Experts Split Over S.64: Ophthalmologists Cite Limited Safety Evidence; Optometrists Urge Expanded Scope With Guardrails

Senate Health & Welfare committee members heard competing expert testimony Feb. 18 on S.64, a bill that would expand procedural authority for optometrists in Vermont.

Ophthalmologists who testified said the committee has not been shown robust U.S. evidence that the invasive procedures listed in the bill can be performed safely by optometrists. "No data proving similarity in outcomes between US optometrists and ophthalmologists has been presented, nor has any data establishing the safety of optometry performed procedures," ophthalmologist Chris Brady told the panel, citing what he called a single, small U.S. study and the limits of that evidence. Brady warned that studies reporting zero complications do not prove a procedure is risk‑free and used the statistical "rule of 3" to note small samples can mask meaningful complication rates.

Ophthalmologist Libby Gould flagged specific gaps in S.64's training and oversight framework, saying the bill's minimums "do not define how proficiency is evaluated" and expressing concern that the bill requires as few as "2 supervised cases" to demonstrate competence. She said S.64 lacks standardized adverse‑event definitions, independent review and explicit emergency‑readiness or facility standards that she said are integral to surgical safety.

Representatives of optometry education and practicing optometrists disagreed. Dr. Alicia Fice, speaking as president of the Association of Schools and Colleges of Optometry and dean of the Arizona College of Optometry, described national curricula, standardized board examinations and simulation‑based competency checks, and said U.S. programs updated training in 2019 to reflect expanded practice. "There is an outside entity that is overseeing what is happening" in licensing and training, Fice told the committee, and she urged members to consider the depth of classroom, lab and supervised clinical training students receive.

Practicing optometrist Amy Puerto said the procedures in S.64 — including YAG capsulotomy, selective laser trabeculoplasty and chalazion excision — are part of routine care in some states and that Vermont's proposed preceptorships, proctored procedures, documented competency and adverse‑event reporting would create strong statewide safeguards. "S.64 recognizes optometrists are trained to manage appropriate primary level surgical care and will continue to refer when complexity exceeds that level," Puerto said.

Dr. Daniel Phillips and Dr. Tina Keshiva, leaders in Vermont optometry circles, emphasized access and workforce considerations. Phillips told the committee he routinely referred patients for procedures with waits of one to two months and said allowing trained optometrists to perform certain procedures locally would reduce travel, extra visits and delays. Keshiva added that the bill's requirements for extra training, board exams, preceptorship and reporting aim to ensure a high standard of care.

No vote was taken. Chair Jenny Lyons told members the committee would "come back for a broader discussion on the bill" during future business when any markup and possible votes would be scheduled.

The testimony laid out the central tradeoffs before the committee: whether existing educational pathways and the bill's additional safeguards are sufficient to protect patients, or whether the published U.S. evidence and the bill's specific competency and oversight requirements need strengthening before delegation of invasive procedures to optometrists.

Next steps: the committee plans further discussion and potential markup; no adoption or amendment occurred during this hearing.