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Legislature debates optometry scope change as proponents cite rural access and opponents warn of patient‑safety risks
Summary
House Bill 218 would allow certified optometrists to perform certain in‑office anterior‑segment procedures. Proponents emphasized rural access and existing training; ophthalmologists and medical groups warned about training differences and potential complications. The committee heard extensive testimony and technical Q&A; no vote was taken.
Representative Ed Buttry opened the hearing on House Bill 218, which would permit optometrists who meet board‑set certification requirements to perform specified in‑office anterior‑segment procedures and biopsies of eyelid lesions.
"This bill modernizes the practice of optometry in Montana which hasn't been addressed for 25 years," Rep. Buttry said, adding the bill excludes penetrating intraocular surgery, intravitreal injections and refractive procedures such as LASIK.
Supporters — including practicing optometrists from rural communities and the Montana Optometric Association — argued the change would improve timely access to eye care for patients who now travel long distances and wait months for appointments. Dr. Ron Benner, an optometrist in Laurel, described patients who cannot drive long distances and said quicker in‑office care could prevent prolonged vision loss.
"I often send my patients from Laurel, 100 miles south to Cody, Wyoming, where I can get the procedures done within a week and a half to two weeks to my optometric colleagues," Benner said.
Opponents, including ophthalmologists and the Montana Medical Association, urged the committee to reject the expansion on patient‑safety grounds. Opponents emphasized differences in postgraduate training: ophthalmologists complete medical school and several additional years of residency and often fellowship training. Several testified that the complexity of identifying posterior‑segment disease or contouring eyelid cancer excisions requires surgical training and extensive supervised cases.
"This is about patient safety," Dr. Scott Guess, an ophthalmologist, told senators. He described the depth of surgical training for ophthalmologists and warned that some complications (for example, a laser misdirected into the posterior eye) can cause irreversible harm.
Committee members questioned witnesses about continuing education, board endorsement processes, VA and military facility rules, and data from other states. Out‑of‑state and online witnesses with experience in states that permit similar procedures (including Oklahoma) answered questions about credentialing and practice patterns. Board and department staff explained that, if the bill passed, the Board of Optometry would define the certification or endorsement requirements and the licensing department would add an endorsement to a practitioner's license.
Ophthalmology opponents provided empirical concerns from other states and described scenarios in which delayed diagnosis or incorrect procedural selection had harmed patients. Optometry proponents countered that optometry education includes four years devoted to eye care and that board certification and state rules would limit which licensees could perform the procedures.
No final committee vote on HB 218 was recorded in the transcript. The hearing record shows the committee plans to pursue rulemaking and licensing‑endorsement details with the Board of Optometry should the legislature advance the bill.
