Senate Health & Welfare hears safety, training concerns over S.64 optometry scope expansion

Montpelier — Lawmakers in the Vermont Senate Health & Welfare Committee heard more than an hour of testimony on Feb. 4 about S.64, a bill that would expand optometrists’ authorized procedures to include several laser and minor surgical treatments of the eye. Multiple ophthalmologists and the Vermont Board of Medical Practice told the committee they oppose the bill as written, citing training shortfalls, limited supporting data, and patient-safety risks.

Dr. Jessica McDonoughly, who identified herself as an ophthalmologist and president of the Vermont Ophthalmological Society, told the committee the society’s primary concern is ensuring “Vermonters receive safe, high‑quality surgical eye care.” McDonoughly described ophthalmology training as a multi‑year process that includes medical school followed by four to six years of residency and fellowship training accredited by the Accreditation Council for Graduate Medical Education (ACGME). “Surgical treatment with ophthalmic lasers is not a primary eye care service and should be performed by physicians who are hospital residency‑trained surgeons,” she said.

Committee members were shown video and photos of office‑based procedures during McDonoughly’s testimony; she said many of the surgeries listed in S.64 require a procedure room, patient draping, specialized instruments and laser safety measures, and are not simply “chairside” interventions. She also pointed to complications that can occur during laser procedures — including bleeding and, in rare cases, anaphylaxis when dyes are used for fluorescein angiography — and argued that the Office of Professional Regulation’s (OPR) proposed preceptor/checklist training does not substitute for residency‑level experience.

Matt Greenberg, chair of the Vermont Board of Medical Practice, said the board reviewed OPR’s materials and related studies and concluded that the evidence does not show clear benefits for access or cost. Greenberg framed the board’s review around three categories — access, cost and quality — and said the volume of procedures required for proficiency in many safety standards is far higher than the minimum procedural experience described in the bill. “Looking at all of those features together — without a clear benefit in access or cost and a very large difference in training — provides a high risk to effective quality,” Greenberg told the committee.

Several ophthalmologists offered specific patient stories to underline the safety concern. Dr. Jeffrey Young described multiple cases in which patients were referred for lasers or minor procedures that were later judged unnecessary or, in one instance, where the correct diagnosis was a serious infectious disease that would have been missed had a laser been performed. “These cases demonstrate that proper surgical skill and, more importantly, careful surgical judgment requires comprehensive training, not cursory courses,” Young said.

A surgical trainee, Debbie Mara, described the stepwise, high‑volume nature of ophthalmology residency training and said simulation and short workshops cannot replicate the real‑patient experience required to develop judgment and manage complications. Mara urged lawmakers to consider the differences between introductory procedural exposure and years of graduated, supervised surgical responsibility.

Proponents of S.64 have argued that expanding optometrists’ scope would improve access in rural areas and reduce travel and cost for patients. Committee members asked several speakers for outcome data that decisively shows safety or improved access; witnesses acknowledged data are limited and that cross‑jurisdictional comparisons are complicated by differences in training and regulation.

Witnesses and board members indicated willingness to continue negotiations over specific procedures. Committee members asked whether removing higher‑risk items from the bill would make it more palatable to ophthalmologists; those testifying said that possibility merits further conversation and that they would be willing to return to the committee.

The committee did not take a vote on S.64 at the hearing. Lawmakers indicated the bill will be revisited in a future session and that staff and stakeholders may continue to refine training and oversight proposals.

Who said what: McDonoughly and other ophthalmologists repeatedly emphasized differences in residency‑level surgical training versus optometry postgraduate coursework and workshops; Greenberg said the Board of Medical Practice found no clear evidence that S.64 would improve access or lower costs; Young, Mara and others provided clinical examples and a trainee perspective on surgical experience.

Next steps: The committee paused formal action and signaled further discussion and possible amendments, including consideration of removing or reclassifying specific procedures from the bill.