BLOG: Considerations for expanding the scope of optometry
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As a past president of the Pennsylvania Optometric Association, I am very familiar with how our profession expands its scope of practice.
We are a legislated profession, and changes in our scope of practice occur through passing state laws in each commonwealth, state or territory.
Optometric associations in each state must request changes in scope in the form of legislation. This requires the support of a senator or congressman as the prime sponsor, as well as a list of co-sponsors. This piece of legislation, in the form of a bill, must be introduced in the House or Senate and voted upon. It then must pass through a series of challenges on the way to become a new law for that state.
This is not an easy process. A change in scope must be supported with the appropriate education and training and must meet a public health need for the citizens of each respective state. This public health need is critical to the passage of a new optometric practice law.
Each state has its own unique public health needs. Requested changes in scope of practice are variable, but two requested changes are very popular: the use of lasers and the administration of vaccines. Currently, there are 12 states in which optometrists can perform laser procedures and eight states in which optometrists can administer vaccines.
Laser procedures
The passage of legislation to allow laser procedures seems to be the most popular agenda item for most state associations.
The projected need for YAG laser capsulotomy after cataract/IOL procedures is between 20% and 50%. The annual number of cataract surgery procedures in the U.S. is estimated at 3.7 million, yet the number of YAG laser capsulotomies is only 4% (Ling et al), which translates to about 150,000 cases per year nationwide. This would indicate a large unmet need for YAG laser procedures.
Likewise, selective laser trabeculoplasty has been shown to be an effective first-line treatment for glaucoma (Alwazae et al). In the U.S., where the CDC estimates 3 million people have glaucoma, there are only an estimated 140,000 SLT procedures a year. These numbers clearly demonstrate a public health need for expanding access for these laser procedures by including them in the scope of optometric practice.
COVID-19, flu vaccines
The public health need for vaccines, however, is much larger. Currently, at least 270,227,181 people — or 81% of the population — have received at least one dose of the COVID-19 vaccine. Overall, 230,637,348 people, or 70% of the population, are considered fully vaccinated.
The annual flu vaccine, a longstanding public health protocol, is estimated to be 156 million to 170 million doses for the 2023-’24 flu season.
According to the CDC, there are between 9.3 million and 41 million cases of flu per year, with a mortality rate between 10% and 18%. The picture for COVID-19 continues to evolve, with 400 deaths per 100,000 cases; it remains the 10th leading cause of death in the U.S.
Vaccination to reduce infection rates for influenza and coronavirus is required annually, and increasing the percentage of the population that is inoculated will decrease the spread of these contagious viruses. Expanding access for these vaccinations to optometry and making it part of the annual eye examination would significantly improve the nation’s health.
Other vaccine considerations
While COVID-19 and flu require annual vaccinations, they are not the only vaccines for which optometry can improve the rate of population protection. According to the CDC’s Advisory Committee on Immunization Practices, there are 27 recommended vaccines, and of these, five are highly recommended for adults. They are respiratory syncytial virus; shingles; pneumococcal; measles, mumps and rubella; and tetanus, diphtheria and pertussis.
Adding vaccines to the practice of optometry is very consistent with our mission to be a primary care profession, as prevention and wellness are cornerstones of the primary care agenda.
The role for vaccines in health care is rapidly expanding. With the use of monoclonal antibodies and mRNA technology, vaccines may become the mainstream option to prevent rather than treat disease. There continues to be work on a vaccine for neuroprotection that includes retinal ganglion cell loss (Kumar et al). If this research proves effective for humans, we may see a vaccine to prevent vision loss for select glaucoma patients.
Legislation to expand the role of optometry is an important public health initiative to improve the health of a nation. These new bills will allow us to use our education, training and broad community access to improve and save vision with laser treatments and provide preventive care with vaccines.
References:
- 5 vaccinations adults need beyond COVID and flu. https://www.mdedge.com/internalmedicine/article/269460/vaccines/5-vaccinations-adults-need-beyond-covid-and-flu. Published June 5, 2024. Accessed June 27, 2024.
- Alwazae M, et al. Cureus. 2024;doi:10.7759/cureus.52360.
- CDC vision and eye health. https://www.cdc.gov/vision-health/index.html. Accessed June 27, 2024.
- Kumar S, et al. Invest Ophthalmol Vis Sci. 2023;doi:10.1167/iovs.64.7.24.
- Ling R, et al. Clin Ophthalmol. 2020;doi:10.2147/OPTH.S276329.
- New RSV shot is a monoclonal antibody, not a vaccine. https://www.medscape.com/viewarticle/995682?form=fpf. Published Aug. 21, 2023. Accessed June 27, 2024.
- Rossi T, et al. BMJ Open Ophthalmol. 2021;doi:10.1136/bmjophth-2020-000464.
- US coronavirus vaccine tracker. https://usafacts.org/visualizations/covid-vaccine-tracker-states/. Accessed June 27, 2024.
- What ODs need to know about SLT. https://modernod.com/articles/2019-oct/what-ods-need-to-know-about-slt?c4src=article:infinite-scroll. Published October 2019. Accessed June 27, 2024.
- What to know about a posterior capsulotomy (YAG Laser). https://www.webmd.com/eye-health/cataracts/what-to-know-about-posterior-capsulotomy-yag-laser. Published Aug. 24, 2022. Accessed June 27, 2024.
For more information:
Scott A. Edmonds, OD, FAAO, specializes in vision-based neurorehabilitation at Edmonds Eye Associates in Philadelphia. He can be reached at scott@edmondsgroup.com.
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