.64 “represents an expansion of scope into a medical specialty, a high risk specialty without corresponding adequate training standards to ensure patient safety.” Sheffield and other specialty representatives pointed to the structure of graduate medical education and board certification for ophthalmology — medical school followed by multi-year residency with hundreds of supervised surgeries in many programs — as the standard for specialty care and said the bill’s proposed “preceptorship” and waiver language fall short of that standard.

Melissa Davidson, associate dean for graduate medical education at the Larner College of Medicine and designated institutional official for UVM Medical Center, described how residency accreditation and assessment are structured under the Accreditation Council for Graduate Medical Education (ACGME). She explained that residency program requirements and case logs are nationally standardized, subject to regular review and can trigger citations or program closure if minimums are not met. Davidson emphasized that ophthalmology residency training is embedded in patient care and assessed continuously, and she told the committee that optometry residencies are one year while ophthalmology residencies typically last four years.

Optometry witnesses disputed the picture painted by medical-specialty witnesses. Daniel Phillips, a current resident at the Oklahoma College of Optometry who trained at UC Berkeley, described supervising and training third- and fourth-year optometry students performing the procedures at his program. “These are not, like, the entire sphere of ophthalmology. These are specific things that optometrists have been gaining proficiency in since the very beginning of optometry school,” Phillips said, adding that in some programs fourth-year students already meet the procedural requirements associated with scope expansion in S.64.

A long-practicing optometrist and educator who testified (identified in the hearing transcript as Dr. Dorothy Hichmall) said she has performed lasers and minor procedures since the 1990s, teaches at the collegiate level and consults on accreditation. She told the committee that the Department of Veterans Affairs and federal agencies allow optometrists to provide much of this care and that national accreditation and board systems for optometry incorporate modern procedures and assessment standards.

Committee members focused several questions on evidence: whether studies show that expansion reduces travel times or wait lists, whether adverse outcomes have been tracked in states that expanded scope, and how the bill’s continuing-education and waiver provisions would work in practice. Witnesses cited limited and mixed empirical evidence. Hildebrandt referenced a 2023 JAMA Ophthalmology study that found expansion in some states did not reduce patient travel times and in some cases patients traveled farther to reach providers performing laser procedures; other witnesses cited multi-state procedural counts and international outcome studies but acknowledged limitations and reporting lags for malpractice and adverse-event data.

No formal vote or committee action occurred during the Feb. 26 session. Senators and witnesses noted that medical and clinical-certification details will be further considered by the Senate Health and Welfare Committee and that additional ophthalmology testimony is scheduled in a future hearing. The Government Operations committee recessed to take up a separate agenda item on open-meeting law after the S.64 testimony.

Ending: The committee did not take a vote Feb. 26. Lawmakers signaled more hearings and requests for comparative data, procedure‑volume studies and clearer definitions of the bill’s training, supervision and continuing‑assessment provisions before they will consider amendments or final action on S.64.