Committee hears split testimony on S64 to let some optometrists perform defined laser, injection and minor surgical procedures

The Senate Government Operations & Military Affairs committee on May 6 heard hours of testimony on S64, a bill that would add an "advanced therapeutic procedures" specialty to Vermont law and allow optometrists who obtain that endorsement to perform a tightly defined list of in‑office laser procedures, injections and minor eyelid surgeries.

Legislative Counsel Jen Kirby told the committee that S64 changes the statutory definition of the practice of optometry and creates an exclusive list of advanced therapeutic procedures that a specialty holder could perform. The list includes excision and biopsy of selected eyelid/adnexal lesions, chalazion excision or drainage, repair of limited eyelid lacerations, YAG capsulotomy, laser peripheral iridotomy, laser trabeculoplasty, a range of eyelid and adexa injections (including subconjunctival injections) and certain emergency vaccinations if authorized by the health commissioner. The bill also adds a 30‑day adverse‑event reporting requirement and would take effect July 1, 2028, to allow the Office of Professional Regulation (OPR) time for rulemaking and systems work.

Supporters called for the change to expand access and said training standards can protect patients. Dr. Nate Lighheiser, dean at the Oklahoma College of Optometry, described four levels of training—classroom didactic work, hands‑on lab simulation, proficiency testing and supervised clinical practice on live patients—and said that in states that permit in‑office procedures students commonly receive substantial supervised clinic hours. "It would be a huge public‑health win for the citizens of Vermont if optometrists had the ability to do SLT," Lighheiser said, referring to selective laser trabeculoplasty for glaucoma patients. Representatives of optometric education organizations told the committee that national curricula, board exams and supervised preceptorships provide multiple safeguards and that many optometry graduates already receive training on simulated models and, where allowed, supervised live procedures.

OPR witnesses described the sunrise review and oversight framework the agency uses to recommend scope changes. Deputy Secretary Lauren Hippert and Emily, OPR general counsel, outlined safeguards they said the state can bring to bear—statutory specificity, rulemaking review, active state supervision of boards and mandatory public‑comment steps—and said Vermont intends to set high training standards and use statute to constrain the specialty rather than leaving open the risk of board overreach.

Opponents, led by ophthalmology residents and practicing ophthalmologists, urged caution. Delaney Curran, an ophthalmology chief resident, said residency training includes thousands of hours of clinical rotations and graded, supervised progression that builds surgical judgment: "The first time I did an eyelid laceration repair was as a first‑year ophthalmology resident," she said, adding that two supervised repetitions would not produce the experience necessary to operate independently. Dr. Jeff Young, a comprehensive ophthalmologist practicing near Berlin, and the Vermont Ophthalmological Society outlined anonymized cases where optometrist referrals or recommendations would have led to unnecessary or harmful procedures if performed in that context. The society also cited peer‑reviewed analyses that found no consistent improvement in travel time or access after scope expansions in other states.

Committee members questioned whether expanding privileges would change private‑practice incentives and whether the procedures listed (some of which are infrequently needed) would produce sufficient case volumes for physicians or optometrists to remain current. Several legislators said they defer to OPR and health committees on clinical details but indicated the need to weigh safety, access and costs.

No formal action or vote was taken at the hearing. The committee paused its testimony to continue at a later date. If the bill advances, OPR said the 2028 effective date was intended to provide time for the agency to complete rulemaking and operational requirements, and the statute would implement required preceptorship, exam and reporting steps.

What happened next: the committee closed the day's testimony and scheduled continuation; no vote or amendment was recorded during the session.