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Heated testimony on optometry bill as lawmakers urge compromise; no vote taken
Summary
House subcommittee heard more than a dozen witnesses for and against H4103, which would expand optometrists’ procedural authority. Ophthalmologists warned of safety risks and cited cases of patient harm; optometrists and supporters argued modernization would improve access and reflect contemporary training. The committee did not vote and asked parties to negotiate compromise language.
The House regulatory review subcommittee devoted the second half of its hearing to House Bill 4103, a proposed update to South Carolina’s optometry practice act that would expand licensure options, revise definitions and permit certain office-based procedural privileges for doctors of optometry.
The bill prompted sustained and divided public testimony. Supporters, including multiple practicing optometrists and association leaders, said modern optometry education trains clinicians for the requested office procedures, that complication rates in other states have remained low, and that modernized scopes are necessary to preserve the workforce and expand access in underserved areas. Dr. Jondra McNeely (doctor of optometry, Greenville, past president of the South Carolina Optometric Physicians Association) told the committee the state’s practice act has not kept pace with education and training and noted many states already allow the requested privileges.
Opponents — led by ophthalmologists and specialty surgeons — urged caution and opposed expanding surgical privileges through statute without clear, enforceable training standards. Multiple ophthalmologists (including Dr. Carl Sloan, Dr. Mark Robinson of Prisma Health, Dr. Kurt Heitman and others) described the differences in training pathways (medical school + internship + residency) and detailed clinical examples where wrong diagnoses or complications required surgical intervention. Dr. Sloan urged the committee not to allow H4103 to advance, calling several sections "dangerous," and other ophthalmologists cited VA reports and published studies linking expanded optometrist privileges to higher retreatment rates and, in rare cases, vision loss.
Committee members repeatedly acknowledged the access problem in rural counties where ophthalmologists are scarce but emphasized that access arguments do not automatically justify expanding procedural privileges statewide. Several lawmakers asked for comparative data on complication rates and insurance outcomes in states that have updated practice acts. At the hearing’s end, Chairman Wooten said there remain unresolved drafting and training questions, particularly around Section 3 (the list of permitted procedures and exclusions). He encouraged stakeholders to meet and work toward compromise language — for example, residency-like training or staged privileges — and deferred further action. The meeting was adjourned with no committee vote on H4103.
The committee asked parties to share data on outcomes, complication rates and credentialing standards that could inform a compromise. Members suggested pursuing carefully defined training thresholds and practical guardrails rather than a broad statutory redefinition that would effectively add surgery to the optometric practice act.
