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Heated testimony as committee hears pros and cons of allowing optometrists to perform three eye‑laser procedures
Summary
The EDNA committee heard hours of divided testimony on HB 349, a bill that would let certified optometrists perform three in‑office laser procedures after board certification; supporters said the change would improve access and continuity, while ophthalmologists and the medical society warned of patient‑safety and training shortfalls.
House Bill 349 drew one of the longest and most contested hearings of the EDNA session, with optometrists, ophthalmologists, medical‑society leaders and public‑health witnesses testifying for hours before the committee sent the bill to subcommittee for further work.
What the bill would allow: HB 349 authorizes the Board of Registration in Optometry to certify optometrists to perform three specified in‑office laser procedures once an optometrist meets board‑set education, training and supervised proctoring criteria. The three procedures discussed in testimony were: (1) YAG laser capsulotomy (to clear a cloudy membrane that can form after cataract surgery), (2) selective laser trabeculoplasty (SLT) for some glaucoma patients, and (3) laser peripheral iridotomy (LPI) for angle‑closure risk.
Proponents’ case: Sponsors and optometrist witnesses said the curriculum at accredited colleges of optometry includes didactic and clinical training for these lasers, that many optometrists already have training or live‑patient experience in states that allow the procedures, and that authorization would improve access to timely care — especially in rural areas and for telehealth continuity. Representative Katie Petternel, introducing the bill on behalf of the prime sponsor, emphasized rural access problems and long waiting times for ophthalmology; several optometrists described patients who travel lengthy distances or endure months of delay for laser care. Witnesses also said malpractice data and aggregate complication reports do not show increased adverse outcomes in states that permit optometrist lasers; some proponents cited large procedure counts and low overall complication rates as evidence of safety.
Opponents’ case: Practicing ophthalmologists, the New Hampshire Medical Society and other physicians strongly opposed HB 349 on patient‑safety grounds. Witnesses said laser procedures are surgical interventions with real, sometimes sight‑threatening, complications that require prompt surgical management in a minority of cases. Ophthalmologists and surgical‑training witnesses argued that the critical judgment about which patients should undergo laser therapy comes from broad surgical training and experience, and that residency‑based surgical training gives ophthalmologists the breadth and depth to manage complications reliably. Multiple medical witnesses cited peer‑reviewed studies and insurer practice positions: one study presented at the hearing reported a higher hazard of repeat laser treatment when SLT was performed by optometrists in a particular state; the Ophthalmic Mutual Insurance Company (a specialty malpractice underwriter) reportedly will not insure optometrists for surgical laser practice because of limited data on training and liability risk.
Access and alternative solutions: Testimony included an update on a separate, operational access initiative. Dr. Michael Peters (ophthalmologist) described a cooperative plan with Androscoggin Valley Hospital in Berlin and multiple ophthalmologists to rotate specialists into the North Country on a regular schedule; hospital leadership and architects had drafted clinic plans, and the project’s proponents estimated orientation and credentialing could put up‑country ophthalmology clinics into service in 6–12 months. Several committee members suggested the North Country rotating‑specialist plan might address many access concerns without altering scope‑of‑practice rules.
Administrative and practical points: Witnesses noted equipment costs (multiple said an appropriately configured laser microscope can cost $75,000–$100,000), board certification and live‑case proctoring requirements, and differences among other states (some witnesses cited 10–12 states that allow various optometrist laser privileges; others corrected the count to 10). The Board of Optometry would be responsible for rulemaking to set the minimum live‑case and proctoring standards if the statute changed.
Committee action: The committee did not vote on HB 349 at the hearing; members sent the bill to subcommittee to gather additional information and to consider refined training, reporting and oversight language. Committee members indicated they want specific proposals on the minimum number of supervised live procedures, reporting of outcomes, malpractice and credentialing safeguards, and a clear plan for how training and proctoring would operate in New Hampshire.
Speakers on the record included representatives and a broad roster of clinicians: Representative Katie Petternel (introducing); optometrists and educators (Dr. Dorothy Hitchmoth, Dr. Allison Loranger, Dr. Angelique Sawyer and others); pro‑bill advocates (Rep. Chris Muns and other practitioners); ophthalmologists and surgical trainers (Dr. Kimberly Liccardi, Dr. Timothy Blake, Dr. Catherine Miranda and others); residency trainees and medical society testimony; and a hospital representative describing the North Country access initiative.
