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Pushback grows as committee weighs allowing optometrists to perform limited laser eye procedures
Summary
Supporters say HB 349 would expand access to three limited laser procedures for certified optometrists and help rural patients; ophthalmologists and the New Hampshire Medical Society warned the proposal lowers surgical standards and poses patient-safety and statutory oversight problems.
House Bill 349 would let certified optometrists perform three specified ophthalmic laser procedures — capsulotomy, trabeculoplasty and peripheral iridotomy — after meeting board training and proctoring requirements. Proponents said the change reflects modern optometry training, would shorten wait times in underserved areas and give patients more choice.
Supporters included practicing optometrists and educators who described didactic and simulated training in optometry schools and available postgraduate courses, and who said board-set proctoring and reporting requirements would ensure competency. Dr. Lisonbee Loranger, an optometrist who trained in the procedures, told the committee that modern optometry education includes laser instruction and that the bill’s live-case and certification requirements mirror minimums used in other professional training contexts.
Opponents — including ophthalmologists, the New Hampshire Medical Society and several eye surgeons — argued the bill would permit nonphysicians to perform intraocular procedures that they characterized as surgery. Physicians said surgical competency requires medical-school training, residency-level surgical volume and the ability to manage rare but severe complications. Dr. Shakti Maida (ophthalmologist) told the committee that competency cannot be reduced to a minimum number of procedures and that the ACGME case-count standards cited in debate are institution-level requirements for physician residency programs, not individual competence metrics.
The New Hampshire Medical Society and multiple ophthalmologists also raised statutory and regulatory questions. They pointed to existing RSA language that defines surgery and said the bill’s drafting could create confusion about authority and oversight (testimony referenced RSA 329:1 and RSA 327 and concerns about the composition and statutory charge of the Board of Optometry vs. the Board of Medicine).
Supporters countered that dozens of other states allow trained optometrists to perform similar limited procedures without increases in complication or malpractice rates, and noted proctoring, informed consent and mandatory adverse-event reporting in the bill. The committee heard evidence that outreach efforts have expanded ophthalmology services in the North Country, but doctors supporting access alternatives said the new optometry privileges would provide more routine, timely care in places that lack ophthalmologists.
The committee closed the hearing after hearing both sides; no committee vote was recorded in the transcript. Recorded testimony includes technical statutory questions, competing safety claims and examples of new access initiatives in rural New Hampshire.
