Debate intensifies as committee weighs optometry scope expansion to allow certain laser and in‑office procedures

Representative Ed Buttrey introduced House Bill 218 as a modernization of Montana’s optometry practice act, which he said has not been substantially updated in 25 years. The bill would allow doctors of optometry to perform certain in‑office laser procedures and minor anterior‑segment surgical procedures provided they complete required clinical training and are certified by the Montana Board of Optometry.

Proponents — including optometrists Ron Benner, Joseph Vincent and Jon Kolstad and the Montana Optometric Association — said the change would expand timely access to care, particularly in rural areas where ophthalmologists are sparse. Dr. Benner described a patient who had to wait months for a simple YAG capsulotomy outside the state and said the procedure and similar laser treatments “reduce the loss of vision” and can avoid longer waits for specialty care. Supporters emphasized three statutory guardrails: no penetrating intraocular surgery, no refractive procedures (such as LASIK), and no intravitreal injections; the bill would also require board‑approved certification and enrollment on the board registry for qualified optometrists.

Opponents, led by the Montana Academy of Ophthalmology and the Montana Medical Association and including several practicing ophthalmologists, urged the committee to reject or substantially amend the bill on patient‑safety grounds. Nenette Gilbertson, representing the ophthalmology group, cited peer‑reviewed research and a cohort study from Oklahoma that found higher reoperation rates after selective laser trabeculoplasty when the initial procedure was performed by an optometrist (35%) versus an ophthalmologist (15%). Opponents also offered clinical examples in which lesions presumed benign required urgent specialized care after further evaluation.

Several ophthalmologists described differences in training: they noted that ophthalmologists complete medical school plus residency and, often, fellowships with supervised surgical training on live patients, whereas optometry training focuses on eye care education and includes different clinical experiences. Optometry witnesses and some ophthalmologists said optometry students receive substantial clinical experience and that certification and board oversight could manage risks.

The hearing featured technical testimony, published-study citations and contested claims about outcomes and reporting. Committee questions covered training, certification, geographic access, malpractice exposure and how the board would set qualification standards if the bill advanced. No final committee vote was recorded in this hearing segment; supporters and opponents were left to offer written materials and to answer follow‑up questions.