Q&A: New Hampshire bill aims to add minor surgical procedures to optometry practice scope
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In January, the New Hampshire Senate received SB 440, a bill that would expand optometry’s scope of practice in the state to include minor eye surgeries, including several using lasers.
The Senate passed the bill a month later by unanimous “ought to pass” recommendation, and it has now moved to the House.
Healio spoke with Sarah J. Hudson, OD, owner of Harbor Eyecare Center in Exeter, New Hampshire, and Angelique Sawyer, OD, legislative co-chair for the New Hampshire Optometric Association, to discuss the bill and how it could affect optometrists and their patients.
Healio: Please describe the changes specified in the legislation.
Hudson: SB 440 creates exclusions, procedures not within our scope, and makes the state board of optometry responsible for establishing credentialing criteria for any procedures that are allowed. The bill was written this way to avoid repeated legislative action for any new technology or procedure still within this scope. This is a process none of us wishes to repeat on a regular basis.
Sawyer: SB 440 modifies how the profession of optometry is regulated in the state of New Hampshire, placing more of the authority with the state regulatory board, as is the case with all other independent health care professionals in New Hampshire. Additionally, it creates a very broad range of exclusions that prohibit surgical procedures outside of optometric training and education, but it allows for a wider range of in-office optometric procedures that currently are prohibited in New Hampshire but permitted in other states.
Healio: What does SB 440 mean for practicing optometrists?
Hudson: SB 440 will allow a pathway for optometrists in New Hampshire to have the first noted update to our scope of practice in more than 20 years. We would be able to serve our patients with a more complete use of our education and training. This will make New Hampshire a more attractive career home for graduating optometrists as well.
Sawyer: For New Hampshire optometrists, the passing of SB 440 will replace quite outdated, restrictive laws with a modern and contemporary representation of what today’s doctors of optometry are learning at every optometry school in the nation. It will elevate New Hampshire to be a more desirable place to practice optometry and utilize our full skill set, thus allowing the state to draw and retain top quality optometrists.
Healio: What does it mean for patients?
Hudson: Patients will be able to have a treatment performed with the doctor who diagnosed it, with whom they may have a very long history. This will reduce duplications of care, co-pays, wait times for care and multiple appointments, as well as provide access to care closer to home.
Sawyer: There is a significant lack of access to eye care in a large portion of New Hampshire, and that will worsen with our aging patient population and the increasing shortage of ophthalmologists. Out of 10 counties in New Hampshire, two do not have a single ophthalmologist, and two more counties have only a single ophthalmologist. Furthermore, many ophthalmologists throughout the state are not accepting new patient referrals and/or they do not participate with several insurance plans, further limiting patient access.
Doctors of optometry have a far greater distribution throughout the state and have the ability to reduce wait times, travel distances and health care costs for our patients and our health care system when we are able to provide care that aligns with our education and training.
Healio: Who are the key players fighting for and against this legislation?
Hudson: The New Hampshire Optometric Association and the American Optometric Association are supportive of SB 440. Legislators who are concerned about access to care and health care barriers are in support, as well as those who oppose overregulation.
The AMA and the New Hampshire Society of Eye Physicians and Surgeons are opposed. The AMA has a broad campaign against any non-MD or DO providers performing any procedures that meet the definition of “surgery.” Their “Stop Scope Creep” campaign aims to hold all other practitioners at current levels even as technology and medical advances continue.
Sawyer: The New Hampshire Optometric Association is the driving supporter behind SB 440, and the New Hampshire board of optometry also has submitted a letter of support. In the Senate, there has been significant legislative support from lawmakers who recognize the access issues and who acknowledge that these procedures are being performed safely and effectively in so many other states.
The primary opposition to SB 440 has been the New Hampshire Society of Eye Physicians and Surgeons, backed by the American Academy of Ophthalmology, the New Hampshire Medical Society and the New Hampshire Society of Dermatology. The opposition claims that SB 440 is a threat to patient safety, but this unfounded claim has no evidence in the other states [where optometrists] have been performing these procedures — in some cases for multiple decades.
