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Legislative split over expanding optometrists’ scope of practice
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Summary
Legislative staff outlined S.64 to create an 'advanced therapeutic procedure' specialty for Vermont optometrists; supporters said it would improve rural access, while physicians and some lawmakers warned about invasiveness, patient volume and supervision requirements.
Legislative Council attorney Janet Harvey told the Health & Welfare Committee that S.64 would expand the statutory definition of optometry to include ‘‘therapeutic pharmaceutical agents’’ and create an "advanced therapeutic procedure specialty" that licensed optometrists could seek after meeting new education, preceptorship and examination requirements. "There is a definition of adverse event, definition of therapeutic pharmaceutical agent," Harvey said as she reviewed the bill's sections.
The bill would require additional continuing education for licensees holding the specialty, a supervised preceptorship with clinical hours on live patients, and written and clinical exams administered by the National Board of Examiners. Harvey also said licensees must report any adverse event tied to an advanced procedure to the board within 30 days.
Why it matters: Supporters say expanded authority would help Vermonters who lack easy access to ophthalmologists in rural counties; skeptics say the state performs relatively few of the advanced procedures listed and worry about clinician repetition, supervision and the need for hospital backup when complications arise. "It's expanded scope. Right. And what is, nonrecurring…" the chair said, summarizing members' concerns about injections, scalpel use and laser procedures.
Proponents and opponents: Heather Schollis of the Vermont Optometric Association said the association has worked on the bill for five or six years and that the Office of Professional Regulation (OPR) recommended clear lists of permitted and prohibited acts. "We've been working on this bill for 5 or 6 years," Schollis told the committee. Dean Marshall, also representing the state optometric association, noted that "14 states already offer this," and said many liability insurers already cover such procedures across state lines.
Physician concerns centered on a subset of procedures the transcript lists as involving excisional retinal surgery, extraocular muscle surgery and certain eyelid surgeries. Several lawmakers said those procedures, and the limited statewide volume for some of them, argue for a more incremental, supervised rollout. "Models don't bleed," one lawmaker said, criticizing demonstrations that used models rather than live‑patient supervised training.
Committee action and next steps: After extended discussion about training standards, reporting, malpractice coverage and hospital relationships for aftercare, the chair said the committee would set the optometry bill aside and return to it the next day for further consideration. No formal vote on S.64 was taken during this session.
Ending: Committee members asked staff to consider language that would limit higher‑risk procedures and to clarify relationships with hospitals or referral pathways for complications; the bill remains under review.
