Ophthalmologists, medical groups oppose Senate Bill 36’s proposed surgical scope for optometrists

Columbus — Ophthalmologists, the Ohio State Medical Association (OSMA) and other physician groups told the Ohio Senate Health Committee on Tuesday that Senate Bill 36’s proposed expansions of optometrists’ authority to perform lasers, injections and invasive eyelid procedures raise patient-safety concerns and are unlikely to improve access to care.

Monica Hickel, speaking for OSMA, told Chairman Huffman, Vice Chair Johnson and the committee she and other physician groups have occasionally reached neutrality on scope-of-practice bills but that "surgery is a line in the sand" for organized medicine. "When you are doing surgical procedures, you need the most educated and trained individual doing those procedures and those individuals in the state of Ohio are physicians," Hickel said.

The doctors who testified described the types of procedures listed in the bill and detailed specific risks. Nicole Byach, an ophthalmologist and secretary‑treasurer of the Ohio Ophthalmological Society, said the bill as drafted would make Ohio among the most permissive states for optometry surgical privileges and warned that other jurisdictions’ permissive practices have led to adverse outcomes. "Patient safety and outcomes aren't just about learning the technique to perform the YAG laser. You really need to know everything related to the patient and the associated risks as well," Byach said.

Why it matters: The testimony focused on the clinical judgment, training and complication-management experience that ophthalmologists say are required for the procedures listed in SB 36. Supporters of the bill have argued the changes would increase access to care; physician witnesses countered that available data do not support that claim and that the proposed language is too broad.

Key testimony and evidence

- OSMA (Monica Hickel) said statewide surveys and national Medicare billing data show limited evidence that the procedures listed in the bill are creating access gaps that optometry surgery would solve. Hickel said a survey of ophthalmology offices showed the proposed procedures could generally be scheduled "in one week or less," and that 99 percent of Ohioans live within a 30‑minute drive of an ophthalmology office based on Medicare physician data cited in her testimony.

- Byach and other ophthalmologists detailed clinical risks for specific procedures the bill would permit. Byach described YAG capsulotomy risks, saying the tissue targeted is about 4 microns thick and that an improperly targeted laser can damage an intraocular lens or retina and potentially cause irreversible vision loss. She also cited a 3.9‑fold increased risk of retinal breaks and detachment after capsulotomy and described how inadequate preoperative retinal assessment could miss conditions that make the procedure unsafe.

- Ken (identified in testimony as an Ohio Ophthalmological Society member and OSMA affiliate) and Adrienne Delaney, an ophthalmology resident, laid out formal training differences: four years of medical school followed by supervised ophthalmology residency that includes progressive surgical training, wet‑lab practice and supervised operating-room experience. Delaney said typical optometric procedural training is limited to short workshops that cannot replicate real‑world variability and complication management.

- Ophthalmologists also pointed to data they say undercut proponents’ access argument: a review of approximately 127 recent optometry graduates showed only eight became licensed in states that permit optometric surgery, and five of those returned to their home states. The panel cited a net increase of about 277 licensed optometrists (12.6 percent) in Ohio between 2014 and 2024.

What supporters and opponents said about scope and collaboration

- Witnesses opposing SB 36 emphasized the absence of standardized training or credentialing language in the bill for the range of non‑laser invasive procedures it would allow, and noted overlap with specialties such as dermatology, otolaryngology and oncology.

- Testimony from the Ohio Ophthalmological Society (including President Alexandra Raczitskaya) and other physicians acknowledged areas for collaboration with optometrists on child vision screening, diabetic retinopathy screening and other public‑health efforts. Raczitskaya pointed to recent state investments such as elementary‑vision screening programs and Medicaid vision funding as examples of collaborative work that can improve access without expanding surgical scope.

No formal committee action was recorded at the hearing. Multiple physicians and OSMA representatives concluded by urging lawmakers to either narrow the bill’s surgical provisions or pursue non‑surgical, collaborative measures to improve access.

Closing note: Committee members asked clinical and training questions of the physician witnesses. The hearing continued with a panel of clinicians prepared to address surgical procedure specifics and training details; written testimony was also submitted by other health groups, as noted for the record.