It is clear that the opposition is seeking to maintain their “turf’” through a nationwide campaign to “Stop Scope Creep,” actively fighting any attempt to advance health care by any provider other than a doctor of medicine, regardless of the nature of the advancement.
Healio: What does this mean for the future of optometry?
Hudson: Optometry has a history of embracing new technology. We are geographically much more available to patients. As our population ages, especially in New Hampshire, more care will be needed, and ophthalmology is not going to have the capacity to fill that need. Optometrists are educated, trained and ready to fulfill population needs as change occurs, and in so doing, allow ophthalmologists to focus their time on the procedures and care that are solely within their scope of practice. Medical optometry is and will be a valuable and necessary part of our health care system.
Sawyer: The future of optometry will include the authority for doctors of optometry to perform these procedures in every state in the nation. Just as with the authority to use diagnostic dilating drops, to prescribe oral and topical therapeutic medications and to treat glaucoma, the optometric procedures of SB 440 will eventually become standard of care nationwide.
As these prior optometric advancements have occurred across the nation, there has never been a repealing or rolling back of optometric privileges. Optometry has proven our education and training, our responsibility to patient care and our ability to advance the nation’s health care access for its citizens.
As our nation’s population ages and as the supply of health care providers — especially ophthalmologists — declines, optometry is positioned to fulfill the eye care needs of our nation to the full level of our education and training.
Healio: Some ophthalmologists argue that optometrists are not adequately trained to perform these procedures. What are your thoughts?
Hudson: Ophthalmologists have argued at every step of our professional advancement that optometrists are not capable. This argument has not been accurate in the past and is not true now. Evidence of our safe, effective and quality care is easily demonstrated in the dozen or more other states in which optometrists are currently providing this care, some of whom have been doing so for decades. Our past scope expansions have demonstrated that we were ready and capable.
The New Hampshire state board of optometry will set criteria to prove and maintain competency, as is the case with all other doctoral-level professionals in New Hampshire. This bill establishes a pathway for doctors to demonstrate competency; it does not automatically grant privileges upon its passing. Colleges of optometry have been teaching these procedures in classrooms, labs and hands-on settings for decades, as their curriculum is developed to match the most progressive state law in the country.
Sawyer: Ophthalmologists have made this same claim for decades. However, it has become clear that many opponents do not know what current optometric training and education entail. Some truly think that the majority of our 4 years of postgraduate, doctorate-level education and training is simply in the prescribing of glasses and contact lenses. There are thousands of surgical procedures that remain outside the purview of SB 440 and outside the training and education of doctors of optometry. However, the limited minor procedures that are being discussed here are taught in every optometry school in the nation and have been for quite some time.
Ophthalmologists have also made the claim that passing SB 440 will allow any optometrist to come to New Hampshire and start doing whatever procedures they please. It has become clear that many opponents not only fail to understand optometric education and training, but they fail to understand optometric regulation. The New Hampshire board of optometry will be responsible for credentialing and regulating optometrists seeking to perform these procedures, and the New Hampshire board of optometry is part of a larger structure of New Hampshire professional regulatory boards that do not function in isolation and are held to a system of checks and balances.
Healio: What do you think is next in terms of optometry’s scope of practice in New Hampshire?
Hudson: I sincerely hope and expect SB 440 will pass the House and progress to become law, and then our New Hampshire board of optometry will begin setting rules for how optometrists in New Hampshire will prove their competency and begin offering patients access to these procedures.
Sawyer: If SB 440 passes as introduced, it will allow the New Hampshire board of optometry to have greater regulation over the profession and will reduce the need for frequent legislative battles to advance scope.
Reference:
- SB 440. https://legiscan.com/NH/text/SB440/id/2864373. Published Feb. 8, 2024. Accessed April 11, 2024.
For more information:
Sarah J. Hudson, OD, is the owner of Harbor Eyecare Center in Exeter, New Hampshire. She can be reached at drsarahhec@gmail.com. Angelique Sawyer, OD, FAAO, is the owner of Conway Eye Care and Coos Eye Care in New Hampshire and legislative co-chair for the New Hampshire Optometric Association. She can be reached at angeliquesawyerod@gmail.com.
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